Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Cyclophosphamide is a drug that is used
primarily for treating several types of cancer. In order to work,
cyclophosphamide first is converted by the liver into two chemicals, acrolein
and phosphoramide. Acrolein and phosphoramide are the active compounds, and they
slow the growth of cancer cells by interfering with the actions of
deoxyribonucleic acid (DNA) within the cancerous cells. Unfortunately, normal
cells also are affected, and this results in serious side effects. In addition
to slowing the growth of cancerous cells, cyclophosphamide also suppresses the
immune system and is referred to as immunosuppressive. The FDA approved Cytoxan
in November 1959.
GENERIC AVAILABLE: Yes
PRESCRIPTION: Yes
PREPARATIONS: Powder for intravenous injection: 100, 200, 500, 1000,
and 2000 mg). Tablets: 25, 50 mg.
STORAGE: Powder and tablets should be stored at room temperature,
15-30 C (59-86 F). Solutions prepared with bacteriostatic water are usable up to
24 hours if stored at room temperature and up to 6 days if stored in the
refrigerator.
PRESCRIBED FOR: Cyclophosphamide is used alone for the treatment of
several types of cancers but often in combination with other drugs to treat
breast cancer, leukemia and ovarian cancer. It also is approved for treating
nephrotic syndrome (a disease of the kidneys) in children. Unapproved uses
include the treatment of Wegener's granulomatosis, severe rheumatoid arthritis,
lupus erythematosus, advanced mycosis fungoides, and several of forms of
vasculitis.
DOSING: The usual initial dose of cytoxan for adults and children is
40-50 mg/kg administered intravenously over 2-5 days in divided doses. This dose
may repeated at 2-4 week intervals. The usual oral dose is 1-5 mg/kg daily.
Subsequent maintenance doses are adjusted based on the response of the tumor to
treatment and the side effects.
DRUG INTERACTIONS:Allopurinol (Zyloprim) enhances the ability of
cyclophosphamide to reduce production of blood cells from the bone marrow. (See
below.) Cyclophosphamide increases the occurrence of heart failure that is
caused by doxorubicin (Adriamycin), increases the action of blood thinners such
as warfarin (Coumadin), and decreases the effectiveness of quinolone antibiotics
(Cipro).
PREGNANCY: Use of cyclophosphamide during pregnancy may affect the
fetus. Fetuses exposed to cyclophosphamide may be born with missing fingers,
toes and a poorly-developed heart. Cyclophosphamide should not be administered
during pregnancy.
NURSING MOTHERS: Cyclophosphamide is excreted in
breast milk and could
cause serious problems in the nursing infant.
SIDE EFFECTS: Side effects of cyclophosphamide include hair loss,
vomiting, diarrhea, mouth sores, weight loss, sterility, and jaundice.
Cyclophosphamide causes kidney failure, and it also may affect the heart and
lungs. Cyclophosphamide suppresses production of blood cells from the bone
marrow, including white blood cells (leukopenia), red blood cells (anemia) and
platelets (thrombocytopenia). Leukopenia reduces the ability of the body to
fight infection, thrombocytopenia impairs the ability of blood to clot, and
anemia reduces the ability of blood to carry oxygen. Cyclophosphamide suppresses
the immune system which may result in serious and sometimes fatal infections.
Severe allergic reactions also may occur. Cyclophosphamide may cause
inflammation of the urinary bladder with bleeding (hemorrhagic cystitis). This
can result in lower abdominal pain from the bladder, problems urinating due to
blood clots, and anemia due to loss of blood.
Leukemia is a type of cancer of the blood cells in which the growth and development of the blood cells are abnormal. Strictly speaking, leukemia should refer only to cancer of the white blood cells (the leukocytes) but in practice it can apply to malignancy of any cellular element in the blood or bone marrow, as in red cell leukemia (erythroleukemia).
There are many types of ovarian cancer, epithelial carcinoma is the most common. Women with a family history of ovarian cancer have an increased risk of developing the disease. Some ovarian cancer symptoms include abdominal pain, nausea, diarrhea, constipation, and abnormal vaginal bleeding, however, they usually do not present until the disease has progressed. Early diagnosis is important for successful treatment.
Sjögren's syndrome is an autoimmune disease involving the abnormal production of extra antibodies that attack the glands and connective tissue. Sjögren's syndrome with gland inflammation (resulting dry eyes and mouth, etc.) that is not associated with another connective tissue disease is referred to as primary Sjögren's syndrome. Sjögren's syndrome that is also associated with a connective tissue disease, such as rheumatoid arthritis, systemic lupus erythematosus, or scleroderma, is referred to as secondary Sjögren's syndrome. Though there is no cure for Sjögren's syndrome, the symptoms may be treated by using lubricating eye ointments, drinking plenty of water, humidifying the air, and using glycerin swabs. Medications are also available to treat dry eye and dry mouth.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Breast cancer is the most common cancer in women and the second most common cause of cancer death in women in the U.S. Symptoms include a lump in the breast or underarm area, nipple pain, change in breast size or shape, an inverted nipple, nipple discharge, and breast skin changes. Treatment may involve chemotherapy, radiation therapy, biological therapy, hormone therapy, or surgery.
