ENDOXAN 1G INJ

Cyclophosphamide primarily exerts its therapeutic effects through its active metabolites, which are formed by enzymatic conversion in the liver. The drug is a prodrug that undergoes metabolism to produce two major bioactive metabolites, phosphoramide mustard and acrolein. Phosphoramide mustard is responsible for the cytotoxic activity of cyclophosphamide. It acts as an alkylating agent, causing interstrand and intrastrand cross-linking of DNA, which leads to DNA damage and cell death. This mechanism disrupts the cell's ability to divide and proliferate, particularly affecting rapidly dividing cells, such as cancer cells and certain immune cells. By interfering with DNA synthesis and repair, cyclophosphamide's active metabolites induce cell cycle arrest and apoptosis, thereby inhibiting tumor growth and suppressing the immune response in conditions where immune system modulation is desired.

Cyclophosphamide

Alkylating agent

Injection

The following are the uses of Cyclophosphamide Injection:

• Used for treating certain types of cancers, such as lymphoma, leukemia, and multiple myeloma.
• Used for managing severe rheumatoid arthritis and lupus.
• Used for suppressing the immune system to prevent organ rejection in transplant patients.
• Used for reducing inflammation in severe cases of vasculitis.
• Used for treating certain autoimmune conditions like Wegener's granulomatosis.
• Used for managing some rare kidney diseases.
• Used for controlling symptoms in specific types of brain tumors.

In the case of an overdose of Cyclophosphamide Injection, prompt medical attention is necessary. Symptoms may include severe nausea, vomiting, diarrhea, and bone marrow suppression, leading to a significant decrease in white blood cells and platelets. Immediate treatment involves supportive care, such as administering anti-nausea medications and ensuring adequate hydration. Medical professionals should closely monitor the patient's vital signs and perform regular blood tests to assess the extent of the overdose and provide appropriate interventions.

In the case of a missed dose of Cyclophosphamide Injection, it is important to contact your healthcare provider for guidance. They will advise you on the appropriate course of action, as the management of missed doses may depend on your specific treatment plan and medical condition. Generally, it is recommended to administer the missed dose as soon as you remember, but if it is close to the time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not double the dose to make up for a missed one without consulting your healthcare professional.

To administer Cyclophosphamide Injection, prepare the medication by drawing the prescribed dose into a syringe, ensuring the accuracy of the measurement, and inject it intravenously or intramuscularly as directed by your healthcare professional.

Following are the conditions or circumstances when Cyclophosphamide Injection should not be administered:

• Allergy • Not to be used if the patient has a known allergy to Cyclophosphamide or any of its ingredients.
• Pregnancy and Breastfeeding • Contraindicated in pregnant women as it may cause harm to the fetus. Also, it should not be used by breastfeeding mothers due to potential risks to the infant.
• Bone Marrow Suppression • Should be avoided in patients with pre-existing bone marrow suppression or severe myelosuppression, as it can further suppress bone marrow function.
• Infection • Not recommended for patients with severe infections, as it can mask the signs of infection and delay appropriate treatment.
• Kidney Impairment • Should be used with caution in patients with kidney disease or kidney failure, as it is primarily excreted through the kidneys.
• Immunization • Live vaccines should not be given to individuals while on Cyclophosphamide treatment, as it can reduce the body's ability to develop a protective immune response.
• Previous Radiation Therapy • May not be suitable for patients who have recently undergone radiation therapy.
• Severe Dehydration • Not recommended for individuals who are severely dehydrated, as it can increase the risk of kidney damage.

The side effects of Cyclophosphamide Injection may include:

• Nausea and vomiting
• Hair loss
• Fatigue and weakness
• Increased risk of infections
• Mouth sores or ulcers
• Diarrhea
• Skin rashes or itching
• Reduced white blood cell count

Following are the precautions and warnings for Cyclophosphamide Injection:

• It is a potent medication and should be administered under strict medical supervision in a hospital or clinical setting.
• Not recommended for use in individuals with a known hypersensitivity or severe allergic reactions to Cyclophosphamide or any of its components.
• Requires regular monitoring of blood cell counts, liver and kidney function tests, and urinalysis during treatment to detect any potential organ damage.
• Patients should be well-hydrated before and during treatment to reduce the risk of bladder toxicity.
• Caution is advised in patients with pre-existing kidney or liver diseases, as the medication can further impact these organs.
• Cyclophosphamide may cause infertility in both men and women, and appropriate contraceptive measures should be taken during and after treatment.
• Patients should avoid live vaccines during and after treatment as the medication can suppress the immune system.

Following are the drug interactions for Cyclophosphamide Injection:

• Concomitant use with live vaccines is not recommended as it may diminish the immune response to the vaccine.
• Drugs that are nephrotoxic or ototoxic, such as cisplatin or aminoglycosides, can increase the risk of kidney and ear damage when used with Cyclophosphamide.
• The risk of severe myelosuppression may increase when used with other myelosuppressive agents like doxorubicin or paclitaxel.
• Antacids containing aluminum or magnesium can reduce the absorption of Cyclophosphamide when taken orally.
• Interactions with anticoagulants like warfarin may increase the risk of bleeding.
• Drugs that are hepatotoxic, such as acetaminophen, can increase the risk of liver damage when used concurrently.
• Cyclophosphamide may reduce the effectiveness of hormonal contraceptives, requiring alternative birth control methods.

Following are the food interactions to consider with Cyclophosphamide Injection:

• It is recommended to maintain a high-calorie and high-protein diet while on this medication to help prevent side effects like nausea and to support overall health.
• Ensure adequate fluid intake to prevent dehydration, especially if experiencing vomiting or diarrhea.
• Avoid grapefruit and grapefruit juice as they may interfere with the medication's metabolism, leading to higher levels in the blood.
• Limit alcohol consumption as it can increase the risk of stomach irritation and liver problems, especially with long-term use.
• Patients should avoid foods that are difficult to digest or cause stomach irritation, such as spicy, fried, or high-fat foods.
• It is advisable to consume small, frequent meals to minimize gastrointestinal discomfort.
• Follow any dietary guidelines provided by your healthcare team, especially if you have pre-existing conditions like kidney or liver disease.

Cyclophosphamide Injection should be stored in a controlled environment, preferably in a dedicated medication storage area. It should be kept at room temperature, between 20°C and 25°C (68°F to 77°F), away from direct sunlight and moisture. The injection vials should be stored upright and protected from light by wrapping them in an opaque material or storing them in a light-resistant container. It is crucial to keep the medication in its original packaging, ensuring the integrity of the seal, to maintain sterility. When disposing of Cyclophosphamide Injection, follow local regulations and guidelines for hazardous waste disposal. Do not dispose of it in regular trash or pour it down the drain; instead, contact a pharmacist or healthcare professional for guidance on proper disposal methods to minimize environmental impact. Keep this medication securely locked away from children and pets to prevent accidental exposure.

Following are the quick tips for Cyclophosphamide Injection:

• Ensure the injection is administered by a trained healthcare professional.
• Inform your doctor about any allergies or medical conditions before receiving the injection.
• Stay well-hydrated before and after the injection to help your kidneys function properly.
• Avoid crowded places and people with infections to reduce the risk of getting sick.
• Report any signs of infection, unusual bleeding, or persistent nausea to your doctor immediately.
• Regular blood tests may be required to monitor your blood cell counts and organ function.
• Store the injection as directed by your pharmacist, usually protected from light.
• Do not reuse needles or syringes; dispose of them safely after use.