Generic Name: fludarabine (floo-DAYR-a-been)
Brand Name: Fludara
Some patients who received high doses of fludarabine to treat acute leukemia developed severe nervous system side effects, including blindness, coma, and death. Similar nervous system side effects, including coma, seizures, agitation, and confusion, have occurred in patients at doses recommended for the treatment of chronic lymphocytic leukemia. Discuss any questions or concerns with your doctor. Contact your doctor right away if any of these effects occur.
Fludarabine may severely decrease bone marrow function. This can lower your body's ability to fight infection and reduce the ability of your blood to clot properly. Some patients have developed severe and sometimes fatal blood problems (eg, hemolytic anemia, autoimmune thrombocytopenia, hemophilia) while using fludarabine. Your doctor will need to monitor you closely for these conditions. Tell your doctor right away if you develop signs or symptoms of an infection (eg, swollen glands, sore throat, fever, chills), bleeding problems (eg, easy bruising; black, tarry stools; bleeding from the gums), or hemolytic anemia (eg, yellowing of the eyes or skin, dark urine, severe tiredness or weakness). Be sure to keep all doctor and laboratory appointments.
Fatal lung problems have been reported in patients receiving fludarabine along with pentostatin. Fludarabine is not recommended for use with pentostatin.
Fludarabine is used for:
Treating patients with certain types of leukemia who have not responded to other therapy or whose disease has progressed during treatment with other medicines. It may also be used for other conditions as determined by your doctor.
Fludarabine is an antimetabolite. It works by preventing the cancer cell from reproducing, which results in death of the cell.
Do NOT use fludarabine if:
- you are allergic to any ingredient in fludarabine
- you are taking pentostatin
- you have severely decreased kidney function
Contact your doctor or health care provider right away if any of these apply to you.
Before using fludarabine:
Some medical conditions may interact with fludarabine. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
- if you are pregnant, planning to become pregnant, or are breast-feeding
- if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
- if you have allergies to medicines, foods, or other substances
- if you have a history of bone marrow problems (eg, low blood platelet levels, anemia), blood or bleeding problems, kidney problems, immune system problems, nervous system problems, infections, skin cancer, autoimmune hemolytic anemia, or a positive Coombs test
- if you receive other chemotherapy, radiation therapy, or you have received radiation or chemotherapy in the past
- if you have developed an autoimmune reaction (eg, hemolytic anemia) after receiving fludarabine
- if you will be having a blood transfusion
Some MEDICINES MAY INTERACT with fludarabine. Tell your health care provider if you are taking any other medicines, especially any of the following:
- Pentostatin because the risk of fatal lung problems may be increased
- Digoxin because its effectiveness may be decreased by fludarabine
This may not be a complete list of all interactions that may occur. Ask your health care provider if fludarabine may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
How to use fludarabine:
Use fludarabine as directed by your doctor. Check the label on the medicine for exact dosing instructions.
- Fludarabine is usually given as an injection at your doctor's office, hospital, or clinic. If you will be using fludarabine at home, a health care provider will teach you how to use it. Be sure you understand how to use fludarabine. Follow the procedures you are taught when you use a dose. Contact your health care provider if you have any questions.
- Avoid contact with skin and mucous membranes (eg, mouth, nose). If fludarabine accidentally spills on your skin, wash it off immediately with soap and water. If it gets in your eyes, rinse thoroughly with plain tap water.
- Do not use fludarabine if it contains particles, is cloudy or discolored, or if the vial is cracked or damaged.
- If you miss a dose of fludarabine, contact your doctor right away.
Ask your health care provider any questions you may have about how to use fludarabine.
Important safety information:
- Fludarabine may cause drowsiness, dizziness, tiredness, weakness, vision problems, confusion, agitation, or seizures. Some of these effects may be worse if you use it with alcohol or certain medicines. Use fludarabine with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
- If vomiting or diarrhea occurs, you will need to take care not to become dehydrated. Contact your doctor for instructions.
- Fludarabine may reduce the number of clot-forming cells (platelets) in your blood. Avoid activities that may cause bruising or injury. Tell your doctor if you have unusual bruising or bleeding. Tell your doctor if you have dark, tarry, or bloody stools.
