cyclophosphamide (Rx)

Brand and Other Names:Cytoxan
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 500mg
  • 1g
  • 2g

tablet

  • 25mg
  • 50mg

Malignant Diseases

IV (intermittent therapy): 40-50 mg/kg (400-1800 mg/m²) divided over 2-5 days; may be repeated at intervals of 2-4 weeks  

IV (continuous daily therapy): 60-120 mg/m²/day (1-2.5 mg/kg/day)

PO (intermittent therapy): 400-1000 mg/m² divided over 4-5 days

PO (continuous daily therapy): 50-100 mg/m²/day or 1-5 mg/kg/day

Nephrotic Syndrome

2-3 mg/kg/day for up to 12 weeks when corticosteroids unsuccessful  

Non-Hodgkin Lymphoma

600-1500 mg/m² IV with other antineoplastics (part of CHOP regimen); dose intensification possible  

Breast Cancer

600 mg/m² IV with other antineoplastics; dose intensification possible  

Juvenile Idiopathic Arthritis/Vasculitis (Off-label)

10 mg/kg IV every 2 weeks  

Lupus Nephritis (Off-Label)

Induction therapy for lupus nephritis (American College of Rheumatology Guidelines 2012)

Low-dose: 500 mg IV every 2 weeks for 6 doses plus corticosteroids, then maintenance with mycophenolate mofetil or azathioprine

High-dose: 500-1000 mg/m² IV monthly for 6 doses plus corticosteroids

Systemic Sclerosis (Orphan)

Prevention of graft-versus-host disease after allogeneic hematopoietic stem cell transplant

Orphan designation sponsor

  • Accentia Biopharmaceuticals, 324 South Hyde Avenue, Suite 350, Tampa, FL 33606

Dosing Modifications

Hepatic impariment: Give 75% of normal dose if transaminase levels are >3 times upper limit of normal or bilirubin is 3.1-5 mg/dL

Renal impairment: CrCl <10 mL/min, give 75% of normal dose; CrCl >10 mL/min, give full dose

Dosage Forms & Strengths

powder for injection

  • 500mg
  • 1g
  • 2g

tablet

  • 25mg
  • 50mg

Malignant Diseases

IV (intermittent therapy): 40-50 mg/kg (400-1800 mg/m²) divided over 2-5 days; may be repeated at intervals of 2-4 weeks  

IV (continuous daily therapy): 60-120 mg/m²/day (1-2.5 mg/kg/day)

PO (intermittent therapy): 400-1000 mg/m² divided over 4-5 days

PO (continuous daily therapy): 50-100 mg/m²/day

Juvenile Idiopathic Arthritis/Vasculitis

10 mg/kg IV every 2 weeks  

Nephrotic Syndrome

2-3 mg/kg/day for up to 12 weeks when corticosteroids unsuccessful  

Systemic Lupus Erythematosus

500-750 mg/m² IV monthly; not to exceed 1 g/m²  

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Interactions

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              Serious - Use Alternative (23)

              • abametapir

                abametapir will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

                abametapir will increase the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP2B6 substrates. If not feasible, avoid use of abametapir.

              • adenovirus types 4 and 7 live, oral

                cyclophosphamide decreases effects of adenovirus types 4 and 7 live, oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3mo after cessation of immunosuppressive therapy.

              • apalutamide

                apalutamide will decrease the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

              • axicabtagene ciloleucel

                cyclophosphamide, axicabtagene ciloleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • brexucabtagene autoleucel

                cyclophosphamide, brexucabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • ciltacabtagene autoleucel

                cyclophosphamide, ciltacabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • deferiprone

                deferiprone, cyclophosphamide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.

              • etanercept

                etanercept, cyclophosphamide. Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. The incidence of noncutaneous solid malignancies may be increased in patients receiving TNF blocking agents with cyclophosphamide. Coadministration is not recommended.

              • fexinidazole

                fexinidazole will decrease the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Avoid or Use Alternate Drug. Coadministration may decrease plasma concentrations of CYP2B6 substrates owing to fexinidazole inducing CYP2B6.

                fexinidazole will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

              • hydrochlorothiazide

                hydrochlorothiazide increases toxicity of cyclophosphamide by decreasing renal clearance. Avoid or Use Alternate Drug. Increased myelosuppressive effects.

              • idarubicin

                cyclophosphamide increases toxicity of idarubicin by Other (see comment). Avoid or Use Alternate Drug. Comment: May increase formation of toxic anthracycline metabolites in heart tissue.

              • idecabtagene vicleucel

                cyclophosphamide, idecabtagene vicleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • idelalisib

                idelalisib will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

              • influenza virus vaccine quadrivalent, adjuvanted

                cyclophosphamide decreases effects of influenza virus vaccine quadrivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

              • influenza virus vaccine trivalent, adjuvanted

                cyclophosphamide decreases effects of influenza virus vaccine trivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

              • lisocabtagene maraleucel

                cyclophosphamide, lisocabtagene maraleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • lonafarnib

                lonafarnib will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

              • palifermin

                palifermin increases toxicity of cyclophosphamide by Other (see comment). Avoid or Use Alternate Drug. Comment: Palifermin should not be administered within 24 hrbefore, during infusion of, or within 24 hr after administration of antineoplastic agents. Coadministration of palifermin within 24 hr of chemotherapy resulted in increased severity and duration of oral mucositis.

              • ropeginterferon alfa 2b

                ropeginterferon alfa 2b, cyclophosphamide. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Myelosuppressive agents can produce additive myelosuppression. Avoid use and monitor patients receiving the combination for effects of excessive myelosuppression.

              • tisagenlecleucel

                cyclophosphamide, tisagenlecleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • tofacitinib

                cyclophosphamide, tofacitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • tucatinib

                tucatinib will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

              • voxelotor

                voxelotor will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

              Monitor Closely (87)

              • acalabrutinib

                acalabrutinib, cyclophosphamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may increase risk of myelosuppressive effects.

              • allopurinol

                allopurinol increases toxicity of cyclophosphamide by decreasing metabolism. Use Caution/Monitor.

              • amiodarone

                amiodarone increases toxicity of cyclophosphamide by unspecified interaction mechanism. Use Caution/Monitor.

              • antithrombin III

                cyclophosphamide increases effects of antithrombin III by unknown mechanism. Use Caution/Monitor.

              • argatroban

                cyclophosphamide increases effects of argatroban by unknown mechanism. Use Caution/Monitor. Additive risk of bleeding may be seen in thrombocytopenic patients receiving antineoplastic agents in combination with argatroban because these agents can decrease platelet counts.

              • atazanavir

                atazanavir will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

                atazanavir increases toxicity of cyclophosphamide by unspecified interaction mechanism. Use Caution/Monitor.

              • belatacept

                belatacept and cyclophosphamide both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.

              • belzutifan

                belzutifan will decrease the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

              • bendamustine

                bendamustine, cyclophosphamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • bivalirudin

                cyclophosphamide increases effects of bivalirudin by unknown mechanism. Use Caution/Monitor. Additive risk of bleeding may be seen in thrombocytopenic patients receiving antineoplastic agents in combination with anticoagulants such as bivalirudin.

              • bupivacaine implant

                cyclophosphamide, bupivacaine implant. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.

