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cyclophosphamide IV

cyclophosphamide IV

Drug Name	Form	Strength	Non-Formulary	Restricted	TX Sub	Notes
Cytoxan Lyophilized	INJECTION, INJECTABLE	500 mg, 1,000 mg

Display Antineoplastic Agents, Immunosuppressive Agents Class : 100000, 924400

High Alert Drug : Policy

Medication comments:

High Alert Drug: Chemotherapeutic Agents - Parenteral
• Stored separately in pharmacy. • Pharmacist reviews literature in order to to verify calculations and dose prescribed. • Two pharmacists independently verify preparation. • No telephone orders. Pre-printed order sheet available. • Chemo is administered by specially trained RNs. • 2 RNs independently verify pump settings and drug on continuous infusions prior to administration. • IV sites are assessed every 2 hours. • Drugs are transported in plastic bags/designated transport containers labeled with sticker indicating CHEMOTHERAPY DRUG.

High Alert Drug: Chemotherapeutic Agents - Parenteral

• Stored separately in pharmacy.
• Pharmacist reviews literature in order to to verify calculations and dose prescribed.
• Two pharmacists independently verify preparation.
• No telephone orders. Pre-printed order sheet available.
• Chemo is administered by specially trained RNs.
• 2 RNs independently verify pump settings and drug on continuous infusions prior to administration.
• IV sites are assessed every 2 hours.
• Drugs are transported in plastic bags/designated transport containers labeled with sticker indicating CHEMOTHERAPY DRUG.

Per policy, these medications require cardiac and/or special monitoring. (KEY: "Y" = may be given as described on chart. "N" = may NOT be given except in Rapid Response/Code Blue situations or as otherwise described in Exceptions section of Policy.
generic (Brand) / Notes	CCU, OR, PACU, CCL, ED	PCU	2N (Tele)	1N (Tele), 3N (Tele)	Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N)	BirthPlace	SNF	ICS	OPS
cytotoxic agents (chemotherapy) IV Push, IV Infusion (chemotherapy) Key: certified RN and 1N designated staff only	Y (CCU only)	N	N	Y (1N only)	Y (1N only)	N	N	Y	N

Per policy, these hazardous drugs have special waste requirements.
Generic (Brand)	Waste Requirements
cyclophosphamide (Cytoxan)	If > 3% by weight of drug remains ⇒ BLACK BUCKET Trace amounts/uncontaminated PPE ⇒ YELLOW BUCKET

USP <800> Hazardous Drugs
Per Policy, these drugs have special handling requirements (any drug with an "AOR" is exempt from these requirements under normal circumstances).
generic (Brand) Route	Relative Risk Level	AOR?	NIOSH 2024 Table	MSHI?^↑	Warnings
cyclophosphamide (Cytoxan) IV	Highest	N/A	1A^↑	Yes	IARC‑1^↑ NTP‑1^↑
NIOSH Supplemental information (2016): N/A FDA Pregancy Category D: There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks;

Adult Extravasation Management
cyclophosphamide (Cytoxan)

Agent type:	Chemotherapeutic
Vesicant/Irritant:	Irritant
Local Care:	Cold compress
Antidote:	Sodium thiosulfate 1/6 M (4%)
Antidote link(s):
Comments:	• Administer 5 mL subcutaneously into the extravasation site.

Last updated: Jun. 18, 2025

Hazard.Drug Handling(USP 800) USP<800> Hazardous Drug
Hazardous Waste BLACK BUCKET/YELLOW BUCKET
Chemotherapy

UpToDate Lexidrug

Pharmacy Contact Info:

Main Inpatient Pharmacy: ext 4599, 3503
Fax: 704-878-7283

Director of Pharmacy - Randi Raynor, PharmD: ext 4501
Clinical Coordinator - Laura Rollings, PharmD: ext 4597
Pharmacy Informaticist - Stephen Pringle, PharmD: ext 7645
Pharmacy Technician Supervisor - Amy Wingler, CPhT: ext 7385
Pharmacy Automation Coordinator (Omnicell) - Melissa Fulford, CPhT: ext 3556

This site is intended for the staff of Iredell Health System. While others may view accessible pages, Iredell Health System makes no warranty, express or implied, as to the use of this information outside of Iredell Health System. The content of this policy and procedure document serves as guidance to the delivery of quality patient care. Care providers are expected to exercise critical thinking and situational awareness skills, and in specific situations to take such action as is necessary for the delivery of quality patient care.