Cytarabine - Dosage | Interactions | Precautions
Cytarabine is a drug belonging to the group of antimetabolite anticancer drugs also called pyrimidine antagonists and is used to treat various types of cancer. In the body, Cytarabine is converted into cytarabine-5-triphosphate which inhibits the DNA polymerase (an enzyme crucial for tumor cells) which results in a cytotoxic effect.
Cytarabine is used to treat following types of cancers:
- Acute myeloid leukemia (AML)
- Acute lymphoblastic leukemia (ALL)
- Chronic myeloid leukemia (CML)
- Non-Hodgkin lymphoma
Contraindications and precautions
Cytarabine must not be used in patients who are allergic to this medicine.
The most serious side effect of this drug is bone marrow suppression - also known as myelotoxicity, Therefore hematological tests should be carried out regularly during the treatment.
Given that this drug may increase the level of uric acid in the blood and induce a state called hyperuricaemia, regular control of uric acid levels in the blood is recommended. Extra precaution is needed in patients suffering from gout.
Cases of pericarditis (inflammation of the pericardium) have been reported in patients who are treated with this drug, and regular ECG monitoring during the treatment is therefore recommended.
Sexually mature females and males must apply appropriate contraception methods during the treatment and for six months after stopping treatment because the use of this drug during pregnancy is contraindicated.
Considering the fact that it can weaken the immune system (as it reduces the number of leukocytes in the blood), this medication should be avoided in patients with severe infections. If you notice flu-like symptoms (fever, cough or sore throat), you should contact your doctor because it may be a sign that leukopenia has been occurred.
Avoid direct contact with skin or mucous membranes because it can cause damage. However, if contact occurs, it is necessary to wash the skin with large amounts of cold water and soap.
Cases of severe respiratory failure, which can be life-threatening, have also been reported! If you notice a cough, wheezing or difficulty breathing, contact your doctor immediately.
Cases of ileus and intestinal ulcers, which consequently can lead to life-threatening septicemia caused by Gram-negative bacteria, have also been reported. If you notice nausea, vomiting, severe abdominal pain, stomach bloating and constipation, contact your doctor immediately.
Also, the available studies show that this drug can cause cerebral toxicity, convulsions and other central nervous system adverse effects, which may also have serious consequences for your health.
Cytarabine, pregnancy and breastfeeding
If applied during pregnancy, Cytarabine may cause severe birth defects and therefore should be avoided during pregnancy. However, considering the life-threatening risk that exists for the mother and therefore for the child if the cancer is not treated, your doctor may decide that this medicine should be applied during pregnancy.
Men who are sexually mature are advised to take cryopreservation (freezing and storing the sperm) before starting the treatment because Cytarabine can cause infertility.
Breastfeeding should be discontinued while you're on the Cytarabine therapy.
Cytarabine is administered as a rapid intravenous infusion because it is better tolerated than the slow intravenous infusion. It can be administered only by the experienced oncologist.
There is no oral form of this drug.
The dosage is calculated according to body surface area, and usual dosage is 70-200 mg / m2 of body surface area per day. The dose may be increased up to 3000 mg / m2 of body surface area per day if your doctor believes that high dose is necessary.
Cytarabine can be administered via the intrathecal route of administration (installation of implantable infusion pumps) and in that case recommended dosage is 5-75 mg / m2 of body surface area per day.
Co-administration of Cytarabine with below listed drugs increases the risk of low white blood cell count and these interactions consequently may cause life-threatening infections:
- Adalimumab and golimumab (monoclonal antibodies used in the treatment of juvenile idiopathic arthritis, rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis)
- Certolizumab (a monoclonal antibody that is used for the treatment of Chron's disease)
- Natalizumab (a monoclonal antibody that is used for the treatment of multiple sclerosis)
- Leflunomide (a drug used for the treatment of rheumatoid arthritis and psoriatic arthritis)
- Teriflunomide (a drug used for the treatment of multiple sclerosis)
- Clozapine (an antipsychotic)
- Inhibitors of tumor necrosis factor (TNF), such as: infliximab and etanercept (used for the treatment of rheumatoid arthritis and psoriatic arthritis)
Cytarabine may cause the following side effects:
- Myelosuppression (leucopenia, granulocytopenia, thrombocytopenia, and anemia)
- Muscle pain
- Flu-like symptoms
- Bone pain
- Chest pain
- Severe respiratory failure
- Cardiopulmonary arrest
- Peripheral neuropathy
- Intestinal ulceration
- Liver damage