              • busulfan

                cyclophosphamide, busulfan. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor.

                busulfan, cyclophosphamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • butabarbital

                butabarbital will decrease the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

              • cannabidiol

                cannabidiol, cyclophosphamide. affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Owing to the potential for both CYP2B6 induction and inhibition with the coadministration of CYP2B6 substrates and cannabidiol, consider reducing dosage adjustment of CYP2B6 substrates as clinically appropriate.

              • carbamazepine

                carbamazepine will decrease the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

              • carboplatin

                carboplatin, cyclophosphamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • carmustine

                carmustine, cyclophosphamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • cenobamate

                cenobamate will decrease the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP2B6 substrate, as needed, when coadministered with cenobamate.

                cenobamate will decrease the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

              • chlorambucil

                chlorambucil, cyclophosphamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • cholera vaccine

                cyclophosphamide decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.

              • cisplatin

                cisplatin, cyclophosphamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • crizotinib

                cyclophosphamide will increase the level or effect of crizotinib by aldehyde dehydrogenase inhibition. Use Caution/Monitor.

              • crofelemer

                crofelemer increases levels of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

              • dabrafenib

                dabrafenib will decrease the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

              • dacarbazine

                cyclophosphamide, dacarbazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • dalteparin

                cyclophosphamide increases effects of dalteparin by unknown mechanism. Use Caution/Monitor. Due to potential thrombocytopenic effects of cyclophosphamide, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants.

              • darunavir

                darunavir will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • dengue vaccine

                cyclophosphamide decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.

              • denosumab

                cyclophosphamide, denosumab. Other (see comment). Use Caution/Monitor. Comment: Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

              • digoxin

                cyclophosphamide decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • doxorubicin

                doxorubicin increases toxicity of cyclophosphamide by unspecified interaction mechanism. Use Caution/Monitor. Increased risk of hemorrhagic cystitis.

              • doxorubicin liposomal

                doxorubicin liposomal increases toxicity of cyclophosphamide by unspecified interaction mechanism. Use Caution/Monitor. Increased risk of hemorrhagic cystitis.

              • efavirenz

                efavirenz will decrease the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • elagolix

                elagolix will decrease the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

              • enoxaparin

                cyclophosphamide increases effects of enoxaparin by unknown mechanism. Use Caution/Monitor. Due to potential thrombocytopenic effects of cyclophosphamide, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants.

              • fedratinib

                fedratinib will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

              • fingolimod

                cyclophosphamide increases effects of fingolimod by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects. .

              • fluvoxamine

                fluvoxamine will increase the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

              • fondaparinux

                cyclophosphamide increases effects of fondaparinux by unknown mechanism. Use Caution/Monitor. Due to potential thrombocytopenic effects of cyclophosphamide, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants.

              • heparin

                cyclophosphamide increases effects of heparin by unknown mechanism. Use Caution/Monitor. Due to potential thrombocytopenic effects of cyclophosphamide, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants.

              • hydroxyurea

                cyclophosphamide, hydroxyurea. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of myelosuppression.

              • ifosfamide

                cyclophosphamide, ifosfamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

                ifosfamide, cyclophosphamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration with ifosfamide may increase the risk of immunosuppression and myelosuppression.

              • iloperidone

                iloperidone increases levels of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

              • indinavir

                indinavir will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • influenza A (H5N1) vaccine

                cyclophosphamide decreases effects of influenza A (H5N1) vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce immune response to H5N1 vaccine.

              • influenza virus vaccine (H5N1), adjuvanted

                cyclophosphamide decreases effects of influenza virus vaccine (H5N1), adjuvanted by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce immune response to H5N1 vaccine.

              • isavuconazonium sulfate

                cyclophosphamide and isavuconazonium sulfate both decrease immunosuppressive effects; risk of infection. Use Caution/Monitor.

              • istradefylline

                istradefylline will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

              • ketoconazole

                ketoconazole increases toxicity of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • lemborexant

                lemborexant will decrease the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Monitor CYP2B6 substrate for adequate clinical response. Consider increasing the CYP2B6 substrate dose according to specific prescribing recommendations.

              • lenacapavir

                lenacapavir will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir (a moderate CYP3A4 inhibitor) may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.

              • letermovir

                letermovir increases levels of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • lomustine

                cyclophosphamide, lomustine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

                lomustine, cyclophosphamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration with lomustine may increase the risk of immunosuppression and myelosuppression.

              • lopinavir

                lopinavir will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • lumacaftor/ivacaftor

                lumacaftor/ivacaftor, cyclophosphamide. affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2B6 substrates. .

              • mechlorethamine

                cyclophosphamide, mechlorethamine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration with mechlorethamine may increase the risk of immunosuppression and myelosuppression.

                mechlorethamine, cyclophosphamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration with mechlorethamine may increase the risk of immunosuppression and myelosuppression.

              • meningococcal group B vaccine

                cyclophosphamide decreases effects of meningococcal group B vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Individuals with altered immunocompetence may have reduced immune responses to the vaccine.

              • mifepristone

                mifepristone will increase the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

                mifepristone will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • mitotane

                mitotane decreases levels of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

              • nelfinavir

                nelfinavir will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • ocrelizumab

                cyclophosphamide and ocrelizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration of ocrelizumab with immunosuppressants may increase the risk of immunosuppression.

              • ofatumumab SC

                ofatumumab SC, cyclophosphamide. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

              • olaparib

                cyclophosphamide and olaparib both increase pharmacodynamic synergism. Use Caution/Monitor. Coadministration with other other myelosuppressive anticancer agents, including DNA damaging agents, may potentiate and prolongate the myelosuppressive toxicity.

              • pentobarbital

                pentobarbital will decrease the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

              • phenobarbital

                phenobarbital will decrease the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

              • primidone

                primidone will decrease the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

              • rifampin

                rifampin will decrease the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

                rifampin will decrease the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • ritonavir

                ritonavir will increase the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

                ritonavir will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • rucaparib

                rucaparib will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

              • saquinavir

                saquinavir will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • secobarbital

                secobarbital will decrease the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

              • siponimod

                siponimod and cyclophosphamide both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

              • sipuleucel-T

                cyclophosphamide decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.

              • sodium sulfate/?magnesium sulfate/potassium chloride

                sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of cyclophosphamide by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

              • sodium sulfate/potassium sulfate/magnesium sulfate

                sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of cyclophosphamide by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

              • sorafenib

                sorafenib will increase the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

              • stiripentol

                stiripentol, cyclophosphamide. affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP2B6 inhibitor and inducer. Monitor CYP2B6 substrates coadministered with stiripentol for increased or decreased effects. CYP2B6 substrates may require dosage adjustment.

                stiripentol, cyclophosphamide. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

              • streptozocin

                cyclophosphamide, streptozocin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • succinylcholine

                cyclophosphamide increases levels of succinylcholine by decreasing metabolism. Use Caution/Monitor. Neuromuscular blockade may be prolonged because of inhibition of cholinesterase activity. Prolonged respiratory depression with extended periods of apnea may occur. .

              • tecovirimat

                tecovirimat will decrease the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

              • thiotepa

                cyclophosphamide, thiotepa. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive myelosuppression.

