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©2013 UpToDate ® Print Email Algorithm for adjusting oral cyclophosphamide dose for adult patients with renal insufficiency Creatinine clearance* (mL/minute) Cyclophosphamide (CYC) oral dose (mg/kg/day) • > 100 2 50-99 1.5 25-49 1.2 15-24 1 < 15 or dialysis Δ 0.8 CYC: cyclophosphamde; Clcr: creatinine clearance Initial 2 mg/kg per day dose and adjustments for renal insufficiency are for daily oral administration of "low dose" cyclophosphamide therapy in renal and rheumatic diseases.  For approach, other dose adjustments that may be needed, and duration of therapy, refer to topic on General principles of the use of cyclophosphamide in rheumatic and renal disease. * Can be estimated by using the Cockroft-Gault equation. Clcr = [140-age] * weight (kg)/serum Cr in mg/dL * 72. Multiply result by 0.85 for women. Separate calculators for creatinine clearance using conventional and SI units are available in UpToDate.  • Usual maximum daily dose is 200 mg.  For patients who are overweight or obese, an estimate of ideal or lean body weight is used for estimating Clcr and determining daily CYC weight-based dose. Calculators are available in UpToDate. Δ CYC is variably dialyzable (~20-50 percent).  Dose may require further adjustment depending upon type of dialysis. For intermittent hemodialysis, give dose after session on dialysis days. Adapted with permission from: Rheumatic Disease Clinics of North America 2001. 27(4):863. Copyright © 2001 Elsevier Science.  Additional information from de Groot et al. Ann Intern Med 2009. 150(10):670.