Endoxan

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What Is Endoxan?

Endoxan is an oral tablet from Baxter containing cyclophosphamide 50 mg. Cyclophosphamide is a prodrug alkylating cytotoxic agent (nitrogen mustard family). It is metabolised in the liver to active 4-hydroxycyclophosphamide and the toxic metabolite acrolein. Used in many haematological cancers, solid tumours and severe autoimmune diseases.

Uses and Indications

• Haematological: chronic lymphocytic leukaemia, low-grade non-Hodgkin lymphoma, multiple myeloma, Waldenström macroglobulinaemia, conditioning before stem cell transplant
• Solid tumours: breast cancer (CMF, AC regimens), small-cell lung cancer, ovarian cancer, neuroblastoma, sarcoma (high-dose IV)
• Severe autoimmune disease: lupus nephritis, ANCA-associated vasculitis (granulomatosis with polyangiitis, microscopic polyangiitis), refractory rheumatoid arthritis
• Off-label: nephrotic syndrome (steroid-resistant), pemphigus vulgaris

Dosage and How to Take

Oral regimens vary by indication; specialist prescribing only. Examples for adults:

• Low-dose continuous oral: 1–3 mg/kg/day
• Pulsed oral cyclophosphamide for vasculitis: 50–200 mg/day

1. Take in the morning with plenty of fluid — aim for at least 3 L of fluid intake per day during active dosing to flush the bladder of acrolein and reduce haemorrhagic cystitis risk.
2. Empty bladder frequently. Consider mesna prophylaxis at higher cumulative dose under specialist guidance.
3. Take with food if nausea occurs. Antiemetic (ondansetron) 1 hour before if needed.
4. Swallow tablets whole. Do NOT crush. Caregivers handling tablets should wash hands.
5. Mandatory monitoring: FBC every 1–2 weeks; urinalysis monthly (haematuria); LFTs monthly; baseline + ongoing renal function.
6. Fertility preservation: discuss before starting in reproductive-age patients. Cyclophosphamide is gonadotoxic — sperm banking, oocyte / embryo cryopreservation, or GnRH-agonist ovarian protection should be offered.

Side Effects

Common: nausea, vomiting (preventable with antiemetics), alopecia, anorexia, mucositis, fatigue.

Important:

• Myelosuppression — nadir at 7–10 days; full recovery by day 21
• Haemorrhagic cystitis — from acrolein bladder toxicity; prevent with high fluid intake (3 L/day) and frequent bladder emptying; mesna for high-dose regimens
• Permanent infertility — gonadotoxic; sperm banking and oocyte preservation should be offered before starting in reproductive-age patients
• Bladder cancer (long-term, dose-related)
• Secondary leukaemia / myelodysplastic syndrome
• Cardiotoxicity (mostly high-dose IV regimens)
• Pulmonary fibrosis (rare)
• SIADH and water intoxication (high-dose IV)

Warnings

• Pregnancy: teratogenic and abortifacient. Strict contraception throughout treatment + 12 months after for women, 6 months for men.
• Breastfeeding: contraindicated.
• Severe hepatic or renal impairment: reduce dose, specialist guidance.
• Live vaccines: contraindicated.
• Active urinary tract infection: treat before starting.
• Caregivers: wear gloves when handling tablets or contaminated body fluids; wash exposed skin immediately.

Drug Interactions

Storage

• Room temperature, 15–25°C, original blister.
• Out of reach of children, women of childbearing potential, pets.
• Caregivers wear gloves when handling.

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Frequently Asked Questions

Why do I need so much fluid on Endoxan?

Cyclophosphamide produces a toxic metabolite called acrolein that concentrates in the bladder and causes haemorrhagic cystitis — bleeding from the bladder wall. Aggressive hydration (at least 3 L of fluid per day during active dosing) flushes acrolein out before it damages the bladder. Empty your bladder frequently and avoid holding urine overnight if possible. For higher-dose regimens, mesna (a thiol drug that neutralises acrolein) is prescribed.

Will Endoxan make me infertile?

Yes — cyclophosphamide is gonadotoxic and may cause permanent infertility, especially with cumulative doses > 5–7 g/m² and in older reproductive-age patients. Fertility preservation should be offered before starting in any reproductive-age patient: sperm banking (men), oocyte or embryo cryopreservation (women), or GnRH-agonist ovarian protection during treatment. Discuss with the oncologist before the first dose.

What blood tests do I need?

Mandatory: FBC every 1–2 weeks (nadir at days 7–10, recovery by day 21); urinalysis monthly (haematuria detection); LFTs monthly; baseline + ongoing renal function. Inform your specialist of any blood in urine, fever, mouth ulcers, or unusual bleeding.

Why is bladder cancer a long-term risk?

Long-term cyclophosphamide exposure increases bladder cancer risk, dose-related and cumulative-dose-related. After a course of cyclophosphamide, regular urinalysis (at least annually) for haematuria is reasonable; cystoscopy if persistent haematuria. Stop smoking — smoking compounds the bladder cancer risk dramatically.

Can I get pregnant on Endoxan?

No — cyclophosphamide is teratogenic and abortifacient. Reliable contraception throughout treatment AND for at least 12 months after the last dose (women) or 6 months (men). Discuss family planning with your specialist; consider fertility preservation before starting.

Can I have live vaccines?

No — live vaccines (MMR, yellow fever, BCG, oral polio, varicella) contraindicated during cyclophosphamide and for 3–6 months after stopping. Inactivated vaccines (annual flu, pneumococcal, COVID-19) are not only safe but recommended.

What infections should I watch for?

Cyclophosphamide-induced lymphopenia raises risk of opportunistic infections. Seek same-day care for any fever > 38°C, persistent cough, breathlessness, severe diarrhoea, or new rash. PCP prophylaxis (co-trimoxazole) may be prescribed at higher doses or in transplant settings.

Caregivers handling Endoxan — any precautions?

Yes — cyclophosphamide tablets and patient body fluids (urine, vomit) for the first 48 hours after a dose contain cytotoxic compounds. Caregivers should wear gloves when handling tablets, contaminated linen, or body fluids; wash hands afterwards; double-flush the toilet. Pregnant caregivers should avoid handling cyclophosphamide entirely.

Why order from MedsBase

Every batch is sourced from a WHO-GMP certified manufacturer. Orders are dispatched in plain, unbranded packaging from our fulfilment partners and covered by our Reshipment Assurance Policy: if a parcel does not arrive within 20 business days we send a free reshipment, no questions asked.

Related Anti-Cancer Medications

Other oncology medications stocked alongside this product:

• Celkeran (chlorambucil 2 mg)
• Lomoother (lomustine 40 mg)
• Folitrax (methotrexate 2.5/7.5/10 mg)
• Imutrex (methotrexate 2.5/7.5/10 mg)
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