              • tipranavir

                tipranavir will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • trastuzumab

                trastuzumab, cyclophosphamide. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • trastuzumab deruxtecan

                trastuzumab deruxtecan, cyclophosphamide. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

              • ublituximab

                ublituximab and cyclophosphamide both increase immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Owing to potential additive immunosuppressive effects, consider duration of effect and mechanism of action of these therapies if coadministered

              • voclosporin

                voclosporin, cyclophosphamide. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

              Minor (341)

              • abemaciclib

                cyclophosphamide will increase the level or effect of abemaciclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • abiraterone

                cyclophosphamide will increase the level or effect of abiraterone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • acalabrutinib

                cyclophosphamide will increase the level or effect of acalabrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • acetazolamide

                acetazolamide will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ado-trastuzumab emtansine

                cyclophosphamide will increase the level or effect of ado-trastuzumab emtansine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • alfentanil

                cyclophosphamide will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • alfuzosin

                cyclophosphamide will increase the level or effect of alfuzosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • alpelisib

                cyclophosphamide will increase the level or effect of alpelisib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • alprazolam

                cyclophosphamide will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ambrisentan

                cyclophosphamide will increase the level or effect of ambrisentan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • amiodarone

                cyclophosphamide will increase the level or effect of amiodarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • amlodipine

                cyclophosphamide will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • anastrozole

                anastrozole will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • apalutamide

                cyclophosphamide will increase the level or effect of apalutamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • apixaban

                cyclophosphamide will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • apomorphine

                cyclophosphamide will increase the level or effect of apomorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • apremilast

                cyclophosphamide will decrease the level or effect of apremilast by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • aprepitant

                cyclophosphamide will increase the level or effect of aprepitant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • aripiprazole

                cyclophosphamide will increase the level or effect of aripiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • armodafinil

                cyclophosphamide will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • artemether/lumefantrine

                cyclophosphamide will decrease the level or effect of artemether/lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • aspirin

                aspirin will decrease the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • astemizole

                cyclophosphamide will increase the level or effect of astemizole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • atazanavir

                cyclophosphamide will increase the level or effect of atazanavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • atogepant

                cyclophosphamide will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • atorvastatin

                cyclophosphamide will increase the level or effect of atorvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • avanafil

                cyclophosphamide will increase the level or effect of avanafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • avapritinib

                cyclophosphamide will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • avatrombopag

                cyclophosphamide will increase the level or effect of avatrombopag by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • axitinib

                cyclophosphamide increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • bedaquiline

                cyclophosphamide will increase the level or effect of bedaquiline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • benzhydrocodone/acetaminophen

                cyclophosphamide will increase the level or effect of benzhydrocodone/acetaminophen by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • benzphetamine

                cyclophosphamide will increase the level or effect of benzphetamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • bortezomib

                cyclophosphamide will increase the level or effect of bortezomib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • bosentan

                cyclophosphamide will increase the level or effect of bosentan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • bosutinib

                cyclophosphamide will increase the level or effect of bosutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • brentuximab vedotin

                cyclophosphamide will increase the level or effect of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • brexpiprazole

                cyclophosphamide will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • brigatinib

                cyclophosphamide will increase the level or effect of brigatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • bromocriptine

                cyclophosphamide will increase the level or effect of bromocriptine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • budesonide

                cyclophosphamide will increase the level or effect of budesonide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • buprenorphine

                cyclophosphamide will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • buprenorphine transdermal

                cyclophosphamide will increase the level or effect of buprenorphine transdermal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • buspirone

                cyclophosphamide will increase the level or effect of buspirone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • busulfan

                cyclophosphamide will increase the level or effect of busulfan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • cabozantinib

                cyclophosphamide will increase the level or effect of cabozantinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • calcifediol

                cyclophosphamide will increase the level or effect of calcifediol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • calcitriol

                cyclophosphamide will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • capmatinib

                cyclophosphamide will increase the level or effect of capmatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • carbamazepine

                cyclophosphamide will increase the level or effect of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • cariprazine

                cyclophosphamide will increase the level or effect of cariprazine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • chlordiazepoxide

                cyclophosphamide will increase the level or effect of chlordiazepoxide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • chloroquine

                cyclophosphamide will increase the level or effect of chloroquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • chlorpheniramine

                cyclophosphamide will increase the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ciclesonide inhaled

                cyclophosphamide will increase the level or effect of ciclesonide inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • cilostazol

                cyclophosphamide will increase the level or effect of cilostazol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • cisapride

                cyclophosphamide will increase the level or effect of cisapride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • citalopram

                cyclophosphamide will increase the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • clarithromycin

                cyclophosphamide will increase the level or effect of clarithromycin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • clonazepam

                cyclophosphamide will increase the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • clorazepate

                cyclophosphamide will increase the level or effect of clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • cobicistat

                cyclophosphamide will increase the level or effect of cobicistat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • cobimetinib

                cyclophosphamide will increase the level or effect of cobimetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • cocaine topical

                cyclophosphamide will increase the level or effect of cocaine topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • colchicine

                cyclophosphamide will increase the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • conivaptan

                cyclophosphamide will increase the level or effect of conivaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • conjugated estrogens

                cyclophosphamide will increase the level or effect of conjugated estrogens by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • copanlisib

                cyclophosphamide will increase the level or effect of copanlisib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • cyclosporine

                cyclophosphamide will increase the level or effect of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • dabrafenib

                cyclophosphamide will increase the level or effect of dabrafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • daclatasvir

                cyclophosphamide will increase the level or effect of daclatasvir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • dantrolene

                cyclophosphamide will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • dapsone

                cyclophosphamide will increase the level or effect of dapsone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • darifenacin

                cyclophosphamide will increase the level or effect of darifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • darunavir

                cyclophosphamide will increase the level or effect of darunavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • dasatinib

                cyclophosphamide will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • deflazacort

                cyclophosphamide will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • delavirdine

                cyclophosphamide will increase the level or effect of delavirdine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • dexamethasone

                cyclophosphamide will increase the level or effect of dexamethasone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • dexlansoprazole

                cyclophosphamide will increase the level or effect of dexlansoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • diazepam

                cyclophosphamide will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • diazepam intranasal

                cyclophosphamide will increase the level or effect of diazepam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • dihydroergotamine

                cyclophosphamide will increase the level or effect of dihydroergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • dihydroergotamine intranasal

                cyclophosphamide will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • diltiazem

                cyclophosphamide will increase the level or effect of diltiazem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • disopyramide

                cyclophosphamide will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • docetaxel

                cyclophosphamide will increase the level or effect of docetaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • doravirine

                cyclophosphamide will increase the level or effect of doravirine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • doxepin cream

                cyclophosphamide will increase the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • doxorubicin

                cyclophosphamide will increase the level or effect of doxorubicin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • doxorubicin liposomal

                cyclophosphamide will increase the level or effect of doxorubicin liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • dronabinol

                cyclophosphamide will increase the level or effect of dronabinol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • dronedarone

                cyclophosphamide will increase the level or effect of dronedarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • duvelisib

                cyclophosphamide will increase the level or effect of duvelisib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • efavirenz

                cyclophosphamide will increase the level or effect of efavirenz by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • elagolix

                cyclophosphamide will increase the level or effect of elagolix by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • elbasvir/grazoprevir

