Cyclophosphamide Corticosteroids

Clinically important, potentially hazardous interactions with altretamine, amikacin, aminoglycosides, antineoplastics, bleomycin, busulfan, carboplatin, carmustine, chlorambucil, cisplatin, corticosteroids, cyclophosphamide, cytarabine, dacarbazine, dactinomycin, daunorubicin, docetaxel, doxorubicin, estramustine, etoposide, fludarabine, fluorouracil, gemcitabine, gentamicin, hydroxyurea, idarubicin, ifosfamide, indomethacin, kanamycin, levamisole, lomustine, mechlorethamine, melphalan, mercaptopurine, methotrexate, mitomycin, mitotane, mitoxantrone, neomycin, pentostatin, plicamycin, procarbazine, streptomycin, streptozocin, thioguanine, thiotepa, tobramycin, tretinoin, uracil, vinblastine, vincristine, vinorelbine... 

Clinically important, potentially hazardous interactions with amiloride, aminoglycosides, amphotericin B, ampicillin, anisindione, anticoagulants, armodafinil, atorvastatin, azathioprine, azithromycin, bacampicillin, basiliximab, bezafibrate, bosentan, bupropion, carbenicillin, caspofungin, cholestyramine, clarithromycin, cloxacillin, co-trimoxazole, corticosteroids, cyclophosphamide, daclizumab, danazol, dicloxacillin, dicumarol, digoxin, diltiazem, disulfiram, echinacea, erythromycin, ethotoin, etoposide, ezetimibe, flunisolide, fluoxymesterone, fluvastatin, foscarnet, fosphenytoin, gemfibrozil, hemophilus B vaccine, HMG-CoA reductase inhibitors, imatinib, imipenem/cilastatin, influenza vaccines, ketoconazole, lanreotide, lopinavir, lovastatin, mephenytoin, methicillin, methoxsalen, methylphenidate, methylprednisolone, methyltestosterone, mezlocillin, mizolastine, mycophenolate, nafcillin, nisoldipine, NSAIDs, orlistat, oxacillin, penicillins, phellodendron, phenytoin, pravastatin, prednisolone, prednisone, pristinamycin, ranolazine, red rice yeast, rifabutin, rifampin, rifapentine, ritonavir, rosuvastatin, simvastatin, sirolimus, spironolactone, St John s wort, sulfacetamide, sulfadiazine, sulfamethoxazole, sulfisoxazole, sulfonamides, tacrolimus, telithromycin, tenoxicam, testosterone, ticarcillin, tolvaptan, trabectedin, triamterene, troleandomycin, ursodeoxycholic acid, vaccines, vecuronium, warfarin, zofenopril... 

Clinically important, potentially hazardous interactions with antacids, azathioprine, basiliximab, cholestyramine, corticosteroids, cyclophosphamide, cyclosporine, daclizumab, hemophilus B vaccine, mercaptopurine, metronidazole, norfloxacin, tacrolimus, vaccines... 

When used in combination with corticosteroids, cyclophosphamide is dosed at 1-3 mg/kg for oral therapy and 0.5-1.0 g/m of body surface area for intravenous therapy. The most common route of cyclophosphamide administration is intravenous, although there is little evidence that this is better than oral administration. Likewise, there is no evidence to suggest the optimal duration of treatment. Based on empirical experience, cyclophosphamide generally is dosed monthly for 6 months and then every 3 months for a period of either 2 years or for 1 year after the nephritis is in remission." " Of course, cyclophosphamide therapy is not without risk. Serious toxic effects include suppression of hematopoiesis, opportunistic infections, bladder complications (e.g., hemorrhagic cystitis and cancer), sterility, and teratogenesis. White blood cell counts must be monitored during cyclophosphamide therapy, and if the nadir is less than 1500/mm, the dose must be adjusted to keep the white cell count above 1500/mm. Nausea and vomiting associated with cyclophosphamide can be controlled with oral ondansetron plus dexamethasone. ... 

Initial therapy frequently consists of an alkylating agent in conjunction with corticosteroids these regimens can be found in the CLL (chlorambucil, cyclophosphamide) and multiple... 

The treatment of collagen disease is based on immunosuppressive therapies. Immunosuppressive agents, such as corticosteroids, are widely used. In addition, cytotoxic agents (azathioprine, cyclophosphamide, and methotrexate) have also been administered. 

Advantage is taken of the properties of antimctabolitcs in chemotherapy. In cancer chemotherapy, several antimetabolites are used. These include methotrexate, 6-mercaptopunne, 6-thioguanine, 5-fluorouracil, and cystine arabinoside. In the chemotherapy of metastatic breast cancer, 5-fluorouracil and methotrexate, in combination with cyclophosphamide, have been used. Antimetabolites, sometimes along with corticosteroids, are used in the therapy of various autoimmune diseases, such as thrombocytenic purpura, thyroiditis, Goodpasture s syndrome, among others. 

