Table 11

Potential serious adverse events with cyclophosphamide and prevention recommendations

Adverse reactionsPrevention
Bladder toxicity1 L prehydration with sodium chloride 0.9% or orally over 1 hour before cyclophosphamide
3 L/day oral fluid intake for 3 days
Mesna 200 mg intravenous in 100 mL sodium chloride 0.9% infusion over 30 min before cyclophosphamide
Mesna 400 mg PO at 2 hours post cyclophosphamide
Mesna 400 mg PO at 6 hours post cyclophosphamide
Pneumocystis jirovecii pneumoniaCotrimoxazole 480 mg three times a week (care with allergy)
Gastrointestinal disturbanceCyclizine 50 mg slow intravenous bolus or ondansetron 8 mg slow intravenous bolus 15 min before cyclophosphamide
Domperidone 10–20 mg PO three times a day for 3–5 days
Cervical intraepithelial neoplasiaAnnual smear for 3 years
Follow-up as per national guidelines
Avoid live vaccination
Fungal infectionConsider prophylaxis
Staphylococcus aureus Consider treatment in ANCA-associated vasculitis
Consider cryopreservation if clinically permitted
OsteoporosisBisphosphonate+calcium + vitamin D
TuberculosisRisk assessment
HBV, HCV, HIV, VZVScreen pretreatment
Treat if indication (specialist discussion)
  • HBV, hepatitis B virus; HCV, hepatitis C virus; PO, orally; VZV, varicella zoster virus.