                cyclophosphamide will increase the level or effect of elbasvir/grazoprevir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • eletriptan

                cyclophosphamide will increase the level or effect of eletriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • eliglustat

                cyclophosphamide will increase the level or effect of eliglustat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • elvitegravir

                cyclophosphamide will increase the level or effect of elvitegravir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                cyclophosphamide will increase the level or effect of elvitegravir/cobicistat/emtricitabine/tenofovir DF by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • encorafenib

                cyclophosphamide will increase the level or effect of encorafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • enfortumab vedotin

                cyclophosphamide will increase the level or effect of enfortumab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • entrectinib

                cyclophosphamide will increase the level or effect of entrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • enzalutamide

                cyclophosphamide will increase the level or effect of enzalutamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • eplerenone

                cyclophosphamide will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ergoloid mesylates

                cyclophosphamide will increase the level or effect of ergoloid mesylates by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ergonovine

                cyclophosphamide will increase the level or effect of ergonovine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ergotamine

                cyclophosphamide will increase the level or effect of ergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • erlotinib

                cyclophosphamide will increase the level or effect of erlotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • erythromycin base

                cyclophosphamide will increase the level or effect of erythromycin base by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • erythromycin ethylsuccinate

                cyclophosphamide will increase the level or effect of erythromycin ethylsuccinate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • erythromycin lactobionate

                cyclophosphamide will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • erythromycin stearate

                cyclophosphamide will increase the level or effect of erythromycin stearate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • escitalopram

                cyclophosphamide will increase the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • esomeprazole

                cyclophosphamide will increase the level or effect of esomeprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • estradiol

                cyclophosphamide will increase the level or effect of estradiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • estrogens conjugated synthetic

                cyclophosphamide will increase the level or effect of estrogens conjugated synthetic by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • estrogens esterified

                cyclophosphamide will increase the level or effect of estrogens esterified by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • estropipate

                cyclophosphamide will increase the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • eszopiclone

                cyclophosphamide will increase the level or effect of eszopiclone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ethinylestradiol

                cyclophosphamide will increase the level or effect of ethinylestradiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ethosuximide

                cyclophosphamide will increase the level or effect of ethosuximide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • etoposide

                cyclophosphamide will increase the level or effect of etoposide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • etravirine

                cyclophosphamide will increase the level or effect of etravirine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • everolimus

                cyclophosphamide will increase the level or effect of everolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • exemestane

                cyclophosphamide will increase the level or effect of exemestane by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • fedratinib

                cyclophosphamide will increase the level or effect of fedratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • felbamate

                cyclophosphamide will increase the level or effect of felbamate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • felodipine

                cyclophosphamide will increase the level or effect of felodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • fenofibrate

                cyclophosphamide will increase the level or effect of fenofibrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • fenofibrate micronized

                cyclophosphamide will increase the level or effect of fenofibrate micronized by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • fenofibric acid

                cyclophosphamide will increase the level or effect of fenofibric acid by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • fentanyl

                cyclophosphamide will increase the level or effect of fentanyl by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • fentanyl intranasal

                cyclophosphamide will increase the level or effect of fentanyl intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • fentanyl transdermal

                cyclophosphamide will increase the level or effect of fentanyl transdermal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • fentanyl transmucosal

                cyclophosphamide will increase the level or effect of fentanyl transmucosal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • finerenone

                cyclophosphamide will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • flibanserin

                cyclophosphamide will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • flunisolide inhaled

                cyclophosphamide will increase the level or effect of flunisolide inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • flurazepam

                cyclophosphamide will increase the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • flutamide

                cyclophosphamide will increase the level or effect of flutamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • fluticasone furoate

                cyclophosphamide will increase the level or effect of fluticasone furoate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • fluticasone inhaled

                cyclophosphamide will increase the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • fosamprenavir

                cyclophosphamide will increase the level or effect of fosamprenavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • fosaprepitant

                cyclophosphamide will increase the level or effect of fosaprepitant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • fostamatinib

                cyclophosphamide will increase the level or effect of fostamatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • gefitinib

                cyclophosphamide will increase the level or effect of gefitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • glasdegib

                cyclophosphamide will increase the level or effect of glasdegib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • glecaprevir/pibrentasvir

                cyclophosphamide will increase the level or effect of glecaprevir/pibrentasvir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • guanfacine

                cyclophosphamide will increase the level or effect of guanfacine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • haloperidol

                cyclophosphamide will increase the level or effect of haloperidol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • hydrocodone

                cyclophosphamide will increase the level or effect of hydrocodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • hydroxyprogesterone caproate

                cyclophosphamide will increase the level or effect of hydroxyprogesterone caproate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ibrutinib

                cyclophosphamide will increase the level or effect of ibrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • idelalisib

                cyclophosphamide will increase the level or effect of idelalisib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ifosfamide

                cyclophosphamide will increase the level or effect of ifosfamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • imatinib

                cyclophosphamide will increase the level or effect of imatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • indinavir

                cyclophosphamide will increase the level or effect of indinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • irinotecan

                cyclophosphamide will increase the level or effect of irinotecan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • irinotecan liposomal

                cyclophosphamide will increase the level or effect of irinotecan liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • isavuconazonium sulfate

                cyclophosphamide will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • isosorbide dinitrate

                cyclophosphamide will increase the level or effect of isosorbide dinitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • isosorbide mononitrate

                cyclophosphamide will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • isradipine

                cyclophosphamide will increase the level or effect of isradipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • istradefylline

                cyclophosphamide will increase the level or effect of istradefylline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • itraconazole

                cyclophosphamide will increase the level or effect of itraconazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ivacaftor

                cyclophosphamide will increase the level or effect of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ivosidenib

                cyclophosphamide will increase the level or effect of ivosidenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ixabepilone

                cyclophosphamide will increase the level or effect of ixabepilone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ixazomib

                cyclophosphamide will increase the level or effect of ixazomib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ketamine

                cyclophosphamide will increase the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • lacosamide

                cyclophosphamide will increase the level or effect of lacosamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • lansoprazole

                cyclophosphamide will increase the level or effect of lansoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • lapatinib

                cyclophosphamide will increase the level or effect of lapatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • larotrectinib

                larotrectinib will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

                cyclophosphamide will increase the level or effect of larotrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • lemborexant

                cyclophosphamide will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • levamlodipine

                cyclophosphamide will increase the level or effect of levamlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • levoketoconazole

                levoketoconazole will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • levomilnacipran

                cyclophosphamide will increase the level or effect of levomilnacipran by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • levonorgestrel intrauterine

                cyclophosphamide will increase the level or effect of levonorgestrel intrauterine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • levonorgestrel oral

                cyclophosphamide will increase the level or effect of levonorgestrel oral by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • linagliptin

                cyclophosphamide will increase the level or effect of linagliptin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • lomitapide

                cyclophosphamide increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • lonafarnib

                cyclophosphamide will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • lopinavir

                cyclophosphamide will increase the level or effect of lopinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • lorlatinib

                cyclophosphamide will increase the level or effect of lorlatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • losartan

                cyclophosphamide will increase the level or effect of losartan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • lovastatin

                cyclophosphamide will increase the level or effect of lovastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • lumacaftor/ivacaftor

