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Buy cytoxan
Latin name: Cytoxan
Pharmacological groups: alkylating agents
Nosological classification (ICD-10): C34 Malignant neoplasm bronchus and lung. C40-C41 Malignant neoplasms of bone and articular cartilage. C45-C49 Malignant neoplasms of mesothelial and soft tissue. C50 Malignant neoplasm of breast cancer. C51-C58 Malignant neoplasms of female genital mutilation. C56 Malignant neoplasm of ovary. C61 Malignant neoplasm of the prostate. C62 Malignant neoplasm testis. C64 Malignant neoplasm kidney, except renal pelvis. C67 Malignant neoplasm of the bladder. C69.2 retina. C71 Malignant neoplasm of the brain. C71.9 Cerebral unspecified location. C81 Hodgkin’s disease [lymphogranulomatosis]. C82 Follicular [nodular] non-Hodgkin’s lymphoma. C83 Diffuse non-Hodgkin’s lymphoma. Large-C83.3 (diffuse). C83.7 Burkitt’s tumor. C84.0 granulosarcoid. C85 Other and unspecified types of non-Hodgkin’s lymphoma. C85.0 Lymphosarcoma. C90.0 Multiple myeloma. C91 Lymphoid leukemia [lymphocytic leukemia]. C91.0 Acute lymphoblastic leukemia. C91.1 Chronic lymphocytic leukemia. C92 myelogenous leukemia [myeloid leukemia]. C95 Leukemia unspecified cell type. D59.1 Other autoimmune hemolytic anemia. L40.5 Psoriasis Arthropathic. M06.9 Rheumatoid arthritis, unspecified. M30-M36 Systemic connective tissue destruction. N04 Nephrotic syndrome. T85.9 Complications related to internal prosthetic device implant and graft, unspecified
Pharmacological action
Substance (INN) Cyclophosphamide (Cyclophosphamide)
Application: small cell lung cancer, ovarian cancer, cervical and uterine, breast, bladder, prostate, testicular seminoma, neuroblastoma, retinoblastoma, angiosarcoma, clasmocytoma, lymphosarcoma, chronic lymphatic and myeloid leukemia, acute lymphoblastic, myeloblastic, monoblastny leukemia, lymphogranulomatosis, non-Hodgkin’s lymphoma, myeloma, Wilms tumor, Ewing’s tumor, soft tissue sarcoma, ossifying sarcoma, germ cell tumor, granulosarcoid, autoimmune diseases, including systemic diseases of connective tissue, including rheumatoid arthritis, psoriatic arthritis, autoimmune hemolytic anemia, nephrotic syndrome, the suppression of transplant rejection reactions.
Contraindications: Hypersensitivity, severe renal dysfunction, bone marrow hypoplasia, leukopenia (white blood cell count less than 3,5 Ї109 / l) and / or thrombocytopenia (platelet count less than 120Ї109 / l), severe anemia, marked cachexia, terminal stage of cancer, pregnancy, breastfeeding.
Restrictions apply: Assessment of risk-benefit ratio is necessary when the need to appoint the following conditions: chickenpox, herpes zoster, and other systemic infections, renal failure (urolithiasis, gout, etc.), the liver, severe heart disease, depression of bone marrow function , infiltration of bone marrow tumor cells, hyperuricemia, cystitis, adrenalectomy, previous cytotoxic or radiation therapy, the elderly and children’s age.
Application of pregnancy and breastfeeding: Contraindicated during pregnancy. At the time of treatment should stop breastfeeding.
Side effects: on the part of the digestive tract: anorexia, stomatitis, dry mouth, nausea, vomiting, diarrhea, stomach pain, gastrointestinal bleeding, hemorrhagic colitis, toxic hepatitis, jaundice.
From the nervous system and sensory organs: asthenia, dizziness, headache, confusion, blurred vision.
Since the cardiovascular system and blood (hematopoiesis, hemostasis): mielodepressiya, leukopenia, agranulocytosis, thrombocytopenia, anemia, bleeding and hemorrhage, the blood rush to face, cardiotoxicity, heart failure, palpitations, bleeding mioperikardit, pericarditis.
From the respiratory system: dyspnea, pneumonitis, interstitial pneumosclerosis.
On the part of the digestive system: hemorrhagic cystitis, urethritis, bladder fibrosis, cell atypia of the bladder, hematuria, frequent, painful or difficult urination, hyperuricemia, nephropathy, edema of lower extremities, hyperuricosuria, necrosis of renal tubules, amenorrhea, inhibition of ovarian function, azoospermia.
For the skin: alopecia, hyperpigmentation (the fingernails, palms), in / to hemorrhage, facial flushing, rash, hives, itching, congestion, swelling, pain at the injection site.
Other: anaphylactoid reactions, pain syndrome (pain in the back, side, bones, joints), a feverish syndrome, chills, infection, syndrome of inappropriate secretion of ADH, myxedema (swelling of the lips), hyperglycemia, increased activity of transaminases in the blood.
Interaction: Effect of reinforcing chlorpromazine, tricyclic antidepressants, barbiturates, theophylline, chloroquine, thyroid hormones, inducers of microsomal liver enzymes (increase the formation of alkylating metabolites), weaken (including toxic effects) – glucocorticoids and chloramphenicol. Other myelotoxicity drugs, radiation therapy, allopurinol may potentiate the inhibition of bone marrow function. Attenuates the effectiveness of inactivated vaccines, immunization, using vaccines that contain live viruses, enhances viral replication and side effects of vaccination. May increase (due to suppression of synthesis of clotting factors in the liver and violations of platelet formation) or decrease the activity of anticoagulants of indirect action. Attenuates effect (increases the concentration of uric acid) arthrifuge drugs (allopurinol, colchicine, probenecid, or sulfinpirazona) in the treatment of hyperuricemia and gout (requires adjustment of doses of the latter). Increases cardiotoxicity cytarabine, doxorubicin, enhances blockade of neuromuscular transmission caused by succinylcholine. Urikozuricheskie means increase the risk of nephropathy, immunosuppressants (azathioprine, chlorambucil, glucocorticoids, cyclosporine, mercaptopurine) – the risk of secondary tumors and infections. Against the background of lovastatin in patients after heart transplantation increases risk of rhabdomyolysis and acute renal failure.
