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Hemorrhagic cystitis may develop in patients treated with cyclophosphamideRarelythis condition can be severe and even fatalFibrosis of the urinary bladdersometimes extensivealso may develop with or without accompanying cystitisAtypical urinary bladder epithelial cells may appear in the urineThese adverse effects appear to depend on the dose of cyclophosphamide and the duration of therapySuch bladder injury is thought to be due to cyclophosphamide metabolites excreted in the urineForced fluid intake helps to assure an ample output of urinenecessitates frequent voidingand reduces the time the drug remains in the bladderThis helps to prevent cystitisHematuria usually resolves in a few days after cyclophosphamide treatment is stoppedbut it may persistMedical and/or surgical supportive treatment may be requiredrarelyto treat protracted cases of severe hemorrhagic cystitisIt is usually necessary to discontinue cyclophosphamide therapy in instances of severe hemorrhagic cystitis.

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Hepatic imparimentGive 75of normal dose if transaminase levels are3 times upper limit of normal or bilirubin is 3.1-5 mg/dL.

Do not increase your dose or take this medication more often without your doctor’s approvalYour condition will not improve any faster and the risk of serious side effects may be increased.

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