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Cyclophosphamide (Endoxan, Cycloxan): What to Expect and Watch For

Medically reviewed by Dr. C. Raghavendra Reddy, Medical Oncologist, MBBS (Gold Medal) · DNB · DM (Medical Oncology, Gold Medal) · Last reviewed September 2026

Cyclophosphamide is a chemotherapy medicine used in many cancers. Two things it does are rarely explained at the first appointment: it can irritate the bladder lining if you do not drink enough water, and it can permanently affect fertility. Both are manageable when you know they are coming.

Medically reviewed by Dr. C. Raghavendra Reddy, Medical Oncologist, MBBS (Gold Medal) · DNB · DM (Medical Oncology, Gold Medal) · Last reviewed September 2026

Prescription-only medicine.

Cyclophosphamide is a prescription-only medicine administered under the direct supervision of a specialist oncologist in a hospital or clinical setting. It cannot be started, adjusted or stopped on the basis of anything read online or in this article. It is not suitable for everyone — see who this is not for below.

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In short

Cyclophosphamide (sold in India as Endoxan and Cycloxan) is a chemotherapy medicine that damages cancer cell DNA. It is given by injection or as a tablet. Two things most people are not warned about: it can irritate the bladder lining, and it can permanently affect fertility. Both need to be addressed before treatment starts.

Step by step

How is cyclophosphamide given?

Blood tests first

Your blood counts are checked before each cycle. Low counts may delay treatment by a day or two — this is common and not a sign of failure.

Pre-treatment fluids (IV treatment)

For IV treatment, fluids run through the drip before the medicine starts. This begins bladder protection before cyclophosphamide enters your system.

The medicine itself

Cyclophosphamide arrives by IV drip or, for some plans, as tablets taken by mouth on specific days of your cycle. Your oncologist decides which form applies to you.

Fluids after (IV treatment)

More fluids follow the IV dose. You are also asked to drink plenty of water through the rest of the day and into the night at home.

Instructions before you leave

Your team will give you a drinking target for the next 24 hours and tell you specifically which bladder symptoms to report the same day.

In detail

Why does your team tell you to drink so much water?

Cyclophosphamide breaks down inside the body into a substance called acrolein, which leaves the body through urine. Acrolein irritates the bladder lining — and the longer urine sits in the bladder, the more concentrated the contact.

Drinking large amounts of water dilutes the acrolein and keeps the bladder flushing. Your team may also give you a medicine called mesna alongside treatment — mesna neutralises acrolein in the urine before it can damage the bladder wall.

Report any blood in your urine, or a burning feeling when you pass urine, the same day you notice it. This can develop hours or days after a dose. It is treatable, but early reporting is what keeps it manageable.

In detail

What does cyclophosphamide do to fertility?

Cyclophosphamide can damage the cells that produce eggs and sperm. In women, this may lead to irregular periods, early menopause, or permanent loss of ovarian function, depending on age and the total amount received. In men, it can reduce sperm count, sometimes permanently.

This is a conversation that needs to happen before treatment starts — not after the first cycle. Fertility preservation options such as egg freezing, embryo freezing and sperm banking must be arranged in advance, because there is no way to restore fertility once it has been lost.

If you are of childbearing age, ask specifically about fertility preservation at your next appointment. Your oncologist can refer you to a reproductive specialist or explain whether your treatment timeline allows for it.

Eligibility

Who should not receive cyclophosphamide

Cyclophosphamide is not given, or is given with extreme caution, in the following situations. Eligibility in every individual case is decided by an oncologist based on a full clinical assessment.

Severe bone marrow failure or very low baseline blood counts, where further suppression would be unsafe.
Severe active infectionThe medicine reduces the immune system's ability to fight infection further.
Severely impaired kidney or liver function, which affects how the medicine is processed and cleared from the body.
Existing bladder outlet obstruction or active haemorrhagic cystitis.
PregnancyCyclophosphamide can harm a developing baby and is generally avoided, particularly in the first trimester.
Known severe hypersensitivity to cyclophosphamide or its components.

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In detail

What other side effects should you expect?

Nausea is common in the day or two after an IV dose. Anti-nausea medicine is given before the drip as standard. Tell your team if nausea is stopping you from drinking, because staying hydrated is too important to fall behind on.

Hair thinning or loss depends on the dose and your treatment plan. At lower doses it may be minimal. At higher doses it is more likely. Hair typically grows back after treatment ends, though timing varies between people.

Blood counts fall in the days after each cycle. A fever, chills or unusual tiredness during this period needs a same-day call to your team — these can be signs of infection when your immune system is at its lowest point.

At a glance

Words your team will use

AcroleinA breakdown product of cyclophosphamide that leaves the body through urine. It is the substance that irritates the bladder lining and the reason drinking water is so important.

