Cytarabine

Cytarabine is an antineoplastic agent. It is a synthetic pyrimidine nucleoside, which is converted intracellularly to the nucleotide, cytarabine triphosphate. The exact mechanism of action of cytarabine is not fully understood, but cytarabine triphosphate appears to inhibit DNA synthesis by the inhibition of DNA polymerase. Cytarabine's actions are cell-cycle specific, acting at the S-phase. Cytarabine is also an immunosuppressant and has demonstrated antiviral activity in vitro. It is used alone or in combination with other chemotherapeutic agents for induction of remission of leukaemia, particularly for acute myeloid leukaemia, in adults and children.

• Acute Myeloid Leukemia (AML)
• Acute Lymphocytic Leukemia (ALL)
• Chronic Myeloid Leukemia (CML)
• Erythroleukemia
• Meningeal Leukemia
• Non-Hodgkin's Lymphoma (children)

Cytarabine is an antineoplastic agent. Cytarabine is a synthetic pyrimidine nucleoside, which is converted intracellularly to the nucleotide, cytarabine triphosphate. The exact mechanism of action of cytarabine is not fully understood, but cytarabine triphosphate appears to inhibit DNA synthesis by the inhibition of DNA polymerase. Cytarabine's actions are cell-cycle specific. Cytarabine is also an immunosuppressant and has demonstrated antiviral activity in vitro.

Cytarabine is converted intracellularly to cytarabine triphosphate which inhibits DNA synthesis by inhibiting DNA polymerase, specifically at the S-phase of the cell cycle. It stops the growth and multiplication of cancer cells.

Adult - Acute Nonlymphocytic Leukemia (Induction): 100-200 mg/sq.meter/day IV for 5-10 days; OR 100 mg/sq.meter IV every 12 hours for 7 days.

Adult - Meningeal Leukemia (Intrathecal): 5-75 mg/sq.meter every 2-7 days until CNS findings normalize.

Adult - Refractory Leukemia: 3 g/sq.meter IV (infusion over 1-3 hours) every 12 hours x 4-12 doses; repeat every 2-3 weeks.

Adult - Meningeal Leukemia (IT): 30 mg/sq.meter intrathecal every 4 days until CSF findings normal plus one additional dose.

This medicine is given by intravenous infusion or injection, subcutaneously, or intrathecally (preservative free preparation only). Your doctor or nurse will give you this medicine. Kindly do not self administer.

Cytarabine is an injection medicine given by healthcare professionals. You cannot miss a dose yourself. Do not miss your appointments with your doctor.

Common Side Effects:

• Rash
• Skin ulcer
• Nausea
• Vomiting
• Hair loss
• Abdominal pain
• Anal ulcers
• Anemia
• Decreased white blood cell count
• Fever
• Infection
• Abnormal liver function
• Low blood platelets
• Mouth ulcer
• Pneumonia
• Sepsis
• Mouth sore
• Stomatitis

Serious Side Effects:

• Myelosuppression (leukopenia, thrombocytopenia, anemia)
• Cytarabine syndrome (fever, myalgia, bone pain, rash, conjunctivitis)
• Neurotoxicity (with intrathecal use)
• Anaphylactoid reactions
• Flu-like syndrome

• May affect your ability to drive.
• Use a reliable contraceptive method to prevent pregnancy while taking this medicine.
• Inform your doctor immediately if you notice any signs of infection such as fever, sore throat, rash or severe diarrhea.
• Regular blood tests are required to check blood cells, heart, liver, and uric acid levels.
• Patients with previous drug-induced bone marrow suppression should use with caution.

• Hypersensitivity
• Pregnancy
• Lactation

Gentamicin, digoxin, flucytosine: May reduce efficacy.

Potentially Fatal: Potentiates bone marrow depression with radiotherapy and other myelotoxic drugs.

Other cytotoxic agents (intrathecal): May increase risk of neurotoxicity.

It is not known whether it is safe to consume alcohol with Cytarabine. Please consult your doctor.

Pregnancy Category D. Cytarabine is unsafe during pregnancy as there is definite evidence of risk to the developing baby. May be prescribed in life-threatening situations if benefits outweigh risks. Please consult your doctor.

Cytarabine is unsafe during breastfeeding. Data suggests that the drug may cause toxicity to the baby. Women should be advised not to breastfeed while being treated with cytarabine.

Appropriate studies with cytarabine have not been performed in the paediatric population. However, paediatric specific problems that would limit the usefulness of this medication in children are not expected.

Although studies with cytarabine have not been performed in the geriatric population, geriatric specific problems that would limit the usefulness are not expected. However, elderly patients are more likely to have age related renal impairment, which may require dose reduction.

Renal impairment: Cytarabine is safe to use in patients with kidney disease. No dose adjustment is recommended. However, talk to your doctor if you have any underlying kidney disease.

Hepatic impairment: Limited information available on the use in patients with liver disease. Cautious use is recommended. Please consult your doctor.

Severe bone marrow depression, gastrointestinal toxicity and vomiting are among the signs and symptoms expected. Treatment should be ceased and supportive measures instituted. Blood product transfusions may be required and active measures may be necessary to combat infection.

Store the vial in original carton at 15°C to 30°C. Protect from light. Do not refrigerate. Keep out of reach of children.

Cytarabine