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Immunosuppressive drugs such as cytoxan cyclophosphamide and imuran azathioprine may be added if the inflammation is not completely controlled with corticosteroids.

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Increased hematotoxicity and/or immunosuppression may result from a combined effect of cyclophosphamide andfor exampleACE inhibitorsACE inhibitors can cause leukopeniaNatalizumab PaclitaxelIncreased hematotoxicity has been reported when cyclophosphamide was administered after paclitaxel infusionThiazide diuretics Zidovudine Increased cardiotoxicity may result from a combined effect of cyclophosphamide andfor exampleAnthracyclines Cytarabine Pentostatin Radiation therapy of the cardiac region Trastuzumab Increased pulmonary toxicity may result from a combined effect of cyclophosphamide andfor exampleAmiodarone G-CSFGM-CSFgranulocyte colony-stimulating factorgranulocytemacrophagecolony-stimulating factorReports suggest an increased risk of pulmonary toxicity in patients treated with cytotoxic chemotherapy that includes cyclophosphamide and G-CSF or GMCSFIncreased nephrotoxicity may result from a combined effect of cyclophosphamide andfor exampleAmphotericin B IndomethacinAcute water intoxication has been reported with concomitant use of indomethacin Increase in other toxicitiesAzathioprineIncreased risk of hepatotoxicityliver necrosisBusulfanIncreased incidence of hepatic veno-occlusive disease and mucositis has been reportedProtease inhibitorsIncreased incidence of mucositis Increased risk of hemorrhagic cystitis may result from a combined effect of cyclophosphamide and past or concomitant radiation treatment.

The following adverse reactions are discussed in more detail in other sections of the labeling.

When cyclophosphamide is included in combined cytotoxic regimensit may be necessary to reduce the dose of cyclophosphamide as well as that of the other drugs.

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What are possible late side effects of treatment with cyclophosphamideWith the use of this drugthere is risk of developing side effects months or years after treatment has been completedIn rare instancesa secondary malignancy may occur as a result of receiving this drugA secondary malignancy is a new and unrelated cancer that occurs in an individual as a result of previous treatment with radiation or chemotherapyPatients should ask their physician about the possibility of developing a secondary malignancy as a result of their treatment.

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