                cyclophosphamide will increase the level or effect of lumacaftor/ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • lumefantrine

                cyclophosphamide will increase the level or effect of lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • lurasidone

                cyclophosphamide will increase the level or effect of lurasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • macimorelin

                cyclophosphamide will increase the level or effect of macimorelin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • maraviroc

                cyclophosphamide will increase the level or effect of maraviroc by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • marijuana

                cyclophosphamide will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • medroxyprogesterone

                cyclophosphamide will increase the level or effect of medroxyprogesterone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • mefloquine

                cyclophosphamide will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • mestranol

                cyclophosphamide will increase the level or effect of mestranol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • metaxalone

                cyclophosphamide will increase the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • methadone

                cyclophosphamide will increase the level or effect of methadone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • methylergonovine

                cyclophosphamide will increase the level or effect of methylergonovine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • methylprednisolone

                cyclophosphamide will increase the level or effect of methylprednisolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • miconazole oral

                cyclophosphamide will increase the level or effect of miconazole oral by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • midazolam

                cyclophosphamide will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • midazolam intranasal

                cyclophosphamide will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • midostaurin

                cyclophosphamide will increase the level or effect of midostaurin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • mifepristone

                cyclophosphamide will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • mirtazapine

                cyclophosphamide will increase the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • modafinil

                cyclophosphamide will increase the level or effect of modafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • montelukast

                cyclophosphamide will increase the level or effect of montelukast by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • naldemedine

                cyclophosphamide will increase the level or effect of naldemedine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • naloxegol

                cyclophosphamide will increase the level or effect of naloxegol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • nefazodone

                cyclophosphamide will increase the level or effect of nefazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • nelfinavir

                cyclophosphamide will increase the level or effect of nelfinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • netupitant/palonosetron

                cyclophosphamide will increase the level or effect of netupitant/palonosetron by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • nevirapine

                cyclophosphamide will increase the level or effect of nevirapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • nicardipine

                cyclophosphamide will increase the level or effect of nicardipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • nifedipine

                cyclophosphamide will increase the level or effect of nifedipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • nilotinib

                cyclophosphamide will increase the level or effect of nilotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • nimodipine

                cyclophosphamide will increase the level or effect of nimodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • nisoldipine

                cyclophosphamide will increase the level or effect of nisoldipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • norethindrone

                cyclophosphamide will increase the level or effect of norethindrone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • norgestrel

                cyclophosphamide will increase the level or effect of norgestrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • olaparib

                cyclophosphamide will increase the level or effect of olaparib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ombitasvir/paritaprevir/ritonavir

                cyclophosphamide will increase the level or effect of ombitasvir/paritaprevir/ritonavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)

                cyclophosphamide will increase the level or effect of ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • omeprazole

                cyclophosphamide will increase the level or effect of omeprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ondansetron

                cyclophosphamide will increase the level or effect of ondansetron by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • osilodrostat

                cyclophosphamide will increase the level or effect of osilodrostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • osimertinib

                cyclophosphamide will increase the level or effect of osimertinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ospemifene

                cyclophosphamide will increase the level or effect of ospemifene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • oxycodone

                cyclophosphamide will increase the level or effect of oxycodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • paclitaxel

                cyclophosphamide will increase the level or effect of paclitaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • paclitaxel protein bound

                cyclophosphamide will increase the level or effect of paclitaxel protein bound by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • palbociclib

                cyclophosphamide will increase the level or effect of palbociclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • panobinostat

                cyclophosphamide will increase the level or effect of panobinostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • paricalcitol

                cyclophosphamide will increase the level or effect of paricalcitol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • pazopanib

                cyclophosphamide will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • perampanel

                cyclophosphamide will increase the level or effect of perampanel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • pexidartinib

                cyclophosphamide will increase the level or effect of pexidartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • pimavanserin

                cyclophosphamide will increase the level or effect of pimavanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • pimozide

                cyclophosphamide will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • pitolisant

                cyclophosphamide will increase the level or effect of pitolisant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • polatuzumab vedotin

                cyclophosphamide will increase the level or effect of polatuzumab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • pomalidomide

                cyclophosphamide will increase the level or effect of pomalidomide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ponatinib

                cyclophosphamide will increase the level or effect of ponatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • praziquantel

                cyclophosphamide will increase the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • primaquine

                cyclophosphamide will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • progesterone intravaginal gel

                cyclophosphamide will increase the level or effect of progesterone intravaginal gel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • progesterone micronized

                cyclophosphamide will increase the level or effect of progesterone micronized by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • progesterone, natural

                cyclophosphamide will increase the level or effect of progesterone, natural by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • quazepam

                cyclophosphamide will increase the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • quetiapine

                cyclophosphamide will increase the level or effect of quetiapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • quinidine

                cyclophosphamide will increase the level or effect of quinidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • quinine

                cyclophosphamide will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • rabeprazole

                cyclophosphamide will increase the level or effect of rabeprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ranolazine

                cyclophosphamide will increase the level or effect of ranolazine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • regorafenib

                cyclophosphamide will increase the level or effect of regorafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • repaglinide

                cyclophosphamide will increase the level or effect of repaglinide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ribociclib

                ribociclib will increase the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

                cyclophosphamide will increase the level or effect of ribociclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • rifabutin

                cyclophosphamide will increase the level or effect of rifabutin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • rimegepant

                cyclophosphamide will increase the level or effect of rimegepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • riociguat

                cyclophosphamide will increase the level or effect of riociguat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ritonavir

                cyclophosphamide will increase the level or effect of ritonavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • rivaroxaban

                cyclophosphamide will increase the level or effect of rivaroxaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • roflumilast

                cyclophosphamide will increase the level or effect of roflumilast by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • rolapitant

                cyclophosphamide will increase the level or effect of rolapitant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • romidepsin

                cyclophosphamide will increase the level or effect of romidepsin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ropivacaine

                cyclophosphamide will increase the level or effect of ropivacaine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ruxolitinib

                cyclophosphamide will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ruxolitinib topical

                cyclophosphamide will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • salmeterol

                cyclophosphamide will increase the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • saquinavir

                cyclophosphamide will increase the level or effect of saquinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • saxagliptin

                cyclophosphamide will increase the level or effect of saxagliptin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • selpercatinib

                cyclophosphamide will increase the level or effect of selpercatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • sildenafil

                cyclophosphamide will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • simvastatin

                cyclophosphamide will increase the level or effect of simvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • siponimod

                cyclophosphamide will increase the level or effect of siponimod by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • sirolimus

                cyclophosphamide will increase the level or effect of sirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • sofosbuvir/velpatasvir

                cyclophosphamide will increase the level or effect of sofosbuvir/velpatasvir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • solifenacin

                cyclophosphamide will increase the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • sonidegib

                cyclophosphamide will increase the level or effect of sonidegib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • sorafenib

                cyclophosphamide will increase the level or effect of sorafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • stiripentol

                cyclophosphamide will increase the level or effect of stiripentol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • sufentanil

                cyclophosphamide will increase the level or effect of sufentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • sufentanil SL

                cyclophosphamide will increase the level or effect of sufentanil SL by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • sunitinib

                cyclophosphamide will increase the level or effect of sunitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • suvorexant

