Potential serious adverse events with cyclophosphamide and prevention recommendations
| Adverse reactions | Prevention |
| Bladder toxicity | 1 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 pneumonia | Cotrimoxazole 480 mg three times a week (care with allergy) |
| Gastrointestinal disturbance | Cyclizine 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 neoplasia | Annual smear for 3 years Follow-up as per national guidelines |
| Vaccination | Influenza Pneumococcus Avoid live vaccination |
| Fungal infection | Consider prophylaxis |
| Staphylococcus aureus | Consider treatment in ANCA-associated vasculitis |
| Infertility | Counsel Consider cryopreservation if clinically permitted |
| Osteoporosis | Bisphosphonate+calcium + vitamin D |
| Tuberculosis | Risk assessment |
| HBV, HCV, HIV, VZV | Screen pretreatment Treat if indication (specialist discussion) |
HBV, hepatitis B virus; HCV, hepatitis C virus; PO, orally; VZV, varicella zoster virus.