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Combined or sequential use of cyclophosphamide and other agents with similar toxicities can potentiate toxicities.

Metabolism and Nutritionhyponatremiafluid retentionblood glucose increasedblood glucose decreased.

In some casesthe second malignancy developed several years after cyclophosphamide treatment had been discontinuedIn a single breast cancer trial utilizing two to four times the standard dose of cyclophosphamide in conjunction with doxorubicin a small number of cases of secondary acute myeloid leukemia occurred within two years of treatment initiationUrinary bladder malignancies generally have occurred in patients who previously had hemorrhagic cystitisIn patients treated with cyclophosphamide-containing regimens for a variety of solid tumorsisolated case reports of secondary malignancies have been publishedOne case of carcinoma of the renal pelvis was reported in a patient receiving long-term cyclophosphamide therapy for cerebral vasculitisThe possibility of cyclophosphamide-induced malignancy should be considered in any benefit-to-risk assessment for use of the drug.

MetronidazoleAcute encephalopathy has been reported in a patient receiving cyclophosphamide and metronidazoleCausal association is unclearIn an animal studythe combination of cyclophosphamide with metronidazole was associated with increased cyclophosphamide toxicity.

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eight of the patients were studied for a further 2 weeks cytoxan suspension and the mean amitriptyline plus nortriptyline concentration was then 111 – 19 micrograms l.

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