What is the most important information I should know about Cytoxan?

• Cytoxan should only be administered under the supervision of a qualified healthcare provider experienced in the use of cancer chemotherapeutic agents.
• Serious side effects have been reported with the use of Cytoxan including: allergic reactions (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); decreased bone marrow function and blood problems (extreme fatigue; easy bruising or bleeding; black, bloody or tarry stools; fever or chills; or signs of infection such as fever; chills, or sore throat); bladder problems; and others. Talk to your doctor about the possible side effects from treatment with Cytoxan.
• In some cases, secondary cancers have been reported to occur during and following treatment with Cytoxan. Talk to your doctor about the risks and benefits of this medication.

What is Cytoxan?

• Cytoxan is a cancer (chemotherapeutic) medication. Cytoxan interferes with the growth of cancer cells and slows their growth and spread in the body.
• Cytoxan is used to treat several types of cancer. Cytoxan is also used to treat certain cases of nephrotic syndrome (kidney disease) in children.
• Cytoxan may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before taking Cytoxan?

• Before taking Cytoxan, tell your doctor if you
  • have an infection or have had recent vaccinations;
  • have a low level of white blood cells or platelets (detected by blood tests);
  • have bone marrow problems;
  • have been previously treated with x-ray therapy;
  • have been previously treated with other chemotherapy medicines (i.e., Alkeran, CeeNU, Leukeran, Myleran, and others);
  • have had your adrenal glands removed;
  • need to have surgery;
  • have any unhealed wounds;
  • have a history of heart disease;
  • have liver disease; or
  • have kidney disease.
• You may not be able to take Cytoxan, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
• Cytoxan is in the FDA pregnancy category D. This means that Cytoxan is known to be harmful to an unborn baby. Cytoxan may also affect egg production in women and sperm production in men. Do not take Cytoxan without first talking to your doctor if you are pregnant or could become pregnant during treatment. Use of Cytoxan by the father prior to conception has also been associated with birth defects. Contraceptive measures are recommended during treatment with Cytoxan for both men and women.
• Cytoxan passes into breast milk and may harm a nursing infant. Do not take Cytoxan without first talking to your doctor if you are breast feeding a baby.

How should I take Cytoxan?

• Take Cytoxan exactly as directed by your doctor. If you do not understand these instructions, ask your doctor, nurse or pharmacist to explain them to you.
• Take each oral dose with a large glass of water.
• To avoid urinary bladder irritation during treatment with either oral or injectable Cytoxan, drink plenty of fluid during treatment and for 48 hours following treatment, usually 7 to 12 cups (3 quarts) per day, and empty your bladder frequently, every 2 to 3 hours including once during the night.
• Taking oral Cytoxan on an empty stomach is preferable. If severe stomach upset occurs, take Cytoxan with food. Continue to take Cytoxan even if nausea and vomiting occurs. Do not stop taking the medicine without first talking to your doctor. Check with your doctor if vomiting occurs shortly after taking a dose of Cytoxan. Your doctor may want you to take another dose, but do not do this without checking with your doctor first.
• If you are taking a liquid form of Cytoxan by mouth, use a dose measuring spoon or cup to ensure that you get the correct dose.
• Injectable Cytoxan should only be administered under the supervision of a qualified healthcare provider experienced in the use of cancer chemotherapeutic agents.
• Your doctor will determine the correct amount and frequency of treatment with Cytoxan depending upon the type of cancer being treated and other factors. Talk to your doctor if you have any questions or concerns regarding the treatment schedule.
• Your doctor will probably want you to have regularly scheduled blood tests and other medical evaluations during treatment with Cytoxan to monitor progress and side effects.
• Store Cytoxan oral tablets at or below 77 degrees Fahrenheit (25 degrees Celsius). Brief exposures to 86 degrees Fahrenheit (30 degrees Celsius) are permitted but the tablets should be protected from temperatures above 86 degrees Fahrenheit. Your healthcare provider will store Cytoxan injection as directed by the manufacturer. If you are storing Cytoxan injection at home, follow the directions provided by your healthcare provider.
• Store Cytoxan oral liquid in a glass container in the refrigerator for up to 14 days.

What happens if I miss a dose?

• Take the missed oral dose as soon as you remember. If it is almost time for the next dose, skip the dose you missed and take only the next regularly scheduled dose as directed. Do not take a double dose of this medication.
• Contact your doctor if you miss a dose of Cytoxan injection.

What happens if I overdose?

• Seek emergency medical attention.
• Symptoms of a Cytoxan overdose may include decreased bone marrow function, infection, and heart problems.

What should I avoid while taking Cytoxan?

• Cytoxan can lower the activity of the immune system making you more susceptible to infection. Avoid contact with people who have colds, the flu, or other contagious illnesses. In addition, do not receive vaccines that contain a live strain of the virus (e.g., live oral polio vaccine) and avoid contact with individuals who have recently been vaccinated with a live virus.

What are the possible side effects of Cytoxan?

• If you experience any of the following serious side effects, seek emergency medical attention or contact your doctor immediately:
  • an allergic reaction (shortness of breath; closing of your throat; difficulty breathing; swelling of your lips, face, or tongue; or hives);
  • blood in the urine;
  • black or tarry stools;
  • painful or difficult urination;
  • signs of infection such as fever; chills, or sore throat;
  • jaundice (yellowing of the skin or eyes);
  • lower back or side pain;
  • chest pain, difficulty breathing, or swelling;
  • unusual bleeding or bruising; or
  • changes in bone marrow function (detected by blood tests).
• Other less serious side effects may be more likely to occur. Talk to your doctor if you experience
  • nausea, vomiting, or decreased appetite;
  • mouth sores;
  • abdominal pain;
  • diarrhea;
  • temporary hair loss;
  • temporary or permanent sterility;
  • rash;
  • changes in skin color; or
  • changes in nails.
• In some cases, secondary cancers have been reported to occur during and following treatment with Cytoxan. Talk to your doctor about the risks and benefits of this medication.
• Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Cytoxan?

• Before taking Cytoxan, tell your doctor if you are taking any other medicines, especially any of the following:
  • phenobarbital (Luminal, Solfoton);
  • allopurinol (Zyloprim);
  • digoxin (Lanoxin);
  • warfarin (Coumadin);
  • a thiazide diuretic (water pill) such as chlorothiazide (Diuril), hydrochlorothiazide (HCTZ, HydroDiuril, Esidrix, Microzide, Oretic), chlorthalidone (Hygroton, Thalitone), indapamide (Lozol), metolazone (Mykrox, Zaroxolyn), and others; or
  • another chemotherapy medicine.
• You may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.
• Do not receive “live” vaccines during treatment with Cytoxan. Administration of a live vaccine may be dangerous during treatment with Cytoxan.
• Other drugs may interact with Cytoxan. Talk to your doctor and pharmacist before taking any other prescription or over-the-counter medicines, including herbal products, during treatment with Cytoxan.