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Rev Bras Reumatol Engl Ed. 2017 Nov - Dec;57(6):596-604. doi: 10.1016/j.rbre.2016.09.008. Epub 2016 Oct 24.

Cyclophosphamide administration routine in autoimmune rheumatic diseases: a review.

[Article in English, Portuguese]

Author information

1
Universidade de Brasília (UnB), Departamento de Ciências da Saúde, Brasília, DF, Brazil. Electronic address: kaian.teles@gmail.com.
2
Universidade de Brasília (UnB), Departamento de Ciências da Saúde, Brasília, DF, Brazil; Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil. Electronic address: pmedeirossouza@uol.com.br.
3
Universidade de Brasília (UnB), Hospital Universitário de Brasília, Serviço de Reumatologia, Ambulatório de Colagenoses, Brasília, DF, Brazil.
4
Hospital Universitário de Brasília (HuB), Brasília, DF, Brazil.
5
Universidade de Brasília (UnB), Hospital Universitário de Brasília, Serviço de Reumatologia, Brasília, DF, Brazil; Hospital de Base do Distrito Federal, Serviço de Reumatologia, Ambulatório de Artrite Reumatoide Inicial, Brasília, DF, Brazil.

Abstract

Cyclophosphamide is an alkylating agent widely used for the treatment of malignant neoplasia and which can be used in the treatment of multiple rheumatic diseases. Medication administration errors may lead to its reduced efficacy or increased drug toxicity. Many errors occur in the administration of injectable drugs. The present study aimed at structuring a routine for cyclophosphamide use, as well as creating a document with pharmacotherapeutic guidelines for the patient. The routine is schematized in three phases: pre-chemotherapy, administration of cyclophosphamide, and post-chemotherapy, taking into account the drugs to be administered before and after cyclophosphamide in order to prevent adverse effects, including nausea and hemorrhagic cystitis. Adverse reactions can alter laboratory tests; thus, this routine included clinical management for changes in white blood cells, platelets, neutrophils, and sodium, including cyclophosphamide dose adjustment in the case of kidney disease. Cyclophosphamide is responsible for other rare - but serious - side effects, for instance, hepatotoxicity, severe hyponatremia and heart failure. Other adverse reactions include hair loss, amenorrhea and menopause. In this routine, we also entered guidelines to post-chemotherapy patients. The compatibility of injectable drugs with the vehicle used has been described, as well as stability and infusion times. The routine aimed at the rational use of cyclophosphamide, with prevention of adverse events and relapse episodes, factors that may burden the health care system.

KEYWORDS:

Antiemetics; Antieméticos; Chemotherapy; Ciclofosfamida; Cistite; Cyclophosphamide; Cystitis; Quimioterapia

PMID:
29173694
DOI:
10.1016/j.rbre.2016.09.008
[Indexed for MEDLINE]
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