Indications
Fludarabine is a cancer medicine used mainly to treat chronic lymphocytic leukaemia (CLL), a slowly progressing cancer of white blood cells. It is also used for some low-grade non-Hodgkin lymphomas and, in hospital transplant units, as part of the conditioning treatment given before a stem cell (bone marrow) transplant.
How It Works
Fludarabine is an antimetabolite. Inside the body it is changed into an active form that resembles one of the building blocks of DNA. Cancer cells take it up, and it blocks the enzymes they need to make and repair DNA, so the cells stop dividing and die. It also strongly suppresses lymphocytes (a type of white blood cell), which is why it is useful before transplants.
Dosage and Administration
Fludarabine is given under the supervision of a cancer specialist. The injection is given into a vein by a doctor or nurse; tablets, where used, are taken exactly as the specialist directs. The dose is calculated from body surface area and kidney function and is usually given for a few days in a row every 4 weeks, often together with other medicines such as Cyclophosphamide or Rituximab. Never change the dose yourself.
Interactions
Fludarabine must not be combined with Pentostatin, as this has caused severe, sometimes fatal lung damage. Dipyridamole and similar medicines may reduce its effect. Other medicines that suppress the bone marrow add to its toxicity. Live vaccines must be avoided during and after treatment. Only irradiated blood products should be used for transfusion during and after treatment.
Contraindications
It should not be given to people with severe kidney impairment, haemolytic anaemia (red cell breakdown) caused by the immune system, known allergy to fludarabine, or in combination with Pentostatin. It is not used during pregnancy or breastfeeding.
Side Effects
Common side effects include:
- Low blood counts, with a raised risk of infections (including unusual infections such as pneumonia caused by Pneumocystis), bleeding and anaemia
- Fever, chills, tiredness and weakness
- Nausea, vomiting, diarrhoea, loss of appetite and mouth sores
- Cough and shortness of breath
- Numbness or tingling in the hands and feet
Serious effects can include immune destruction of red cells or platelets, nerve and brain problems (confusion, vision changes, seizures), tumour lysis syndrome and lung inflammation.
Get urgent medical help if you have a temperature of 38°C or more, chills, shortness of breath, dark or red urine, yellowing of the skin or eyes, unusual bleeding or bruising, confusion, vision problems, seizures, or severe weakness.
Pregnancy and Lactation
Fludarabine can harm an unborn baby. Women and men must use effective contraception during treatment and for at least 6 months after the last dose, or as advised by the specialist. Breastfeeding must be stopped during treatment.
Precautions and Warnings
Blood counts, kidney function and signs of infection are checked closely. Medicines to prevent infections are often prescribed. Tell your doctor about any history of haemolytic anaemia, kidney disease or nerve problems. Drink plenty of fluids as advised. Avoid contact with people who have infections, and do not have live vaccines.
Overdose
High doses can cause severe, sometimes permanent nerve and brain damage (including blindness and coma) and prolonged, severe bone marrow suppression. There is no specific antidote; treatment is in hospital and is supportive.
Therapeutic Class
Antineoplastic (anticancer) agent; purine analogue antimetabolite.
Storage
Store as directed on the pack; injection vials are usually kept in a refrigerator at 2 to 8°C and must not be frozen. It is handled by hospital pharmacy staff, away from light and out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.