Erban SB, Sokas RK. Kaposi s sarcoma in an elderly man with Wegener s granulomatosis treated with cyclophosphamide and corticosteroids. Arch Intern Med 1988 148(5) 1201-3. 

Nephrotic syndrome. Patients with minimal change disease respond well to daily or alternate day therapy. With a total of prednisolone 60 mg/d, 90% of those who will lose their proteinuria will have done so within 4-6 weeks, and the dose is tapered off over 3-4 months. Longer courses only induce adverse effects. Relapses are common (50%) and it is then necessary to find a minimum dose of steroid that will keep the patient well. If a steroid is for any reason undesirable, cyclophosphamide or chlorambucil may be substituted. Membranous nephropathy may respond to high dose corticosteroid with or without chlorambucil. 

Zisman DA, Lynch JP 3rd, Toews GB, Kazerooni EA, Flint A, Martinez FJ. Cyclophosphamide in the treatment of idiopathic pulmonary fibrosis a prospective study in patients who failed to respond to corticosteroids. Chest 2000 117(6) 1619-26. 

Pryor BD, Bologna SG, Kahl LE. Risk factors for serious infection during treatment with cyclophosphamide and high-dose corticosteroids for systemic lupus erythematosus. Arthritis Rheum 1996 39(9) 1475-82. 

Chemotherapy drugs can directly or indirectly cause acute pneumonitis (bleomycin, carmustine, gemcita-bine, methotrexate, mitomycin, procarbazine, and vinca alkaloids) pulmonary fibrosis (bleomycin, carmustine, cyclophosphamide, methotrexate, and mitomycin) hypersensitivity pneumonitis (bleomycin, methotrexate, and procarbazine) noncardiogeneic pulmonary edema (cytarabine, cyclophosphamide, methotrexate, mitomycin, and teniposide). Docet-axel is associated with fluid retention, which may result in pulmonary edema or pleural effusion. Some of these conditions respond to corticosteroid therapy but some cases of pulmonary fibrosis are fatal. 

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Recommendation 4. For the prevention of delayed emesis after cisplatin therapy in adults, dexamethasone with metoclopramide or a SSRI is recommended. Thechoice of agent should be based on patient-specific factors and cost. For delayed emesis after cyclophosphamide, doxorubicin, or carboplatin therapy, a SSRI with dexamethasone is recommended. In pediatric patients, chlorpromazine, lorazepam, or a SSRI can be used in combination with a corticosteroid. 

Cytotoxic agents, when used in conjunction with corticosteroids, are effective in increasing the remission rate of nephrotic syndrome and reducing the frequency of ESKD at 10 years. Ponticelli and colleagues devised such a regimen by combining intravenous methyl-prednisolone (1 g) for 3 days followed by oral methylprednisolone (0.4 mg/kg) for the subsequent 27 days of months 1, 3, and 5. Oral chlorambucil (0.2 mg/kg) is to be given daily in months 2, 4, and 6. They also substituted cyclophosphamide (2.5 mg/kg per day) for chlorambucil, which resulted in similar rates of proteinuria remission and relapse, but with fewer serious side effects in those who received cyclophosphamide. ... 

Evidence supporting the use of cyclophosphamide in lupus nephritis has been collected over the last several decades. Controlled clinical trials have shown that cyclophosphamide improved the longterm outcomes in lupus nephritis. " Based on controlled trials, combination prednisone and cyclophosphamide has become standard treatment for focal and diffuse proliferative lupus nephritis (WHO class III/IV) and is superior to prednisone alone. There are no studies examining cyclophosphamide in earlier stages of nephritis (WHO class II/III), and therefore, corticosteroids remain the treatment of... 

Although there have been many reports describing how patients with EMS have been treated, results were not successful in the majority of patients. Basically, the treatment of EMS has consisted of discontinuation of L-tryp-tophan and administration of corticosteroids, nonsteroidal anti-inflammatory drugs, and several other drugs, such as D-penicillamine and colchicine, cyclophosphamide, AZA (azathioprine), methotrexate, amitriptyline, acetaminophen, aspirin, naproxen, diphenhydramine, cyclobenzaprine, and fluoxetine.2132 56 In general, it was concluded that prednisone was helpful in the acute phase of the disease. Slow improvement was reported in 79% of the 193 patients. However, no treatment was clearly valuable in the management of the later phase of the syndrome.55... 

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