Methylprednisolone and Cyclophosphamide for Lung Fibrosis

You have been given this leaflet because you are having treatment which uses cyclophosphamide and methylprednisolone.

What are methylprednisolone and cyclophosphamide?

Cyclophosphamide and methylprednisolone are medicines, which are used to suppress the immune system.

Why have I been prescribed this treatment?

You have a lung condition known as pulmonary or lung fibrosis. This may progress or worsen over time due to your immune system being overactive. You have been offered this treatment to try to slow or stop the condition from worsening.

It is important to realise that this treatment will not reverse or heal the scarring that has already occurred, but hopefully it will prevent it from worsening.

What will happen before I start this treatment?

Before starting this treatment your Doctor will check:

• That your kidney and liver function is normal, this is done by a blood test.

• Whether you have had any recent infections.

• Whether you are prone to bladder infections.

• That you do not have any allergies which may stop this treatment.

• That you are not pregnant or planning to become pregnant.

• That you are not breast feeding.

• Whether you have had any vaccinations recently.

• Whether you have had chicken pox or measles in the past.

You will be given an anti-sickness drug before receiving your treatment, to try to prevent vomiting or feelings of nausea.

What will happen during my treatment?

Your treatment will take place in the Chemotherapy Day Unit of either North Tees Hospital or Hartlepool Hospital, depending on which is closer to your home. The medication is given in this unit as the staff have the expertise in administering this treatment.

Each treatment is called a ‘pulse’ and these are usually given every 3 to 4 weeks.

The complete treatment will take 4 to 6 hours. The Nurse looking after you will monitor your pulse and blood pressure during the treatment. One hour before each treatment, you will be given a medication called Mesna. This is used to prevent bladder inflammation, a possible side effect of the drug.

The two medicines are given separately into your vein, through a drip and each one takes an hour to be given. After you have been given your medicine, you will go home.

What side effects could I have from this treatment?

Every patient is an individual; your experience may be different to other patients receiving this treatment. Potential side effects include:

• Fatigue – Many people feel tired and have low energy levels for a few days after treatment. If you suffer fatigue (tiredness), it is best to take gentle exercise and rest often. This feeling of fatigue is quite normal and energy levels should begin to improve a few days after treatment.

• Nausea (feeling sick) and vomiting (being sick) – The severity of any nausea and vomiting will vary from person to person. To try to stop this, you will be given an anti-sickness drug before receiving your treatment and some tablets to take home with you.

• An increased risk of infection – You may be more prone to catching infections when receiving this treatment. If possible, it is best to avoid contact with people who have an infection while you are receiving this treatment.
  
  It is also best to avoid contact with children who have chicken pox. If you have contact with a child who develops chicken pox, please contact your consultant or GP so that we can check if you are immune to it. This is done by performing a blood test at the hospital.
  
  Rarely, you may develop a very severe lung infection called ‘PCP’ or ‘pneumocystis’ while having this treatment. We try to prevent this infection by asking you to take an antibiotic called ‘co-trimoxazole (Septrin)’.
  
  The Nurses at the Chemotherapy Day Unit will provide information about which symptoms to look out for and who to contact if you are feeling unwell.

• Inflammation of the bladder – This may occur with the treatment. To help prevent this, you will be given additional fluid by a drip and asked to drink plenty of fluids for 24 hours after the treatment. We suggest that you drink approximately 3 litres of fluid on the day of your treatment.

• Infertility – If you are planning to have a family in the future, please tell your Doctor as cyclophosphamide can make some people infertile. Infertility may be permanent and can occur in both men and women.
  
  For men wishing to father children in the future, you will need to consider sperm banking before treatment. 
  
  For women, cyclophosphamide may also cause a temporary or permanent change in monthly periods, causing them to become irregular or causing them to stop. Women may experience an earlier menopause.

• Extravasation – Occasionally, the tip of your drip may slip out of the vein into the fatty tissue and skin around the vein. This can cause cyclophosphamide to leak into the tissue around the vein. This is known as extravasation.
  
  This can cause damage to the tissue. You must inform your Nurse immediately if you start notice pain, stinging, swelling or redness around the vein that your drip is in.

• Other possible side effects – Very rarely, some patients experience hair thinning, which will grow back on completion of the treatment. You may also experience mouth ulcers and thrush.

Will I need more tests while I am taking this treatment?

You will need a blood test before each ‘pulse’. This will be performed in the Chemotherapy Day Unit 5 to 7 days before the next treatment. Depending on the results, your ‘pulse’ may need to be delayed.

We will test your urine before every treatment to ensure that you are not developing an infection or any bladder inflammation.

What if I miss a ‘pulse’ of this treatment?

If you need to miss a ‘pulse’ for any reason, you will need to inform the Chemotherapy Day Unit staff and they will arrange another date. If you are missing a ‘pulse’ due to side effects, they will discuss with your consultant who will make a decision on your further treatment.

Can this treatment react with my other tablets?

Cyclophosphamide can react with some other medications. Your consultant will review all of your medication to make sure that there are no potential problems.

It is important that you also tell your consultant of any herbal or over-the-counter medications that you are also taking.

Can this treatment affect pregnancy or breatfeeding?

Yes. Cyclophosphamide must not be taken during pregnancy or while you are breastfeeding as it can harm a developing baby and can be passed to your child through breast milk.

Both men and women should avoid starting a family for at least 6 months after treatment.

It is important that you continue to use highly reliable contraception while you are having treatment. The medical staff will provide advice on contraception.

Please inform your consultant or Nurse if your period is late and you think you may be pregnant.

Should this treatment be stopped for an operation?

Yes. If you need to undergo any elective operations, you must tell the team looking after you, as they will need to decide how long to stop the treatment before you can undergo an operation.

Can I drink alcohol while taking this treatment?

Yes, but please drink alcohol in moderation.

What if I have an infection?

You should not receive this treatment while you have an infection.  Please let your nurse or doctor know if you develop any infections.

Steroids, especially at high doses, could make you sleepy or feel dizzy. If you notice these side effects then you should not drive or operate machinery. You should report this to your GP or Lung Doctor.

Contact Numbers

University Hospital of North Tees

Chemotherapy Day Unit

Telephone: 01642 383122
Monday to Friday, 9:00 am to 5:00 pm

Lung Health

Telephone: 01642 624270
Monday to Friday, 9:00 am to 5:00 pm

Department of Respiratory Medicine

Telephone: 01642 624936
Monday to Friday, 9:00 am to 5:00 pm

Emergency Department

Telephone: 01642 382899
24 hours a day, 7 days a week.

Telephone: 01642 382899

University Hospital of Hartlepool

Chemotherapy Day Unit

Telephone: 01429 622760
Monday to Friday, 9:00 am to 5:00 pm

Further information is available from:

NHS Choices

Telephone: 111 (when it is less urgent than 999).
Calls to this number are free from landlines and mobile phones
or via the website at www.nhs.uk

NHS Choices – Steroids

Website: http://nhs.uk/conditions/steroids/

BNF (British National Formulary)

Website: https://bnf.nice.org.uk/interaction/methylprednisolone-2.html

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

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The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]