                cyclophosphamide will increase the level or effect of suvorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • tacrolimus

                cyclophosphamide will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • tacrolimus ointment

                cyclophosphamide will increase the level or effect of tacrolimus ointment by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • tadalafil

                cyclophosphamide will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • tamoxifen

                cyclophosphamide decreases effects of tamoxifen by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • tamsulosin

                cyclophosphamide will increase the level or effect of tamsulosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • tasimelteon

                cyclophosphamide will increase the level or effect of tasimelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • tazemetostat

                cyclophosphamide will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • temsirolimus

                cyclophosphamide will increase the level or effect of temsirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • teniposide

                cyclophosphamide will increase the level or effect of teniposide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • tetracycline

                cyclophosphamide will increase the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • tezacaftor

                cyclophosphamide will increase the level or effect of tezacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • theophylline

                cyclophosphamide will increase the level or effect of theophylline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • tiagabine

                cyclophosphamide will increase the level or effect of tiagabine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ticagrelor

                cyclophosphamide will increase the level or effect of ticagrelor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ticlopidine

                cyclophosphamide will increase the level or effect of ticlopidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • tinidazole

                cyclophosphamide will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • tipranavir

                cyclophosphamide will increase the level or effect of tipranavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • tofacitinib

                cyclophosphamide will increase the level or effect of tofacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • tolterodine

                cyclophosphamide will increase the level or effect of tolterodine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • tolvaptan

                cyclophosphamide will increase the level or effect of tolvaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • toremifene

                cyclophosphamide will increase the level or effect of toremifene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • trabectedin

                cyclophosphamide will increase the level or effect of trabectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • tramadol

                cyclophosphamide will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • trazodone

                cyclophosphamide will increase the level or effect of trazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • triazolam

                cyclophosphamide will increase the level or effect of triazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • trimethoprim

                cyclophosphamide will increase the level or effect of trimethoprim by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • trimipramine

                cyclophosphamide will increase the level or effect of trimipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ubrogepant

                cyclophosphamide will increase the level or effect of ubrogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • ulipristal

                cyclophosphamide will increase the level or effect of ulipristal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • umeclidinium bromide/vilanterol inhaled

                cyclophosphamide will increase the level or effect of umeclidinium bromide/vilanterol inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • upadacitinib

                cyclophosphamide will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • valbenazine

                cyclophosphamide will increase the level or effect of valbenazine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • vandetanib

                cyclophosphamide will increase the level or effect of vandetanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • vardenafil

                cyclophosphamide will increase the level or effect of vardenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • velpatasvir

                cyclophosphamide will increase the level or effect of velpatasvir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • vemurafenib

                cyclophosphamide will increase the level or effect of vemurafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • venetoclax

                cyclophosphamide will increase the level or effect of venetoclax by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • venlafaxine

                cyclophosphamide will increase the level or effect of venlafaxine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • verapamil

                cyclophosphamide will increase the level or effect of verapamil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • vilanterol/fluticasone furoate inhaled

                cyclophosphamide will increase the level or effect of vilanterol/fluticasone furoate inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • vilazodone

                cyclophosphamide will increase the level or effect of vilazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • vinblastine

                cyclophosphamide will increase the level or effect of vinblastine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • vincristine

                cyclophosphamide will increase the level or effect of vincristine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • vincristine liposomal

                cyclophosphamide will increase the level or effect of vincristine liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • vinorelbine

                cyclophosphamide will increase the level or effect of vinorelbine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • vorapaxar

                cyclophosphamide will increase the level or effect of vorapaxar by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • voriconazole

                cyclophosphamide will increase the level or effect of voriconazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • vortioxetine

                cyclophosphamide will increase the level or effect of vortioxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • voxilaprevir

                cyclophosphamide will increase the level or effect of voxilaprevir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • warfarin

                warfarin will decrease the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • zanubrutinib

                cyclophosphamide will increase the level or effect of zanubrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • zolpidem

                cyclophosphamide will increase the level or effect of zolpidem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • zonisamide

                cyclophosphamide will increase the level or effect of zonisamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              >10%

              Alopecia (40-60%)

              Nausea and vomiting

              GI toxicity

              Leukopenia

              Amenorrhea

              Sterility

              1-10%

              Facial flushing

              Headache

              Rash

              Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

              Nasal congestion

              Frequency Not Defined

              Cardiomyopathy, CHF (high dose)

              Stevens-Johnson syndrome

              Toxic epidermal necrolysis (rare)

              Hemorrhagic cystitis

              Azoospermia

              Oligozoospermia

              Interstitial pneumonia

              Infectious disease

              Secondary malignancies: Urinary bladder, myeloproliferative, lymphoproliferative

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              Adverse Effects

              Frequency Not Defined

              Neutropenia

              Fever

              Nausea

              Vomiting

              Anorexia

              Abdominal discomfort or pain

              Diarrhea

              Hemorrhagic colitis

              Oral mucosal ulceration

              Jaundice

              Alopecia

              Skin rash

              Pigmentation of skin and changes in nails

              Postmarketing Reports

              Cardiac: Cardiac arrest, ventricular fibrillation, ventricular tachycardia, cardiogenic shock, pericardial effusion (progressing to cardiac tamponade), myocardial hemorrhage, myocardial infarction, cardiac failure (including fatal outcomes), cardiomyopathy, myocarditis, pericarditis, carditis, atrial fibrillation, supraventricular arrhythmia, ventricular arrhythmia, bradycardia, tachycardia, palpitations, QT prolongation

              Congenital, familial and genetic: Intrauterine death, fetal malformation, fetal growth retardation, fetal toxicity (including myelosuppression, gastroenteritis)

              Ear and labyrinth: Deafness, hearing impaired, tinnitus

              Endocrine: Water intoxication

              Eye: Visual impairment, conjunctivitis, lacrimation

              Gastrointestinal: Gastrointestinal hemorrhage, acute pancreatitis, colitis, enteritis, cecitis, stomatitis, constipation, parotid gland inflammation

              General disorders and administrative site conditions: Multiorgan failure, general physical deterioration, influenza-like illness, injection/infusion site reactions (thrombosis, necrosis, phlebitis, inflammation, pain, swelling, erythema), pyrexia, edema, chest pain, mucosal inflammation, asthenia, pain, chills, fatigue, malaise, headache

              Hematologic: Myelosuppression, bone marrow failure, disseminated intravascular coagulation and hemolytic uremic syndrome (with thrombotic microangiopathy)

              Hepatic: Veno-occlusive liver disease, cholestatic hepatitis, cytolytic hepatitis, hepatitis, cholestasis; hepatotoxicity with hepatic failure, hepatic encephalopathy, ascites, hepatomegaly, blood bilirubin increased, hepatic function abnormal, hepatic enzymes increased

              Immune: Immunosuppression, anaphylactic shock, hypersensitivity reaction

              Infections: Myelosuppression and immunosuppression may increase risk for and severity of pneumonias (including fatal outcomes), other bacterial, fungal, viral, protozoal and, parasitic infections; reactivation of latent infections, (including viral hepatitis, tuberculosis), Pneumocystis jiroveci, herpes zoster, Strongyloides, sepsis and septic shock

              Investigations: Blood lactate dehydrogenase increased, C-reactive protein increased

