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Musculoskeletal Services

Methylprednisolone and Cyclophosphamide

This information sheet is offered as a guide to you and your family offering background information on this treatment. Your treatment will be fully explained by your doctor or nurse, who will be happy to answer any questions.

Who can benefit?

Patients with a severe flare up e.g. inflammation of the lungs, or kidney, or significant worsening of their connective tissue disease e.g. Systemic Lupus Erythmatosus (SLE, Lupus), Scleroderma, Vasculitis and Polymyositis. We are aiming to prevent long- term damage.

Treatment
Your doctor has suggested that you may benefit from a course of methylprednisolone and cyclophosphamide pulses. These drugs are given by a drip into a vein in your arm. You will attend ward 20 day unit for this treatment.

What are Methylprednisolone and Cyclophosphamide?

Both drugs are used to ‘dampen down’ the immune system. Methylprednisolone is a strong long-acting steroid. Cyclophosphamide is also sometimes used in cancer treatment but in much higher doses than those that you will receive.

How is it given?

The two drugs are given separately into the vein. This is called a ‘pulse’ and each infusion takes one hour. The complete treatment will take 4-6 hours. The nurse in the day unit will monitor your pulse and blood pressure. The ‘pulses’ are usually given at 3-4 weekly intervals as decided by your consultant. You may also need to continue taking steroid tablets whilst receiving your treatment.

Your consultant will keep the dose of steroids under review.

Before receiving each pulse you will need a blood test to check your blood count to screen for infection. This can be performed:
 

  • By your GP
  • On the day before your treatment in the musculo-skeletal unit
  • On the day of your treatment

You can decide which of the above options is the most convenient for you. We will need to know the result of the blood tests before starting the ’pulse’. We will also check your blood count ten days after your first three ‘pulses’ to check for any side effects.

The methylprednisolone may give you some initial improvement in your symptoms but it often takes 3-4 ‘pulses’ before a patient notices the benefit of the cyclophosphamide. You will initially need six ‘pulses’ and then your consultant will assess your response to treatment. You might need further ‘pulses’ or you may be switched to a tablet to keep your disease under control.

What are the side effects?

As each patient is an individual, your experience may be different to other patients receiving this treatment. Common side affects you may experience are:

  • Fatigue Many people feel tired and have low energy levels for a few days after treatment. There is little you can do to avoid this but research has shown that patients who suffer fatigue need to take gentle exercise and rest often. This feeling of fatigue is quite normal and energy levels should begin to improve a few days after treatment.
  • Nausea and Vomiting The severity of any nausea and vomiting will vary from person to person and is caused by the cyclophosphamide. To prevent this you will be given an anti-sickness drug  before receiving your treatment and some tablets to take home with you.
  • Inflammation of the bladder To prevent inflammation of the bladder, which may occur with cyclophosphamide, you will be given additional fluid by a drip over four hours and asked to drink plenty of fluids for the next 24 hours. We suggest that you drink approximately three litres of fluid on the day of your infusion. You will also be given a drug called mesna, which reduces the chance of bladder inflammation. You will take three tablets. The nurse will explain when to take these tablets.
  • Extravasation It is very important that the needle through which you are going to receive your drugs is placed in a good vein. If the needle moves from the vein an ‘extravasation’ could occur. This is when chemotherapy is administered outside the vein causing damage to the surrounding tissues. This happens very rarely. The signs of extravasation are pain around the needle, redness or swelling. Your nurse will of course be looking for any signs of extravasation throughout the time of your treatment but it is important that you inform your nurse if problems arise during the infusion.

Pregnancy, Family Planning and Fertility

It is important that you continue to use contraceptives while you are having treatment as cyclophosphamide may harm a developing baby. Please inform your consultant or nurse if your period is late and you think you may be pregnant.

If you are planning to have a family in the future please tell your doctor as cyclophosphamide can make some people infertile. Infertility may be permanent or temporary and can occur in both men  and women. Cyclophosphamide may also cause a temporary or permanent change in your monthly periods, causing them to become irregular or causing them to stop. Women may experience an earlier menopause.

Other possible side effects

  • Cyclophosphamide may also cause some hair thinning which will grow back on completion of the treatment.
  • You also may experience mouth ulcers and thrush.
  • Methylprednisolone can cause flushing to the neck and face during the infusion.

Please remember side effects are usually temporary. If you experience any of them or any other unusual symptoms please inform your consultant or nurse.

You should not receive this treatment whilst you have an infection. The pulse can be postponed. Please let your nurse or doctor know if you develop any infections.

If you have any questions or concerns regarding your treatment or side effects please contact:
Monday to Friday 8.30am to 4.30pm 
Dr Bridget Griffiths’ secretary 0191 2137978
Dr Ian D Griffiths’ secretary 0191 2137996

Monday, Tuesday, Thursday and Friday - 9am to 5.30pm
Karen Walker CTD Nurse Specialist 0191 2231503

In case of an emergency please contact
Monday to Friday - On-Call Registrar 5pm to 7pm
0191 22336161 via hospital switchboard.
Saturday to Sunday - On-Call Registrar 9am to 1pm
0191 2336161 via hospital switchboard.


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