In a few cases with use of high doses, severe, sometimes fatal congestive heart failure seen within a few day after first dose. Histopathologic examination primarily has shown hemorrhagic myocarditis. Hemopericardium seen secondary to hemorrhagic myocarditis and myocardial necrosis. Pericarditis reported independently of any hemopericardiums. No residual cardiac abnormalities seen in patients surviving episodes of apparent cardiotoxicity from use of high doses.
Effects appear to depend on dose and duration of therapy.
Forced fluid intake helps to ensure ample urinary output, necessitates frequent voiding, and reduces time drug remains in bladder, which helps to prevent cystitis. Hematuria usually resolves in a few days after discontinuation, but may persist. Discontinue use if severe hemorrhagic cystitis occurs. Hemorrhagic uteritis and renal tubular necrosis reported and usually resolve following cessation of therapy. If needed, adjust dose of both replacement steroids and cyclophosphamide.