              Metabolism and nutrition: Hyponatremia, fluid retention, blood glucose increased, blood glucose decreased

              Musculoskeletal and connective tissue: Rhabdomyolysis, scleroderma, muscle spasms, myalgia, arthralgia

              Neoplasms: Acute leukemia, myelodysplastic syndrome, lymphoma, sarcomas, renal cell carcinoma, renal pelvis cancer, bladder cancer, ureteric cancer, thyroid cancer

              Nervous system: Encephalopathy, convulsion, dizziness, neurotoxicity has been reported and manifested as reversible posterior leukoencephalopathy syndrome, myelopathy, peripheral neuropathy, polyneuropathy, neuralgia, dysesthesia, hypoesthesia, paresthesia, tremor, dysgeusia, hypogeusia, parosmia

              Pregnancy: Premature labor

              Psychiatric: Confusional state

              Renal and urinary: Renal failure, renal tubular disorder, renal impairment, nephropathy toxic, hemorrhagic cystitis, bladder necrosis, cystitis ulcerative, bladder contracture, hematuria, nephrogenic diabetes insipidus, atypical urinary bladder epithelial cells

              Reproductive system: Infertility, ovarian failure, ovarian disorder, amenorrhea, oligomenorrhea, testicular atrophy, azoospermia, oligospermia

              Respiratory: Pulmonary veno-occlusive disease, acute respiratory distress syndrome, interstitial lung disease as manifested by respiratory failure (including fatal outcomes), obliterative bronchiolitis, organizing pneumonia, alveolitis allergic, pneumonitis, pulmonary hemorrhage; respiratory distress, pulmonary hypertension, pulmonary edema, pleural effusion, bronchospasm, dyspnea, hypoxia, cough, nasal congestion, nasal discomfort, oropharyngeal pain, rhinorrhea

              Skin and subcutaneous tissue: Toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, palmoplantar erythrodysesthesia syndrome, radiation recall dermatitis, toxic skin eruption, urticaria, dermatitis, blister, pruritus, erythema, nail disorder, facial swelling, hyperhidrosis

              Tumor lysis syndrome: May induce tumor-lysis syndrome and hyperuricemia in patients with rapidly growing tumors

              Vascular: Pulmonary embolism, venous thrombosis, vasculitis, peripheral ischemia, hypertension, hypotension, flushing, hot flush

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              Warnings

              Contraindications

              Severe myelosuppression

              Hypersensitivity

              Urinary outflow obstruction

              Cautions

              Use with caution in patients with hepatic or renal impairment, leukopenia, thrombocytopenia, recent radiation therapy or chemotherapy

              Pelvic irradiation potentiates hemorrhagic cystitis

              Potential for radiation recall when used in conjunction with radiation therapy

              Risk of potentially fatal and irreversible interstitial pulmonary fibrosis if given over prolonged periods

              May cause infertility in male patients who received high doses as children

              Monitor for secondary malignancies

              Heart Failure risk

              • Acute heart failure, often occurring within 1 to 10 days of treatment, has been reported
              • Subclinical decreases in LVEF in up to 50% of cases have also been seen
              • The onset of HF usually resolves over 3 to 4 weeks; However, fatalities caused by HF have been reported
              • Large individual doses (greater than 120–170 mg/kg or 1.55 mg/m 2 per day), old age, mediastinal radiation, and anthracycline use have been identified as risk factors
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              Pregnancy & Lactation

              Pregnancy

              Based on mechanism of action and published reports of effects in pregnant patients or animals, drug can cause fetal harm when administered to pregnant woman; exposure to cyclophosphamide during pregnancy may cause fetal malformations, miscarriage, fetal growth retardation, and toxic effects in the newborn; drug is teratogenic and embryo-fetal toxic in mice, rats, rabbits and monkeys; advise pregnant women and females of reproductive potential of the potential risk to the fetus

              Verify the pregnancy status of females of reproductive potential prior to the initiation of therapy

              Contraception

              • Therapy can cause fetal harm; advise females of reproductive potential to use effective contraception during treatment for up to 1 year after completion of therapy
              • Based on findings in genetic toxicity and animal reproduction studies, advise male patients with female partners of reproductive potential to use effective contraception during treatment and for 4 months after completion of therapy

              Infertility

              • Amenorrhea, transient or permanent, associated with decreased estrogen and increased gonadotropin secretion develops in a proportion of women treated with cyclophosphamide
              • Affected patients generally resume regular menses within a few months after cessation of therapy; risk of premature menopause with cyclophosphamide increases with age
              • Oligomenorrhea has also been reported in association with cyclophosphamide treatment
              • Men treated with cyclophosphamide may develop oligospermia or azoospermia, which are normally associated with increased gonadotropin but normal testosterone

              Lactation

              Drug is present in breast milk; neutropenia, thrombocytopenia, low hemoglobin, and diarrhea have been reported in infants breast fed by women treated with cyclophosphamide; because of potential for serious adverse reactions in a breastfed child from therapy, advise lactating women not to breastfeed during treatment and for 1 week after last dose

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Metabolites interfere with malignant cell growth by cross-linking tumor cell DNA; drug does not have specificity for any phase of the cell cycle; also has potent immunosuppressive activity

              Absorption

              Bioavailability: 75%

              Onset: 2-3 hr

              Peak plasma time: Cyclophosphamide, 1 hr; metabolites, 2-3 hr

              Distribution

              Protein bound: Cyclophosphamide, low; metabolites, >60%

              Vd: 0.48-0.71 L/kg

              Metabolism

              Metabolized by liver

              Metabolites: 4-hydroperoxycyclophosphamide, 4-aldophosphamide

              Elimination

              Half-life: 3-12 hr

              Excretion: Urine

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              Administration

              Give dose early in day

              Patients should drink plenty of fluids with PO doses

              Patients should empty bladder frequently to prevent hemorrhagic cystitis

              Sometimes, mesna is used concomitantly as prophylaxis against hemorrhagic cystitis

              Monitor blood counts during therapy (WBC count may decrease to 2000-3000/μL without serious risk of infection)

              May be administered IM, intraperitoneally, intrapleurally, by IV piggy-back, or by continuous IV infusion

              IV Incompatibilities

              Y-site: Amphotericin B cholesteryl sulfate

              IV Compatibilities

              Additive: Cisplatin/etoposide, fluorouracil, hydroxyzine, methotrexate, methotrexate/fluorouracil, mitoxantrone, ondansetron

              Syringe: Bleomycin, cisplatin, doxapram, doxorubicin, droperidol, furosemide, heparin, leucovorin, methotrexate, metoclopramide, mitomycin, vinblastine, vincristine

              Y-site (partial list): Allopurinol, amifostine, bleomycin, most cephalosporins, cisplatin, diphenhydramine, doxorubicin, doxorubicin liposomal, filgrastim, fluorouracil, furosemide, gemcitabine, linezolid, lorazepam, mitomycin, morphine, paclitaxel, prochlorperazine, propofol, sodium bicarbonate, trimethoprim/sulfamethoxazole, vancomycin, vinblastine, vincristine

              IV Preparation

              Maximum concentration of cyclophosphamide is limited to 20 mg/mL because of solubility

              IV push: Reconstitute with NS (do not use SWI, because it is hypotonic)