MesnaA medicine given alongside cyclophosphamide specifically to protect the bladder. It neutralises acrolein in the urine before it can cause damage to the bladder wall.

Haemorrhagic cystitisBleeding from the bladder wall caused by acrolein irritation. It ranges from traces of blood in the urine to heavier bleeding. Always report it the same day you notice it.

NadirThe point in your treatment cycle when blood counts are at their lowest and infection risk is highest. Your team will tell you which days this falls on in your plan.

Alkylating agentThe class of chemotherapy that cyclophosphamide belongs to. It works by interfering with DNA replication, which prevents cancer cells from dividing.

Question by question

Questions people ask about cyclophosphamide

Can I take cyclophosphamide tablets at home?

Oral cyclophosphamide is part of some treatment plans, taken on specific days of the cycle. The hydration rules apply just as strictly at home — drink large amounts of water and pass urine frequently throughout the day and before bed. Your team will give you written instructions. If you miss a dose or are unsure about a delayed one, call your team before taking it. Do not take a double dose to catch up.

Is the hair loss permanent?

Hair usually grows back after a standard course of cyclophosphamide. Timing varies — some people see regrowth within a few months of finishing treatment, others take longer. The new hair may feel or look slightly different at first. At very high doses, permanent thinning is possible, but this is not the typical experience for most treatment plans. Ask your oncologist what to expect from your specific dose and schedule.

Will I go into menopause during treatment?

It depends on your age and the total amount of cyclophosphamide you receive. Younger women with a larger egg reserve are more likely to see periods return after treatment ends. Women closer to natural menopause age may find the change is permanent. Hot flushes, irregular periods or periods stopping altogether are all signs to report to your team. If preserving fertility matters to you, this conversation needs to happen before treatment begins.

How will I know if my bladder is being affected?

The signs to watch for are a burning or stinging feeling when passing urine, needing to go more frequently than usual, or any change in the colour of your urine — pink, red or brown. Report any of these to your team the same day you notice them. Do not wait for your next scheduled appointment. Blood in the urine during cyclophosphamide treatment is never a wait-and-see symptom.

What should I avoid during treatment?

Tell your team about every medicine, supplement, herbal preparation and ayurvedic product you are taking — some interact with cyclophosphamide or affect how the body handles it. Avoid live vaccines while your blood counts are low. Your team will give specific guidance on foods, alcohol and infection precautions around the days when your counts are at their lowest.

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Common questions

Frequently asked questions

What is cyclophosphamide used to treat?

Cyclophosphamide is used in a range of cancers including lymphomas, breast cancer, ovarian cancer and leukaemias, among others. It also appears at lower doses in some autoimmune conditions. Being prescribed it does not tell you much about how advanced your disease is — it is used across many stages and in many different combinations. Your oncologist can explain specifically why it has been chosen for your plan.

Is Endoxan the same medicine as cyclophosphamide?

Yes. Endoxan and Cycloxan are brand names used in India for cyclophosphamide. Your prescription may use any of these names depending on which brand your treatment centre uses. The generic name is cyclophosphamide — use that when looking up information or speaking with another doctor or pharmacist, as it is the name that will be recognised anywhere.

How many cycles will I need?

The number of cycles depends entirely on your treatment plan, your cancer type and how your disease responds. Some regimens give cyclophosphamide on a single day within a three-week cycle; others give it over several consecutive days. Your oncologist will provide a written schedule showing which days the medicine is given, which days blood tests fall, and roughly how many cycles are planned before the first response assessment.

Can I drive on the day of my infusion?

Anti-nausea medicines given before the infusion can cause drowsiness, so it is generally advisable to arrange for someone else to take you home on IV treatment days. Your team will tell you which medicines you are receiving and whether drowsiness is likely for you. As a general rule, do not drive if you feel unwell, drowsy or unsteady after treatment, regardless of what you have been given.

Will cyclophosphamide affect my kidneys?

Cyclophosphamide is processed through the kidneys, and the hydration your team prescribes helps keep them working well during treatment. Kidney damage at standard doses is uncommon in people with healthy kidney function at the start. Your team will monitor kidney function through blood tests during your treatment. If you have a pre-existing kidney condition, make sure your oncologist is aware of it before treatment begins.

Is it safe to be around my family during treatment?

Normal contact with family is not restricted during a standard course of cyclophosphamide. You should be careful around anyone with an active infection during the days when your blood counts are lowest, because your ability to fight infection is reduced at those times. If a family member develops chickenpox, shingles or another significant infection while you are in treatment, call your team the same day rather than waiting for your next appointment.

Who would be treating you

The medical oncologists on the CION panel

Chemotherapy is prescribed, dosed and supervised by a medical oncologist. These are the six on the CION panel.

Dr. Naresh Gundu

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Dr. C. Raghavendra Reddy

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Dr. Bharati Devi Gorantla

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Dr. T. Raghavender Reddy

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