시클로포스파미드

항종양제 / 면역억제제 (알킬화제)

시클로포스파미드는 개와 고양이의 수의학에서 널리 사용되는 강력한 **항종양제** 및 **면역억제제**입니다. * **항종양 용도**: 림프종, 백혈병, 암종 및 육종의 병용 요법에 사용됩니다. 육종 재발을 예방하기 위해 저용량 메트로놈(지속적) 요법도 활용됩니다. * **면역억제 용도**: 전신 홍반성 루푸스(SLE), 면역 매개성 혈소판 감소증(ITP), 면역 매개성 용혈성 빈혈(IMHA) 및 천포창과 같은 중증 면역 매개성 질환에 사용됩니다.

작용 기전: Cyclophosphamide is a prodrug that is metabolized in the liver by **cytochrome P450** enzymes into active metabolites, primarily **phosphoramide mustard** and **acrolein**. **Phosphoramide mustard** → acts as an alkylating agent → forms cross-links within and between DNA strands → interferes with DNA replication and RNA transcription → triggers apoptosis and cell death. **Acrolein** is a toxic byproduct that concentrates in the urinary bladder and is responsible for sterile hemorrhagic cystitis. The drug also profoundly suppresses B-cell and T-cell function, leading to its immunosuppressive effects.

동물 종별 용량

Cats

Immunosuppressant (ITP or IMHA) · 50 mg/m2 PO every 2nd day · PO · q48h · Ongoing · Author prefers cyclosporine or chlorambucil in cats.
To slow progression of FIP · 2-4 mg/kg PO four times a week · PO · 4 times/week · Ongoing

Sheep

Chemical shearing agent · Historical use · PO/IV · Single · Single · Historical use only.

Horses

Neoplastic diseases · 200 mg/m2 (usually 1 gram per horse per dose) IV every 1-2 weeks · IV · q1-2 weeks · Protocol dependent · Consult veterinary oncologist.

SmallMammals

Antineoplastic (lymphoma) in rabbits · 50 mg/m2 PO daily for 3 days each week OR 100-200 mg/m2 IV every 7 days · PO/IV · Varies · Protocol dependent · Consider fully implantable vascular access device for IV.

Dogs

To inhibit local recurrence in dogs with incompletely resected soft tissue sarcomas · 10 mg/m2 PO once daily with piroxicam at 0.3 mg/kg PO once daily · PO · q24h · Continuous (metronomic) · If unacceptable adverse effects develop, increase interval to every other day.
Antineoplastic · 50 mg/m2 PO 4 days/week OR 250 mg/m2 PO once every 3 weeks OR 100-300 mg/m2 IV weekly · PO/IV · Varies · Protocol dependent · Consult veterinary oncologist.

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

POIV

금기

Prior anaphylactic reactions to the drug
Severe pre-existing myelosuppression (leukopenia, thrombocytopenia)
Active infections where immunosuppression may be dangerous
No specific contraindications available in the monograph, but clinically contraindicated in patients with severe pre-existing myelosuppression or active haemorrhagic cystitis.
Pre-existing severe myelosuppression
Active haemorrhagic cystitis

이상반응

Myelosuppression (leukopenia, thrombocytopenia, anemia)
Gastroenterocolitis (anorexia, nausea, vomiting, diarrhea)
Sterile hemorrhagic cystitis (induced by acrolein metabolite)
Alopecia (especially in continuously growing coats like Poodles and Old English Sheepdogs)
Pulmonary infiltrates and fibrosis
Hyponatremia
Secondary leukemia
Myelosuppression (nadir usually 5-14 days post-therapy)
Sterile haemorrhagic cystitis (caused by acrolein metabolite)
Bladder fibrosis
Transitional cell carcinoma (secondary to chronic cystitis)
Vomiting
Diarrhoea
Hepatotoxicity
Nephrotoxicity

약물 상호작용

Allopurinol · May increase the myelosuppression caused by cyclophosphamide
Doxorubicin · Potentiation of cardiotoxicity may occur · major
Chloramphenicol · May inhibit cyclophosphamide metabolism · moderate
Phenobarbital · May increase the rate of metabolism to active metabolites, increasing toxicity risk
Thiazide Diuretics · May increase the myelosuppression caused by cyclophosphamide · major
Succinylcholine · Metabolism may be slowed, prolonging effects due to decreased pseudocholinesterases
Digoxin · Absorption of orally administered digoxin may be decreased (may occur several days after dosing) · moderate
Barbiturates · Increase cyclophosphamide toxicity due to increased rate of conversion to metabolites · major
Phenothiazines · Reduce cyclophosphamide efficacy · moderate
Ondansetron · Reduce cyclophosphamide efficacy · moderate
Insulin · Insulin requirements are altered by concurrent cyclophosphamide · moderate
cimetidine · Inhibits hepatic cytochrome P450 enzyme pathway, potentially altering the metabolism and increasing toxicity of chemotherapeutics. · major

모니터링

Efficacy (tumor response or remission of immune-mediated disease)
Complete Blood Count (CBC) regularly for myelosuppression (nadir typically 7-14 days)
Urinalysis regularly for signs of sterile hemorrhagic cystitis (hematuria)
Uric acid levels (blood and urine)
White Blood Cell (WBC) count (regular monitoring recommended due to myelosuppression)
Urinalysis (monitor for haematuria indicating sterile haemorrhagic cystitis)
Renal and hepatic function panels
Free-catch urine by dipstick prior to and each week of treatment
Haematology
Biochemistry (prior to first treatment and minimum every 6 months)

과용량

Limited information on acute overdoses. The lethal dose in dogs is reported as **40 mg/kg IV**. If an oral overdose occurs, perform gut emptying (emesis/lavage) if indicated and hospitalize the animal for aggressive supportive care, including IV fluids to flush the bladder and prevent hemorrhagic cystitis.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.