Overdose: Symptoms: nausea, vomiting, depression, bone marrow, fever, a syndrome of dilated cardiomyopathy, multiorgan failure, hemorrhagic cystitis, etc.
Treatment: hospitalization, monitoring of vital functions; symptomatic therapy, including appointment antiemetics if necessary – the transfusion of blood components; Stimulants introduction hematopoiesis, broad-spectrum antibiotics, vitamin (pyridoxine V / m 0,05 g, etc.).
Dosing and dose: Inside, a / c, a / m, in the cavity (intraperitoneal or intrapleural). Selecting the route of administration, dosing regime is carried out in accordance with the indications and chemotherapy. Dose is selected individually adjusted on the basis of clinical effect, the degree of toxic action. Heading dose is 8-14 g, then move to supportive care – 0,1-0,2 g 2 times a week. As an immunosuppressive agent prescribed at the rate of 0,05-0,1 g / day (1-1,5 mg / kg / day), with good endurance – 3-4 mg / kg.
Precautions: Use only possible under the supervision of a physician who has experience of chemotherapy. Should strictly observe the dosing regimen, including at certain times of day (especially in combination therapy) and do not double the subsequent dose if the previous skipped. For preparation of drugs to use in newborns is not recommended diluents containing benzyl alcohol, because may develop a fatal toxic syndrome: a metabolic acidosis, CNS depression, respiratory failure, renal failure, hypotension, seizures, intracranial hemorrhage.
Prior to and during treatment (short intervals) to determine the level of hemoglobin or hematocrit, leukocyte count (total, differential), platelets, urea nitrogen, bilirubin, creatinine, uric acid concentrations, the activity of ALT, AST, LDH, measuring urine output, specific density of urine, detection microhematuria. Pronounced leukopenia with the lowest number of white blood cells develop after 7-12 days after administration of the drug. Level of formed elements recovered after 17-21 days. When reducing the number of leukocytes less than 2.5 Ї109 / l and / or platelets – less 100Ї109 / l treatment should be stopped until the symptoms hematotoxicity. Cardiotoxic effect is most pronounced (at doses of 180-270 mg / kg) for 4-6 days.
During the whole course of treatment recommended blood transfusion (100-125 ml of 1 times per week). For the prevention of hyperuricemia and nephropathy caused by increased formation of uric acid (often occur during the initial period of treatment), before therapy with cyclophosphamide and within 72 hours after its application is recommended that adequate fluid intake (up to 3 liters per day), the appointment of allopurinol (in some cases ) and the use of funds, alkalinizing the urine. For the prevention of hemorrhagic cystitis (may develop within several hours or several weeks after injection) should be taken in the morning (most of metabolites appears to sleep), as often as possible to empty the bladder and apply Uromiteksan. When the first signs of hemorrhagic cystitis treatment is terminated before the elimination of symptoms.
In order to reduce dyspeptic phenomena can receive cyclophosphamide in small doses for 1 day. Partial or complete alopecia observed during treatment, is reversible and after completion of treatment normal hair growth is restored (the structure and color can be changed). When the following symptoms: chills, fever, cough or hoarseness, pain in lower back or sides, painful or difficult urination, unusual bleeding or bleeding, black stools, blood in urine or feces should immediately consult a doctor.
The appearance of thrombocytopenia necessitates extreme caution when performing invasive procedures and surgical operations, regular inspection of places w / injections, skin and mucous membranes (for signs of bleeding), limit the frequency venopunktsy and non-i / m injection, control over the content of blood in the urine, vomitus, feces. Such patients need to be careful to shave, manicure, brushing teeth, using dental thread and toothpicks, to prevent constipation, avoid falls and other injuries, as well as the intake of alcohol and acetylsalicylic acid, increase the risk of gastrointestinal bleeding. Should postpone the schedule of vaccination (hold after 3-12 months after the last course of chemotherapy) the patient and staying with family members (should forgo immunization with oral polio vaccine). Recommended to exclude contact with infectious patients or use non-specific measures to prevent infection (protective mask, etc.). During treatment should use adequate contraceptive measures. In case of contact with the drug skin or mucous membranes should be thorough washing with water (mucous membranes), or with soap and water (skin). Dilution, dilution and injection of the preparation is carried out by trained medical personnel in compliance with protective measures (gloves, masks, clothing, etc.).
Cautions: When you perform diagnostic tests (skin test for candida, mumps, trihofitii, tuberculin test) is possible: the suppression of positive reaction, and in carrying out the method of Papanicolaou – obtaining false-positive results. Solution for injection using neliofiolizirovannogo or lyophilized powder is prepared by adding water for injection (sterile or bacteriostatic, using only as a preservative parabens) into vials (concentration of cyclophosphamide at 20 mg / ml). The prepared solution is stable at room temperature for 24 h in the refrigerator – 6 days. For administration by i / v is added to the infusion solutions for parenteral administration. If the solution is not prepared to bacteriostatic water, it should be used within 6 h. With chemotherapy in infants as a diluent precluded the use of benzyl alcohol.