Adjusting oral cyclophosphamide dose for adult patients with kidney function impairment
Adjusting oral cyclophosphamide dose for adult patients with kidney function impairment
Creatinine clearance* (mL/minute)
Cyclophosphamide (CYC) oral dose (mg/kg/day)¶
>100
2
50 to 99
1.5
25 to 49
1.2
15 to 24
1
<15 or dialysisΔ
0.8
Initial 2 mg/kg per day dose and adjustments for kidney function impairment are for daily oral administration of "low-dose" cyclophosphamide therapy in rheumatic diseases. For approach, other dose adjustments that may be needed, and duration of therapy, refer to UpToDate topics on the use of cyclophosphamide in rheumatic diseases.
CYC: cyclophosphamde; Clcr: creatinine clearance. * Can be estimated by using the Cockroft-Gault equation. Clcr = [140-age] * weight (kg)/serum Cr in mg/dL * 72. Multiply result by 0.85 for women. Separate calculators for creatinine clearance using conventional and SI units are available in UpToDate. ¶ Usual maximum daily dose is 200 mg. For patients who are overweight or obese, an estimate of ideal or lean body weight is used for estimating Clcr and determining daily CYC weight-based dose. Calculators are available in UpToDate. Δ CYC is variably dialyzable (approximately 20 to 50 percent). Dose may require further adjustment depending upon type of dialysis. For intermittent hemodialysis, give dose after session on dialysis days.
