THE USUAL DOSE :- 2-3 MG/KG/DAY ORAL, OR 12-15 MG/KG BODY WT. I.V. EVERY 7-10 DAYS.
THE DOSAGE GIVEN MAY VARY CONSIDERABLY DEPENDING ON THE DISEASE BEING TREATED, THE CONDITION OF THE PATIENT INCLUDING THE STATE OF THE BONE MARROW, AND USE WITH RADIOTHERAPY OR OTHER CHEMOTHERAPY. THE WHITE CELL COUNT IS USUALLY USED TO GUIDE THE DOSE.
IN THE UK, EXAMPLES OF LICENSED REGIMENS ARE:
LOW-DOSE: CYCLOPHOSPHAMIDE 2 TO 6 MG/KG WEEKLY AS A SINGLE INTRAVENOUS DOSE OR IN DIVIDED DOSES BY MOUTH
MODERATE-DOSE: 10 TO 15 MG/KG WEEKLY AS A SINGLE INTRAVENOUS DOSE.
HIGH-DOSE: 20 TO 40 MG/KG AS A SINGLE INTRAVENOUS DOSE EVERY 10 TO 20 DAYS, ALTHOUGH HIGHER DOSES HAVE BEEN USED
ALTERNATIVE REGIMENS INCLUDE:
100 TO 300 MG DAILY IN DIVIDED DOSES BY MOUTH
80 TO 300 MG/M2 DAILY AS A SINGLE INTRAVENOUS DOSE
300 TO 600 MG/M2 WEEKLY AS A SINGLE INTRAVENOUS DOSE
600 TO 1500 MG/M2 AS A SINGLE INTRAVENOUS DOSE OR SHORT INFUSION AT 10 TO 20 DAY INTERVALS
THE USE OF MESNA IS GENERALLY RECOMMENDED WITH SINGLE DOSES OF CYCLOPHOSPHAMIDE OVER 2 G, BUT ONE MANUFACTURER SUGGESTS ITS USE WITH DOSES AS LOW AS 10 MG/KG.
IN THE USA, AN INITIAL DOSE OF 40 TO 50 MG/KG HAS BEEN LICENSED FOR SINGLE AGENT THERAPY OF MALIGNANCY, GIVEN INTRAVENOUSLY IN DIVIDED DOSES OVER 2 TO 5 DAYS ALTHOUGH IN PRACTICE TREATMENT OF MALIGNANCY WILL GENERALLY BE WITH COMBINATION REGIMENS. OTHER LICENSED REGIMENS INCLUDE:
3 TO 5 MG/KG TWICE WEEKLY INTRAVENOUSLY
10 TO 15 MG/KG EVERY 7 TO 10 DAYS INTRAVENOUSLY
1 TO 5 MG/KG DAILY ORALLY
A DAILY ORAL DOSE OF 2 TO 3 MG/KG HAS BEEN USED IN CHILDREN WITH MINIMAL CHANGE NEPHROPATHY LEADING TO THE NEPHROTIC SYNDROME, IN WHOM CORTICOSTEROIDS HAVE BEEN UNSUCCESSFUL.
IN PATIENTS WHO ARE TO UNDERGO BONE MARROW TRANSPLANTATION VERY HIGH DOSES OF CYCLOPHOSPHAMIDE SUCH AS 60 MG/KG DAILY FOR 2 DAYS MAY BE GIVEN AS PART OF THE CONDITIONING REGIMEN.