Sarcoidosis, a disease resulting from chronic inflammation, causes small lumps (granulomas) to develop in a great range of body tissues and can appear in almost any body organ. However, sarcoidosis most often starts in the lungs or lymph nodes.
Multiple myeloma is a form of cancer that develops in plasma cells, the white blood cells that make antibodies. Symptoms include bone pain, weakness, extreme thirst, nausea, frequent urination, and broken bones. Treatment of multiple myeloma depends upon the staging and symptoms of the disease.
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body, leading to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis, and the cause is unknown. Treatment of scleroderma is directed toward the individual features that are most troubling to the patient.
Henoch-Schonlein Purpura (HSP or anaphylactoid purpura), a type of blood vessel inflammation, results in rash, arthritis, and occasional abdominal cramping. HSP often resolves on its own. Joint pain may be treated with anti-inflammatory and cortisone medications.
Pulmonary fibrosis is scarring throughout the lungs. Pulmonary fibrosis can be caused by many conditions including chronic inflammatory processes, infections, environmental agents, exposure to ionizing radiation, chronic conditions, and certain medications. Symptoms include shortness of breath, coughing, and diminished exercise tolerance. Treatment options are dependent on the type of pulmonary fibrosis; lung transplant and/or medications are optons.
Interstitial lung disease, is a term to describe a certain lung condition. Causes of interstitial lung disease include lung infection, exposure to toxins in the environment (asbestos for example), medications (chemotherapy), radiation therapy, and chronic autoimmune disorders. Common symptoms of interstitial lung disease include a dry cough and shortness of breath. Diagnosis and treatment depend upon the cause of the condition.
Optic neuritis is inflammation of the optic nerve, the structure that connects the eye to the brain. The precise cause of optic neuritis is unknown, but it is thought to be a type of autoimmune disorder. Optic neuritis most commonly develops due to an autoimmune disorder that may be triggered by a viral infection.
Male breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast cancer is one in 1,000. Signs and symptoms include a firm mass located below the nipple and skin changes around the nipple, including puckering, redness or scaling, retraction and ulceration of the nipple. Treatment depends upon staging and the health of the patient.
A carcinoid tumor is a tumor that develops from enterochromaffin cells. The important characteristic of carcinoid tumors that sets them apart from other gastrointestinal tract tumors, is their potential to cause the carcinoid syndrome. Local symptoms may include abdominal pain, intestinal bleeding, and intestinal obstruction. However, often symptoms of the carcinoid syndrome can be more devastating than the local symptoms. There are many options for the treatment of carcinoid tumors and carcinoid syndrome.
Wegener's granulomatosis, a condition that usually affects young or middle-aged adults, is an inflammation of the arteries supplying blood to the sinuses, lungs, and kidneys. Symptoms of Wegener's granulomatosis include bloody sputum, fatigue, weight loss, joint pain, sinusitis, shortness of breath, and fever. Wegener's granulomatosis may be fatal within months without treatment. Treatment aims to stop inflammation with high doses of prednisone and cyclophosphamide.
Relapsing polychondritis is an uncommon, chronic disorder of the cartilage that is characterized by recurrent episodes of inflammation of the cartilage of various tissues of the body. Tissues containing cartilage that can become inflamed include the ears, nose, joints, spine, and windpipe (trachea). Tissues that have a biochemical makeup similar to that of cartilage such as the eyes, heart, and blood vessels, can also be affected. Nonsteroidal antiinflammatory medications (NSAIDs) is used as treatment for mild cases of the disease. Steroid-related medications also are usually required.
Eosinophilic fasciitis is a skin disease that causes thickening and inflammation of the skin and fascia. Symptoms include redness, warmth, and hardening of the skin, as well as occasional tissue and joint pain. Treatment for eosinophilic fasciitis aims to eliminate inflammation through the use of aspirin, NSAIDs, and cortisone. Aggressive forms of eosinophilic fasciitis may require the use of immune suppression medications.
Weber-Christian disease is a rare inflammatory disease that affects the body's fat tissues. It's also known as relapsing febrile nodular panniculitis syndrome and idiopathic lobular panniculitis. The disorder appears on the skin as red or purple tender, raised lumps. The thighs and lower legs are the most frequently affected areas. Other symptoms may include nausea, vomiting, weight loss, joint pain, and abdominal pain. Though there is no cure for the disease, inflammation may be treated with various antiinflammatory medications.
Optic neuritis is inflammation of the optic nerve, the structure that
connects the eye to the brain. The optic nerve consists of nerve tracts (axons)
that originate in the retina of each eye. The optic nerve carries visual
information from the retina to the nerve cells in the brain stem, where the
information is relayed to the area of the brain that recognizes vision (the
occipital cortex).
Optic neuritis can occur in children or adults and may involve either one or
both optic nerves. Optic neuritis typically affects young adults ranging from
18-45 years of age, with a mean age of 30-35 years. There is a strong female
predominance. The annual incidence is approximately 5/100,000, with a total
prevalence estimated to be 115/100,000.
What causes optic neuritis?
The precise cause of optic neuritis is unknown, but it is thought to be a
type of autoimmune disorder. The immune system is general...
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