Client Information Cyclophosphamide Cytoxan Administration

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					                                College of Veterinary Medicine
                                      Oncology Service
                                        (706) 542-3221

                   Client Information: Cyclophosphamide (Cytoxan)

Today your pet was treated with or sent home with cyclophosphamide (brand name Cytoxan).
This is a chemotherapeutic agent. Please follow the instructions below.

If the cyclophosphamide was sent home with you, please administer all of the tablets at the time
specified by your veterinarian (usually in the morning). This drug is generally given with
furosemide (brand name Lasix) or prednisone to increase urine flow so by-products of the drug
move more rapidly through the urinary tract. These drugs should be given at the same time as
the cyclophosphamide.

Note: Pregnant or nursing women, people actively trying to conceive, and children
should not administer this drug. When handling cyclophosphamide, wear the blue
chemotherapy gloves we have provided. Wash hands after administration. Do not crush
or split pills. Place used gloves, unused medication, and empty containers in a Ziplock
bag and return to the hospital for disposal.

Special Instructions for Care
For dogs: If the by-products of cyclophosphamide sit in the bladder, they will cause an injury to
the bladder resulting in a bloody cystitis. For that reason, for the 24 hours following
cyclophosphamide therapy, your dog must have constant access to water and be allowed to
urinate frequently (approximately every 4 hours).

Note: Furosemide and prednisone will interfere with the ability to concentrate urine.
This will cause your dog to urinate and drink more for about 24 hours. Make sure that
water is available at all times and allow your dog to urinate frequently (approximately
every 4-6 hours) to pass the by-products of the cyclophosphamide.

Some cyclophosphamide will be excreted in the urine. Avoid contact with your dog’s urine for
about 48 hours after treatment. The drug is unstable in the environment, but we do recommend
that you encourage your dog to urinate in low-traffic areas of your yard for the 48 hours after
treatment. If your dog urinates in your home, wear gloves when you clean the area. You can
use soap and water to clean the area.

For cats: Some cyclophosphamide will be excreted in the urine for about 48 hours after
treatment. Avoid direct contact with your cat’s urine during this time. Wear gloves when
cleaning the litter box. You can use flushable litter and flush urine clumps down the toilet or use
scoopable litter and place urine clumps in a plastic bag and throw in the garbage. Change all of
the litter in the box 48 hours after treatment and clean with soap and water.

Note: Pregnant or nursing women, people actively trying to conceive, and children
should not clean the litter box or urine in the house for 48 hours after cyclophosphamide
is administered.
Potential Side Effects
Most patients do not experience side effects with this drug, but potential side effects can
occur. It is important that you are able to recognize side effects. These side effects will
generally resolve with appropriate treatment.

1. Gastrointestinal Side Effects
These are usually seen 2-5 days after treatment. Rarely, patients will vomit during the 24 hours
following treatment. If this happens, please call us. Please monitor your pet for vomiting,
diarrhea, lethargy, or loss of appetite.

For loss of appetite, try feeding boiled chicken and rice for dogs and fishy canned foods for
cats. If your pet does not eat for 24 hours or is lethargic and inappetant, please call us.

For vomiting, if your pet vomits once or twice, withhold food and water for 12 hours and then
reintroduce water. If your pet does not vomit after drinking water, you can offer food. If there
are more then 2 episodes of vomiting, if vomiting resumes with feeding, or if your pet is lethargic
and vomiting, please call us.

For diarrhea, if stools are soft, feed bland food (boiled chicken and rice) for dogs. If the
diarrhea is bloody, watery, persists for more than 24 hours, or if your pet is lethargic and has
diarrhea, please call us.

If your pet is lethargic and has gastrointestinal signs, please call us. This could mean
dehydration or infection and we will most likely have you bring your pet to the hospital for
examination and treatment.

2. Myelosuppression (low white blood cell count)
This usually occurs 5-7 days after treatment and generally does not cause a problem. If the
white blood cell count falls too low, your pet is susceptible to infection. Usually these infections
originate from normal bacteria in the gi tract. Infections will cause fever and make your pet feel
sick. Please monitor your pet for lethargy, vomiting, diarrhea, or loss of appetite. If noted,
please call us. You may check your dog’s temperature rectally at home. A digital thermometer
is easiest to use. Cats usually will not tolerate this. If your dog’s temperature is 103 degrees or
higher, please call us. If signs of an infection are noted, we will recommend that you bring your
pet to the hospital for examination and treatment.

3. Hemorrhagic Cystitis (bleeding and inflammation of the bladder)
This side effect is seen only in dogs. It is largely prevented by administering prednisone or
furosemide to increase urine production and by allowing frequent urination after treatment.
Please monitor your dog for bloody urine, straining to urinate, or increased frequency of
urination. If noted, please call us.

Note: If your pet is showing any of the signs described above or if you have any
concerns about your pet, please call us. With appropriate care, most toxicity will resolve
within a few days.

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