Fludarabin Phosphate

Fludarabin Phosphate is used in the treatment of type of blood cancer called chronic lymphocytic leukemia (CLL). It may be used to treat other conditions, as determined by the doctor. It is sometimes used with certain other medicines as part of combination chemotherapy. Fludarabin Phosphate can be taken with or without food, but try to have it at the same time every day to get the most benefits. Your doctor will decide what dose is necessary and how often you need to take it. This will depend on what you are being treated for and may change from time to time. You should take it exactly as your doctor has advised. Taking it in the wrong way or taking too much can cause very serious side effects. It may take several weeks or months for you to see or feel the benefits but do not stop taking it unless your doctor tells you to. The most common side effects of this medicine include increased risk of infection, vomiting, weakness, nausea, and fatigue. This medicine may reduce the number of blood cells (decrease red blood and white blood cells) in your blood, thereby, increasing the susceptibility to infections. Regular blood tests are required to check your blood cells along with heart, liver, and blood uric acid levels. Before taking it, tell your doctor if you have heart disease, liver, or kidney problems or are taking any medicines to treat infections. Many other medicines can affect, or be affected by, this medicine so let your doctor know all medications you are using. This medicine is not recommended during pregnancy or while breastfeeding. The use of effective contraception by both males and females during treatment is important to avoid pregnancy. Fludarabin Phosphate is an anticancer medication. It works by interfering with the growth of genetic material (DNA and RNA) of the cancer cells in blood. This slows the growth of cancer cells and eventually kills them.

• Blood cancer (Chronic lymphocytic leukemia)

Fludarabine is rapidly dephosphorylated to 2-fluoro-ara-A and then phosphorylated intracellularly by deoxycytidine kinase to the active triphosphate, 2-fluoro-ara-ATP which inhibits DNA polymerase and ribonucleotide reductase resulting in inhibition of DNA synthesis leading to cell death.

Adult Dose: B-Cell Chronic Lymphocytic Leukemia 25 mg/sq.meter IV infusion over 30 minutes qD x5 days (up to 30 mg/sq.meter) 40 mg/sq.meter PO x5 days Repeat q28Days Child Dose: Safety and efficacy not established Renal Dose: Renal impairment CrCl 30-70 mL/min: reduce by 20% CrCl <30 mL/min: IV not recommended; PO reduce 50%

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Fludarabin Phosphate may be taken with or without food, but it is better to take it at a fixed time.

Common: • Increased risk of infection • Vomiting • Weakness • Nausea • Fatigue • Fever • Decreased blood cells (red cells, white cells, and platelets) • Diarrhea • Cough

[UNSAFE] Fludarabin Phosphate may cause side effects which could affect your ability to drive. Some people get tired, feel weak, have disturbed vision, become confused, or agitated or have seizures while they are treated with Fludarabin Phosphate and this may affect your ability to drive. Use a reliable contraceptive method to prevent pregnancy while you are taking this medicine. Inform your doctor immediately if you notice any signs of infection such as fever, sore throat, rash or severe diarrhea.

Renal impairment (CrCl <30 mL/min); decompensated haemolytic anaemia. Pregnancy and lactation. Concomitant use of live vaccines.

Co-administration with pentostatin may lead to pulmonary toxicity. Reduced metabolic activation of fludarabine with cytarabine. Reduced therapeutic efficacy with dipyridamole and other adenosine uptake inhibitors.

[CONSULT YOUR DOCTOR] It is not known whether it is safe to consume alcohol with Fludarabin Phosphate. Please consult your doctor.

[CONSULT YOUR DOCTOR] Fludarabin Phosphate is unsafe to use during pregnancy as there is definite evidence of risk to the developing baby. However, the doctor may rarely prescribe it in some life-threatening situations if the benefits are more than the potential risks. Please consult your doctor.

[UNSAFE] Fludarabin Phosphate is unsafe to use during breastfeeding. Data suggests that the drug may cause toxicity to the baby.

[CAUTION] Fludarabin Phosphate should be used with caution in patients with kidney disease. Dose adjustment of Fludarabin Phosphate may be needed. Please consult your doctor. Use of Fludarabin Phosphate is not recommended in patients with severe kidney disease. [CAUTION] Fludarabin Phosphate should be used with caution in patients with liver disease. Dose adjustment of Fludarabin Phosphate may be needed. Please consult your doctor.

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