藥劑部參考美國 Johns Hopkins 大學研究團隊所建立的 NxP (Nephrotoxic Potential) 專家共識分級清單，本品具「顯著以上腎毒性風險」，被認定具中度至高度腎損傷潛勢，特別是同時合併其他腎毒性藥物、脫水、高齡或既有腎功能異常的患者族群，應更加注意。

淋巴性白血病、散發性腫瘤、慢性淋巴白血病、骨髓性淋巴病、淋巴肉芽腫及各種網狀組織細胞增多症，防止腫瘤復發。

Antineoplastic Agent, Alkylating Agent; Antineoplastic Agent, Alkylating Agent (Nitrogen Mustard); Antirheumatic, Miscellaneous; Immunosuppressant Agent.

Distribution: Vd: 30 to 50 L; crosses into CSF.
Protein binding: ~20%; some metabolites are bound at >60%.
Metabolism: Hepatic to active metabolites acrolein, 4-aldophosphamide, 4-hydroperoxycyclophosphamide, and nor-nitrogen mustard.
Bioavailability: >75%.
Half-life elimination: 3 to 12 hours.
Time to peak: Metabolites: 2 to 3 hours.
Excretion: Urine (10 to 20% as unchanged drug); feces (4%).

History of severe hypersensitivity to cyclophosphamide, its metabolites, or any component of the formulation; urinary outflow obstruction, severe myelosuppression, severe renal or hepatic impairment, active infection (especially varicella zoster), severe immunosuppression.

D; Cyclophosphamide crosses the placental barrier. Treatment with cyclophosphamide has a genotoxic effect and may cause fetal damage when administered to pregnant women.

Cyclophosphamide and its metabolites are present in breast milk.

1. Bone marrow suppression and infection: leukopenia, neutropenia, thrombocytopenia, and anemia.
2. Cardiotoxicity: arrhythmias (supraventricular cardiac arrhythmia and ventricular arrhythmia), heart failure, heart block, hemopericardium, myocarditis, pericarditis, pericardial effusion including cardiac tamponade, and tachyarrhythmias.
3. Hemorrhagic cystitis: pyelitis, ureteritis, and hematuria, bladder fibrosis, necrosis or contracture.
4. Hepatotoxicity: hepatic sinusoidal obstruction syndrome, unexplained weight gain, ascites, hepatomegaly, cholestatic hepatitis or cytolytic hepatitis.
5. Pulmonary toxicity: pneumonitis, pulmonary fibrosis, pulmonary veno-occlusive disease, and acute respiratory distress syndrome.
6. Second primary malignancy: acute leukemia, bladder carcinoma, malignant lymphoma, malignant neoplasm of thyroid, myelodysplastic syndrome, sarcoma.

Continuous treatment: 3 to 6 mg/kg body weight daily (equivalent to 120 to 240 mg/m2 body surface).
Intermittent treatment: 10 to 15 mg/kg body weight (equivalent to 400 to 600 mg/m2 body surface) at intervals of 2 to 5 days.
High-dose intermittent treatment: 20 to 40 mg/kg body weight (equivalent to 800 to 1600 mg/m2 body surface) and higher doses (e.g. for conditioning prior to bone-marrow transplantation) at intervals of 21 to 28 days.

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In adults with cancer with a BMI ≥30 kg/m2:
Cy200 (cyclophosphamide total dose of 200 mg/kg): Use the lesser of IBW or actual body weight (ABW).
Cy120 (cyclophosphamide total dose of 120 mg/kg): Use either IBW (preferred) or ABW for patients ≤ 120% IBW. Use ABW25 for patients >120% IBW.
[ABW25: Adjusted wt (kg) = Ideal body weight (kg) + 0.25 [actual wt (kg) - ideal body weight (kg)]]

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Recommendations for dose reduction in patients with myelosuppression:

Leukocyte count [μl]	Platelet count [μl]	Dosage
> 4,000	> 100,000	100% of the planned dose
4,000 ~ 2,500	100,000 ~ 50,000	50% of the planned dose
< 2,500	< 50,000	Adjustment until values normalize or specific decision is made

CrCl ≥10 mL/minute: no dosage adjustment required.
CrCl <10 mL/minute: administer 75% of normal dose.
Hemodialysis: moderately dialyzable (20% to 50%); administer 50% of normal dose; administer after hemodialysis.
Continuous ambulatory peritoneal dialysis (CAPD): administer 75% of normal dose.
Continuous renal replacement therapy (CRRT): administer 100% of normal dose.

Serum bilirubin 3.1 to 5 mg/dL or transaminases >3 times ULN: administer 75% of dose.
Serum bilirubin >5 mg/mL: avoid use.