Cyclophosphamide (Injection)

• Take small and frequent meals.
• Avoid foods and  smells that may make you feel nauseous, such as oily, fried or strong-smelling food.
• Avoid tight-fitting clothes around the waist.
• Your doctor may prescribe medications to help relieve or prevent nausea or vomiting. Take these as instructed.

• This may be worsened by a change in taste of food and/or nausea.
• Try different flavours of food and small frequent meals.
• For poor appetite, try to include nutritional supplements (such as milk supplements) into your diet.

Mouth ulcers or sores.

• This can occur on the tongue, the sides of the mouth or in the throat and can lead to an infection.

• Rinse your mouth regularly with an alcohol-free mouthwash or salt water to help reduce the chances of an infection.
• Brush your teeth gently after eating and at bedtime with a soft bristle toothbrush.
• If you have dentures, rinse and brush your dentures after eating and soak them in denture solution overnight.
• Avoid spicy food and take soft foods e.g. porridge.
• Your doctor may prescribe medications to help relieve or prevent the mouth sores. Use these as instructed.
• Inform your doctor if you are eating or drinking a lot lesser because of mouth pain.

• Drink plenty of clear fluids (at least 2 litres or 8 cups every day).
• Eat food that is gentler on the stomach such as porridge or soup.
• Avoid milk, dairy products, high-fibre food and oily or spicy food.
• Your doctor may prescribe medications to help relieve diarrhoea. Take these as instructed.
• Proceed to the A&E Department immediately if you have very bad diarrhoea (for example, an increase in bowel movement of more than 4 times per day) that does not improve even after taking anti-diarrhoeal medications.

Hair loss

• This is a temporary side effect and may be more obvious by the second week of treatment.
• You may lose all the hair on your head and may even lose your eyebrows, eyelashes or body hair.

• Consider cutting your hair short before chemotherapy, using wigs or using head coverings like hats or scarves.
• Use a mild shampoo (such as baby shampoo) to wash your hair and scalp.
• Your hair will grow back a few weeks after chemotherapy is completed.

Nail changes that may affect both fingernails and toenails.

Your nails may

• Become more brittle and break easily
• Turn darker in colour
• Develop ridges (lines) on the surface, which may give an uneven appearance
• Rarely, nails may come off.

• Try to keep your nails short, clean and dry.
• Avoid contact with harsh chemicals e.g. detergent or dish-washing liquids.
• Wearing gloves when washing dishes or using detergents can help protect your nails during treatment.
• If you experience pain, redness or swelling around your nails, inform your doctor.

Decrease in white blood cell count. This may increase your chances of getting an infection.

• To reduce the risk of infection:
  • Maintain good hand hygiene. Wash your hands before handling food and after using the toilet.
  • Avoid crowds and do not go near people who are sick. Wear a mask if necessary.
  • Eat freshly cooked and well-cooked food. Avoid raw meats, vegetables and eggs, or half-cooked or uncooked food.
• Proceed to the A&E department immediately if you have any signs of infection such as
  • A fever of 38°C and above
  • Chills
  • Bad sore throat
  • Pain when you pass urine
  • Mouth sores or wounds that do not heal
• Avoid taking Paracetamol to relieve fever as this may mask your fever and delay treatment of the infection.

Decrease in platelet count. Low platelet levels can increase your chance of bleeding. 

• To reduce the risk of bleeding:
  • Be careful when using sharp objects such as scissors or knives.
  • Brush your teeth gently with a soft bristle toothbrush to prevent gum bleeding.
  • Try not to bruise, cut or knock yourself. Apply direct pressure to any cuts or wounds to help stop bleeding.
• Proceed to the A&E department immediately if you have:
  • Bruising without a cause or bruises that get larger in size
  • Black, sticky stools
  • Blood in the urine
  • Coughing out blood or vomit that looks like coffee grounds
  • Bleeding which does not stop

Decrease in the number of red blood cells (anaemia)

As your red blood cells help to carry oxygen to the different parts of your body, this may cause you to feel tired more easily.

• Proceed to the A&E department immediately if you have:
  • Unusual giddiness or light-headedness that does not go away
  • Severe breathlessness or rapid breathing
  • An unusually fast heartbeat while resting

• Drink at least 2 to 3 litres of fluids every day unless informed by your doctor to drink less fluids.

• Proceed to the A&E department immediately if you experience any:
  • Weight gain
  • Severe abdominal pain
  • Dark or tea-coloured urine
  • Pale or light-coloured stools
  • Yellowing of skin or eyes
  • Nausea and vomiting with a loss of appetite

Symptoms of drug allergy including one or more of the following:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body