시클로포스파미드
Cyclophosphamide
N,N-bis(2-chloroethyl)-1,3,2-oxazaphosphinan-2-amine 2-oxide
다른 이름: Cytoxan · Neosar · Procytox · Endoxana · CPM · CTX · B-518 · ciclofosfamida · cyclophosphamidum · cyclophosphanum · NSC-26271 · WR-138719 · Cytophosphane
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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) | 🌎 NA |
| 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 | 🌎 NA |
| Immunosuppressant (IMHA/ITP) | 50 mg/m2 PO every 2nd day | PO | q48h | Adjust to manage side effects | 🌎 NA |
| Immunosuppressant (IMHA pulse therapy) | 50 mg/m2 PO daily for 4 days on, 3 days off | PO | Pulse | Ongoing | 🌎 NA |
| Polyarthritis | 1.5 mg/kg (>30 kg), 2 mg/kg (15-30 kg), 2.5 mg/kg (<15 kg) PO daily on 4 consecutive days each week | PO | 4 days/week | 2-4 months (max 4 months) | 🌎 NA |
| Glomerulonephritis | 2.2 mg/kg PO q24h for 4 days, discontinue for 3 days and then repeat | PO | Pulse | Ongoing | 🌎 NA |
| Lymphoma (COP low dose protocol - Induction) | 50 mg/m2 | PO | alternate days OR first 4 days of each week | First 2 months | 🌍 EU |
| Lymphoma (COP low dose protocol - Maintenance after 2 months) | 50 mg/m2 | PO | alternate days OR first 4 days of each second week | Months 2 to 6 | 🌍 EU |
| Lymphoma (COP low dose protocol - Maintenance after 6 months) | 50 mg/m2 | PO | q48h (one week in three) OR first 4 days of each third week | Months 6 to 12 | 🌍 EU |
- To inhibit local recurrence in dogs with incompletely resected soft tissue sarcomas: If unacceptable adverse effects develop, increase interval to every other day.
- Antineoplastic: Consult veterinary oncologist.
- Immunosuppressant (IMHA/ITP): Used with glucocorticoids.
- Immunosuppressant (IMHA pulse therapy): Alternatively 50 mg/m2 PO every other day.
- Polyarthritis: Given with prednisolone.
- Lymphoma (COP low dose protocol - Induction): Co-administer with 1 mg/kg furosemide q12h on treatment days to reduce cystitis risk.
- Lymphoma (COP low dose protocol - Maintenance after 2 months): Alternate-week therapy.
- Lymphoma (COP low dose protocol - Maintenance after 6 months): Stop and monitor for relapse after 12 months.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Immunosuppressant (ITP or IMHA) | 50 mg/m2 PO every 2nd day | PO | q48h | Ongoing | 🌎 NA |
| To slow progression of FIP | 2-4 mg/kg PO four times a week | PO | 4 times/week | Ongoing | 🌎 NA |
- Immunosuppressant (ITP or IMHA): Author prefers cyclosporine or chlorambucil in cats.
소형 포유류
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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 | 🌎 NA |
- Antineoplastic (lymphoma) in rabbits: Consider fully implantable vascular access device for IV.
말
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Neoplastic diseases | 200 mg/m2 (usually 1 gram per horse per dose) IV every 1-2 weeks | IV | q1-2 weeks | Protocol dependent | 🌎 NA |
- Neoplastic diseases: Consult veterinary oncologist.
양
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Chemical shearing agent | Historical use | PO/IV | Single | Single | 🌎 NA |
- Chemical shearing agent: Historical use only.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
시클로포스파미드는 개와 고양이의 수의학에서 널리 사용되는 강력한 항종양제 및 면역억제제입니다.
- 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.
안전성·주의사항
금기사항
- 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
부작용
- 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)
- Diarrhoea
- Hepatotoxicity
- Nephrotoxicity
- Reduction in hair growth rate / Alopecia
- Gastrointestinal toxicity
주의
WARNING: Cyclophosphamide is potentially teratogenic and embryotoxic. Safe use in pregnancy is not established.
- Hemorrhagic Cystitis: Up to 30% of dogs on long-term therapy may develop sterile hemorrhagic cystitis. Encourage frequent urination and water intake. Co-administration of furosemide may reduce risk.
- Myelosuppression: Monitor CBC closely. Delay doses if severe leukopenia or thrombocytopenia occurs.
- Handling: Cytotoxic precautions must be taken. Do not split or crush tablets. Avoid direct contact with urine or feces of treated animals.
약물 상호작용
May increase the myelosuppression caused by cyclophosphamide
Potentiation of cardiotoxicity may occur
May inhibit cyclophosphamide metabolism
May increase the rate of metabolism to active metabolites, increasing toxicity risk
May increase the myelosuppression caused by cyclophosphamide
Metabolism may be slowed, prolonging effects due to decreased pseudocholinesterases
Absorption of orally administered digoxin may be decreased (may occur several days after dosing)
Increase cyclophosphamide toxicity due to increased rate of conversion to metabolites
Reduce cyclophosphamide efficacy
Reduce cyclophosphamide efficacy
Insulin requirements are altered by concurrent cyclophosphamide
Inhibits hepatic cytochrome P450 enzyme pathway, potentially altering the metabolism and increasing toxicity of chemotherapeutics.
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)
약동학
반감기
흡수
Well absorbed after oral administration with peak levels occurring about 1 hour after dosing.
분포
Distributed throughout the body, including CSF (subtherapeutic levels). Minimally protein bound. Distributes into milk and crosses the placenta.
대사
Metabolized in the liver to several active and inactive metabolites (including phosphoramide mustard and acrolein).
배설
Majority of the drug is excreted as metabolites and unchanged drug in the urine.
과다투여
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.
제품
제형
- Oral tablets
- Powder for injection
- Compounded oral elixir/suspension
- Injectable: 100 mg, 200 mg, 500 mg, 1000 mg powder for reconstitution
- Oral: 50 mg tablets
인용의약품
- Cyclophosphamide Tablets: 25 mg & 50 mg
- Cyclophosphamide Powder for Solution for Injection: 500 mg, 1 g and 2 g
- Endoxana 50 mg tablets
- Endoxana 100 mg, 200 mg, 500 mg, 1000 mg powder for reconstitution
규제 현황
Often requires compounding by specialized pharmacies (e.g., ChemoPet) for accurate veterinary dosing.
Often requires compounding by specialized pharmacies (e.g., ChemoPet) for accurate veterinary dosing.
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Store tablets and powder for injection at <25°C (brief excursions up to 30°C permitted). Store tablets in tight containers. Reconstituted injection is stable for 24 hours at room temperature or 6 days refrigerated. Compounded oral elixir is stable for 14 days refrigerated.
보호자 정보
중요 안전 경고: 이것은 강력한 항암제입니다. 모든 취급 지침을 주의 깊게 따르십시오.
- 취급: 알약을 쪼개거나 부수지 마십시오. 취급 후에는 손을 철저히 씻으십시오. 반려동물이 이 약을 복용하는 동안 소변, 대변 또는 구토물에 직접 접촉하지 마십시오.
- 배뇨: 특히 아침에 배뇨를 유도하기 위해 반려견을 자주 산책시키십시오. 이는 방광 자극을 예방하는 데 도움이 됩니다.
- 수의사에게 연락해야 할 때: 혈뇨, 배뇨 곤란, 비정상적인 출혈, 멍, 심한 무기력, 구토 또는 설사를 발견하면 즉시 수의사에게 연락하십시오.
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