daft question, but when taking Cyclophosphamide on an empty stomach - how soon can I have breakfast?

[djgolding]

I should have asked the pharmacist or doc but keep forgetting until I take my 11 tablets then think "Oh beggar!"

[Oleboyredw-uk]

I looked in the Patient Information Leaflet that I came with my Cyclophosphamide. It states the following:

"Cyclophosphamide should be taken on an empty stomach. If you suffer from severe stomach irritation, you may take Cyclophosphamide with a meal"

I'm not sure if that helps or confuses. From memory I had my breakfast about half an hour after taking all my tablets when I was taking tablets in second half 2012.

I'd check with the doc/pharmacist.

Rob

[djgolding in reply to Oleboyredw-uk]

thanks Rob - its just one of those stupid questions you wish there was an easy answer to. I try to give an hour but boy do I get frustrated knowing that I need my fuel before getting on with my day so its an hour lost. I have a smallholding so there's always lots to get on with and once I put my boots on, that's it, I'm outside!

[Cllcanada Top Poster CURE Hero]

Remember, no grapefruits, grapefruit juice or St. John's Wort when on cyclophosphamide in tablet form.

[djgolding in reply to Cllcanada]

none of those in my bacon, sausage, eggs and beans with toast!

[Oleboyredw-uk]

Hmm, I didnt know about the Grapefruit juice and dont remember it on the PIL. Interested to know the issue there.

Had a dig and found this...

urmc.rochester.edu/news/sto...

Yet not mentioned here...

nyrdtc.nhs.uk/GMMMG/Groups/...

Although it is mentioned for other drugs.

Your post has made me feel hungry!

rob

[HAIRBEAR_UK Founder Admin in reply to Oleboyredw-uk]

I looked up Cyclophosphamide nutrient interactions and cannot find mention in the new British National Formulary website (maybe I am not navigating it properly)??

I did find an interesting article at NHS choices:

Does grapefruit affect my medicine? you may be surprised to find out what other routine medications you may be taking that are affected by grapefruit juice, there is a brief mention about Cytotoxic medicines.

"Cytotoxic medicines

Some medicines used in the treatment of cancers may interact with grapefruit juice.You should check with your doctor before drinking grapefruit juice."

Am having a problem locating UK specific information in relation to adverse nutritional interactions and Cyclophosphamide, as Macmillan guidance and NHS choices guidance about Cyclophosphamide do not list food items to be avoided? Also the American Cancer Society did not mention foods that may have risk?

I found this interesting though:

From Dr Sharman Nutritional Supplements cll-nhl.com/2013/02/nutriti...

"Grapefruit juice should seem harmless enough right? Actually grapefruit is one of the worst things out there for just about anyone who takes drugs. Grapefruit shuts off a set of liver enzymes that are responsible for clearing drugs out of the bloodstream. I remember hearing about a colleague’s patient on a cholesterol lowering drug who decided to go on a grapefruit juice diet. Unfortunately this resulted in toxic levels of the cholesterol drug. The subsequent muscle tissue injury caused kidney failure. It is so well recognized that when companies are developing drugs sometimes the FDA mandates that they study the interaction with grapefruit juice (another reason drug development sometimes takes so long)."

I also recall Tumeric(curcumin) being mentioned as to be avoided in the past?.

When looking on-line at some US information sources for oral Cyclophosphamide (cytoxan) grapefruit is mentioned as well as Tumeric as substances to be avoided when taking Cyclophosphamide.?

webmd.com/drugs/drug-6738-C...

oralchemotherapy.ca/wordpre...

We would benifit from some clarity and the input of an expert if you are reading! Ask your CLL doctor .

MMNN sausages, drool. Sunday breakfast,

[Oleboyredw-uk]

The doc i put a link to was from Manchester/Cheshire NHS I think, so close to my heart. They do highlight grapefruit juice for other drugs but not Cyclophosphamide.

Gave in, bacon sandwich and two toasted hotcross buns mmmmm.

[Cllcanada Top Poster CURE Hero]

Here is a listing... these are oral medications...

Complete list from the Canadian Medical Association (2012)

Note that Imbruvica (ibrutinib) should be added... probably others

cmaj.ca/content/suppl/2012/...

en.wikipedia.org/wiki/Grape...

This link needs to be pasted to your browser...

My cancer agency in Canada

bccancer.bc.ca/NR/rdonlyres...

[HAIRBEAR_UK Founder Admin in reply to Cllcanada]

Many thanks Chris

[PaulaS Volunteer in reply to Cllcanada]

Very interesting links - thank you. Grapefruit doesn't seem such a healthy option any more... I never realised it caused problems when taken with so many drugs - not just anti cancer ones but a wide range of other things, including quite common medications such as Erythromycin and Quinine.

It was also interesting to read about the science behind it - how some chemicals in the grapefruit affect the enzymes that react with the drugs, so bigger doses end up in the bloodstream. It seems possible that marmalade (with its bitter oranges), and other citrous fruits have a similar affect.

[grizzlebear]

Hang on would this be the same for grapes? Ive been really sicky this chemo and someone got me a huge bunch of grapes which i have constantly picked at because they are small and cold. Have they been making me more sick?

[Cllcanada Top Poster CURE Hero in reply to grizzlebear]

Not grapes... grapefruit, bitter Seville oranges used in marmalade and St. John's Wort... that's it...

[djgolding]

no grapefruit with statins - according to my wife!

[Mikey47]

Those of us taking Ibrutinib/Imbruvica were warned about Grapefruit/juice and Seville oranges. The grapefruit/juice because of the action on the liver enzymes as mentioned above by Nick.