              Infusion: Reconstitute with SWI to concentration of 20 mg/mL

              May dilute further with D5W, NS, lactated Ringer solution, or other compatible fluids

              IV Administration

              Infusions may be administered over 1-2 hours

              Doses >500 mg up to ~1 g may be administered over 20-30 minutes

              To minimize bladder toxicity, increase normal fluid intake during and for 1-2 days after cyclophosphamide therapy; most adult patients will require fluid intake of at least 2 L/day; high-dose regimens should be accompanied by vigorous hydration with or without mesna therapy

              Storage

              Store intact vials at room temperature

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              cyclophosphamide oral
              -
              25 mg capsule
              cyclophosphamide oral
              -
              25 mg capsule
              cyclophosphamide oral
              -
              25 mg capsule
              cyclophosphamide oral
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              50 mg capsule
              cyclophosphamide oral
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              25 mg capsule
              cyclophosphamide oral
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              50 mg capsule
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              1 gram vial
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              2 gram vial
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              500 mg vial
              cyclophosphamide intravenous
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              1 gram vial
              cyclophosphamide intravenous
              -
              1 gram vial
              cyclophosphamide intravenous
              -
              1 gram vial
              cyclophosphamide intravenous
              -
              500 mg vial
              cyclophosphamide intravenous
              -
              500 mg vial
              cyclophosphamide intravenous
              -
              1 gram vial
              cyclophosphamide intravenous
              -
              200 mg/mL vial
              cyclophosphamide intravenous
              -
              200 mg/mL vial
              cyclophosphamide intravenous
              -
              2 gram vial
              cyclophosphamide intravenous
              -
              500 mg vial
              cyclophosphamide intravenous
              -
              200 mg/mL vial
              cyclophosphamide intravenous
              -
              500 mg vial
              cyclophosphamide intravenous
              -
              500 mg vial

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              Patient Handout

              Select a drug:
              Patient Education
              cyclophosphamide oral

              CYCLOPHOSPHAMIDE - ORAL

              (sye-klo-FOSS-fuh-mide)

              COMMON BRAND NAME(S): Cytoxan

              USES: Cyclophosphamide is used to treat various types of cancer. It is a chemotherapy drug that works by slowing or stopping cell growth.Cyclophosphamide also works by decreasing your immune system's response to various diseases. It is used to treat a certain type of kidney disease in children after other treatments have not worked.

              HOW TO USE: Take this medication by mouth exactly as directed by your doctor. The dosage is based on your medical condition, weight, response to treatment, and other treatments (such as other chemotherapy drugs, radiation) you may be receiving. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During treatment with this medication, you must drink more fluids than usual and pass urine frequently to help avoid kidney and bladder side effects. Ask your doctor how much you should drink and how often to empty your bladder each day, and follow these instructions carefully.Swallow the tablets/capsules whole. Do not chew or crush the tablets/capsules. Do not open the capsules. If you have accidental contact with broken tablets/capsules, wash your hands thoroughly right away.Since this drug can be absorbed through the skin and lungs and may harm an unborn baby, women who are pregnant or who may become pregnant should not handle this medication or breathe dust from the tablets or capsules.Do not increase your dose or take this medication more often without your doctor's approval. Your condition will not improve any faster and the risk of serious side effects may be increased.

              SIDE EFFECTS: Nausea, vomiting, loss of appetite, stomach ache, diarrhea, or darkening of the skin/nails may occur. Nausea and vomiting can be severe. In some cases, drug therapy may be necessary to prevent or relieve nausea and vomiting. Changes in diet such as eating several small meals or limiting activity may help lessen some of these effects. If these effects last or get worse, notify your doctor or pharmacist promptly.Temporary hair loss may occur. Hair growth should return after treatment has ended or may even return during treatment. However, new hair may have a different color or texture.People using this medication may have serious side effects. However, you have been prescribed this drug because your doctor has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.Tell your doctor right away if you have any serious side effects, including: signs of kidney or bladder problems (such as change in the amount of urine, pink/bloody urine), mouth sores, joint pain, stopping of menstrual periods, existing wounds that are slow healing, black/bloody stools, severe stomach/abdominal pain, yellowing eyes or skin, dark urine, mental/mood changes, muscle weakness/spasm.This medication may rarely cause very serious effects on the heart, especially when used in high doses, or in combination with radiation treatment or certain other chemotherapy drugs (such as doxorubicin). Get medical help right away if you develop: chest pain, jaw/left arm pain, trouble breathing, irregular heartbeat, symptoms of heart failure (such as shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain).This medication decreases bone marrow function, an effect that may lead to a low number of blood cells such as red cells, white cells, and platelets. This effect can cause anemia, decrease your body's ability to fight an infection, or cause easy bruising/bleeding. Tell your doctor right away if you develop any of the following symptoms: unusual tiredness, pale skin, signs of infection (such as sore throat that doesn't go away, fever, chills), easy bruising/bleeding.Cyclophosphamide may lessen the chance of having children in both men and women. Sterility is usually temporary with this medication, but can be permanent in some cases. Consult your doctor for more details.Although cyclophosphamide is used to treat cancer, in some patients it may increase the risk of developing another form of cancer, sometimes months to years after treatment. Consult your doctor for more details. It is important to be closely monitored by your doctor during treatment. You should also see your doctor regularly after treatment is finished. Tell your doctor right away if you develop: unusual growths or lumps, swollen glands, unexplained or sudden weight loss, night sweats, pain in the pelvis, painful or frequent urination.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking cyclophosphamide, tell your doctor or pharmacist if you are allergic to it; or to other chemotherapy drugs (such as busulfan, chlorambucil); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: decreased bone marrow function (such as anemia, leukopenia, thrombocytopenia), liver disease, kidney disease, difficulty urinating (for example, due to blockage), surgery to remove your adrenal glands.Cyclophosphamide can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Consult your doctor if you have been exposed to an infection or for more details.Tell your health care professional that you are using cyclophosphamide before having any immunizations/vaccinations. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Children may be more sensitive to the side effects of this drug, especially possible infertility later in life.Since this drug can be absorbed through the skin and lungs and may harm an unborn baby, women who are pregnant or who may become pregnant should not handle this medication or breathe dust from the tablets or capsules.Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using cyclophosphamide. Cyclophosphamide may harm an unborn baby. Your doctor should order a pregnancy test before you start this medication. Women should ask about reliable forms of birth control while using this medication and for 1 year after stopping treatment. Men with female partners of childbearing age should ask about reliable forms of birth control while using this medication and for 4 months after stopping treatment. If you or your partner become pregnant, talk to your doctor right away about the risks and benefits of this medication.This drug passes into breast milk and may harm a nursing infant. Breast-feeding is not recommended while using this drug and for 1 week after stopping treatment. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: allopurinol, chloramphenicol, chloroquine, digoxin, phenobarbital, phenothiazines, primidone, St John's wort, turmeric (curcumin), voclosporin.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Do not share this medication with others.Lab and/or medical tests (such as complete blood counts, urine tests) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

              MISSED DOSE: It is important to take each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Refrigerate the oral solution. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

              Information last revised December 2022. Copyright(c) 2023 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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              • View the formulary and any restrictions for each plan.
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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.