Cytarabine

Indications

Cytarabine is used for: Acute myeloid leukaemia, acute lymphocytic leukaemia (ALL), lymphomas, Leukaemic meningitis

Adult Dose

Acute Nonlymphocytic Leukemia IV administration for remission induction 100-200 mg/sq.meter/day for 5-10 days; begin second course in 2-4 weeks after initial therapy if necessary OR 100 mg/sq.meter for 7 days OR 100 mg/sq.meter/dose q12hr for 7 days Intrathecal (IT) administration for remission induction 5-75 mg/sq.meter q2-7Days until CNS findings normalize IV administration for remission maintenance 70-200 mg/sq.meter/day for 2-5 days at monthly intervals IM administration for remission maintenance 1-1.5 mg/kg single dose for maintenance at 1- 4 week intervals Meningeal Leukemia IT administration 30 mg/sq.meter intrathecal (IT) q4Days until CSF findings normal plus one additional dose Refractory Leukemia IV administration 3 g/sq.meter IV (infusion over 1-3 hours) q12hr x 4-12 doses Repeat q2-3Weeks

Child Dose

Renal Dose

Administration

IV Administration Rapid IV, infusion over 1-3 hr, or SC intrathecal Has been administered by IM & continuous SC infusion IT: Patient should lie flat for 1 hour after lumbar puncture Liposomal: To reduce incidence of arachnoiditis, administer dexamethasone concurrently IV Preparation Reconstitute vials in BWI containing benzyl alcohol 0.945% as follows (CAUTION: Do not use benzyl alcohol for intrathecal inj) 100 mg vial: add 5 mL diluent to 20 mg/mL 500 mg vial: add 10 mL diluent to 50 mg/mL 1 g vial: add 10 mL diluent to 100 mg/mL 2 g vial: add 20 mL diluent to 100 mg/mL

Contra Indications

Hypersensitivity; pregnancy and lactation.

Precautions

Hepatic and renal dysfunction, severe infections, preexisting drug-induced bone marrow suppression. Monitor WBC, platelet counts and blood uric acid frequently. Assess renal and hepatic function periodically. Lactation: not known if excreted in breast milk, avoid

Pregnancy-Lactation

Pregnancy Category: D Lactation: not known if excreted in breast milk, avoid

Interactions

May reduce efficacy of gentamicin, digoxin and flucytosine. Potentially Fatal: Potentiates bone marrow depression with radiotherapy and other myelotoxic drugs.

Adverse Effects

Side effects of Cytarabine : 1-10% Anorexia, Nausea, Vomiting, Diarrhea, Oral/anal inflammation, Thrombophlebitis, Bleeding, Myelosuppression, Rash, Fever, Hepatic dysfunction Frequency Not Defined Headache, Neuropathy, Chest pain, Pericarditis, Pneumonia, Anemia, Bleeding, Leukopenia, Thrombocytopenia, Kidney disease, Infectious disease, Sepsis, "Cytarabine syndrome": fever, myalgia, bone pain, rash, conjunctivitis, malaise, Skin ulcers, Cellulitis, Urinary retention, Neuritis, Jaundice, Anaphylaxis Potentially Fatal: Convulsions. Cerebellar dysfunction, respiratory distress syndrome, GI perforation, bone marrow suppression.

Mechanism of Action

Cytarabine acts by interfering with DNA synthesis specifically at the S-phase of the cell cycle. It is a potent myelosuppressant and requires careful haematological monitoring during its use. It also has antiviral property.