Intravenous and oral cyclophosphamide pulse therapy in rheumatic diseases: side effects and complications

Twenty five patients (12 with systemic lupus erythematosus, 6 with Wegener's granulomatosis, and 7 with miscellaneous rheumatic diseases) who had been on intravenous or oral cyclophosphamide pulse therapy for more than 3 months were evaluated for safety of treatment. Side effects were reported by 20 patients (80%), mainly nausea (17 patients, 68%). Complications were observed in 13 patients (52%), of whom 6 had severe infections (24%). Oral cyclophosphamide given in repeated low dose pulses (5 mg/kg for 3 consecutive days) is better tolerated with regard to nausea than intravenous administration. The use of cyclophosphamide therapy is recommended in patients with disease that does not respond to conventional regimens, although the attending physician should be aware that infections may appear at any time during treatment, and effective prophylaxis against nausea is required.