Cytoxan and Lupus - A Drug With Serious Side Effects

What You Need to Know About Treating Your Lupus With Cyclophosphamide

A cyclophosphamide drug molecule.
A cyclophosphamide drug molecule. MediaForMedical/UIG/Getty Images

Your doctor may have prescribed you the immunosuppressant drug Cytoxan (cyclophosphamide) if your lupus has gotten severe. The "gold standard" drug regimen for treating severe lupus is Cytoxan in combination with the corticosteroid methylprednisolone.

Cytoxan is actually a cancer drug, but in lupus patients it's used to treat serious kidney inflammation (including lupus nephritis) or other complications that threaten the organs.

Cytoxan has serious side effects, including birth defects, so you'll want to learn more about it.

How Cytoxan Works

Cytoxan is used as a chemotherapy agent for cancers including lymphomas, myeloma and leukemia. According to the American College of Rheumatology, it's also prescribed for severe, refractory rheumatoid arthritis or severe complications of lupus, myositis, scleroderma or vasculitis.

Cytoxan is in a class of drugs known as alkylating agents. This means it slows or stops the growth of malignant cells or other rapidly dividing cells, such as white blood cells that attack your body during a lupus flare.

Immunosuppressives such as Cytoxan are used in the treatment of lupus for two main reasons:

  • They are potent drugs that help control disease activity in major organs.
  • They may reduce or eliminate the need for steroids.

Cytoxan is usually only given for three to six months, until a patient goes into lupus remission.

The drug is usually delivered intravenously, but it can be taken orally. Taken orally, the dosage is based on your medical condition, weight, response to therapy and other treatments you may be receiving. Your doctor will determine the correct dosage and regimen for you.

What Are the Side Effects of Cytoxan?

This drug has many side effects, so it should be closely monitored by your doctor.

The side effects include:

  • Thin, brittle hair
  • Darkened and thickened skin
  • Blistering skin or acne
  • Loss of appetite or weight
  • Fatigue
  • Cough
  • Congestion
  • Fever
  • Dizziness
  • Chills
  • Shortness of breath
  • Sort throat
  • Nausea
  • Vomiting
  • Pink/bloody urine
  • Mouth sores, blistering
  • Joint pain
  • Easy bruising/bleeding
  • Black/bloody stools
  • Severe stomach/abdominal pain
  • Swelling of the ankles/feet
  • Increased risk of shingles
  • Infertility

You should talk to your doctor right away if you experience any of these serious side effects: blood in your urine, fevers and chills, easy bruising or bleeding, shortness of breath or swelling of the feet and ankles.

You should also know that Cytoxan is carcinogenic. This means that it's associated with the development of some types of cancers, especially bladder cancer.

Before you start taking Cytoxan, be sure to tell your doctor if you:

  • Are pregnant, or considering becoming pregnant
  • Are breastfeeding
  • Have ever had kidney disease
  • Are allergic to any drugs

An Alternative You Should Know About

A less toxic drug called mycophenolic acid has been shown to significantly reduce steroid dosage for patients with lupus nephritis or treatment-resistant lupus.

It's considered a first-line therapy for lupus nephritis and can often replace Cytoxan.

Sources:

Cyclophosphamide (Cytoxan). American College of Rheumatology. May 2015.

Cyclophosphamide. MedlinePlus Drug Information. September 15, 2011.

Immune Suppressants. Lupus Foundation of America.

Glomerular Diseases. National Kidney and Urological Diseases Information Clearinghouse. NIH Publication No. 07–4358. April 2006.

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