- Fludarabine may lower the ability of your body to fight infection and may increase the risk of severe and sometimes fatal infection. Avoid contact with people who have colds or infections. Tell your doctor if you notice signs of infection like fever, sore throat, rash, or chills.
- Do not receive a live vaccine (eg, measles, mumps) during or after treatment with fludarabine. Talk with your doctor before you receive any vaccine.
- New or worsening skin cancer has been reported with fludarabine. Tell your doctor if you have a history of skin cancer. Contact your doctor right away if you notice a change in the appearance of a mole, new growth on the skin, or any unusual skin change.
- Serious bone marrow problems (myelodysplastic syndrome [MDS]) and a type of leukemia (acute myeloid leukemia [AML]) have been reported with fludarabine. Most reports were in patients who had also been treated with certain other chemotherapy medicines or radiation. Tell your doctor if you have ever received other chemotherapy or radiation treatments. Contact your doctor if you have questions about this information.
- A severe and possibly fatal nervous system problem (progressive multifocal leukoencephalopathy [PML]) has been reported in patients who use fludarabine. This has been reported to develop between a few weeks and as long as about 1 year after starting treatment. Many of these patients were also taking other chemotherapy or had received other chemotherapy in the past. Contact your doctor right away if you develop signs of PML, such as trouble walking or talking, confusion, vision problems, or vision loss.
- Men who may father a child and women who may become pregnant must use an effective form of birth control (eg, condoms) while using fludarabine and for 6 months after stopping treatment. If you have questions about effective birth control, talk with your doctor.
- Fludarabine may cause infertility in men that is sometimes permanent. Discuss any questions or concerns with your doctor.
- Lab tests, including complete blood cell counts, may be performed while you use fludarabine. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
- Use fludarabine with caution in the ELDERLY; they may be more sensitive to its effects.
- Fludarabine should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed.
- PREGNANCY and BREAST-FEEDING: Fludarabine has been shown to cause harm to the fetus. Avoid becoming pregnant while you use it and for 6 months after you stop treatment. If you think you may be pregnant, contact your doctor. You will need to discuss the benefits and risks of using fludarabine while you are pregnant. It is not known if fludarabine is found in breast milk. Do not breast-feed while using fludarabine.
Possible side effects of fludarabine:
All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:
Seek medical attention right away if any of these SEVERE side effects occur:
Diarrhea; general body discomfort; loss of appetite; muscle pain; nausea; tiredness; vomiting; weakness.
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); abnormal thinking; black, tarry, or bloody stools; bloody or dark urine; changes in strength or the way you walk; chest pain; confusion; coughing or vomiting blood; difficult, decreased, or painful urination; fainting; hearing loss; irregular heartbeat; lower back or side pain; mental or mood changes (eg, agitation); muscle weakness or cramps; numbness or tingling in the hands or feet; red, swollen, blistered, or peeling skin; seizures; severe or persistent tiredness or weakness; shortness of breath; signs of infection (eg, fever, chills, cough, or sore throat); skin changes; swelling of the fingers, hands, or feet; swelling or sores of the mouth, lips, or tongue; unusual bruising or bleeding; vision changes or blindness; vomit that looks like coffee grounds; yellowing of the eyes or skin.
This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.
If OVERDOSE is suspected:
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include bleeding; blindness; coma; infection.Proper storage of fludarabine:
Fludarabine is usually handled and stored by a health care provider. If you are using fludarabine at home, store fludarabine as directed by your pharmacist or health care provider. Keep fludarabine out of the reach of children and away from pets.
- If you have any questions about fludarabine, please talk with your doctor, pharmacist, or other health care provider.
- Fludarabine is to be used only by the patient for whom it is prescribed. Do not share it with other people.
- If your symptoms do not improve or if they become worse, check with your doctor.
- Check with your pharmacist about how to dispose of unused medicine.
This information should not be used to decide whether or not to take fludarabine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about fludarabine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to fludarabine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using fludarabine.
Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using this medicine.
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