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clofarabine (Intravenous route)

kloe-FAR-a-been

Commonly used brand name(s)

In the U.S.

  • Clolar

Available Dosage Forms:

  • Solution

Therapeutic Class: Antineoplastic Agent

Pharmacologic Class: Antimetabolite

Chemical Class: Purine Nucleoside Analog

Uses For clofarabine

Clofarabine injection is used to treat acute lymphoblastic leukemia (ALL), a cancer of the white blood cells, in patients who have already used at least 2 other cancer medicines.

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Clofarabine is an antineoplastic (cancer) medicine. It interferes with the growth of cancer cells, which are eventually destroyed by the body. Since the growth of normal cells may also be affected by clofarabine, other unwanted effects can occur. Before you begin treatment, talk to your doctor about the benefits of clofarabine as well as the possible risks of using it.

clofarabine is to be given only by or under the immediate supervision of your doctor.

Before Using clofarabine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For clofarabine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to clofarabine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of clofarabine injection in children 1 year of age and older.

Geriatric

Appropriate studies on the relationship of age to the effects of clofarabine injection have not been performed in the geriatric population. Safety and efficacy have not been established in elderly patients 65 years of age.

Pregnancy

Pregnancy Category Explanation
All Trimesters D Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of clofarabine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Anemia (low red blood cells) or
  • Infection (eg, bacteria, fungus, virus) or
  • Liver disease or
  • Neutropenia (low white blood cells) or
  • Thrombocytopenia (low platelets in the blood)—Use with caution. May make these conditions worse.
  • Kidney disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of clofarabine

You will receive clofarabine while you or your child are in a hospital or cancer treatment center. A doctor or other trained health professional will give you clofarabine. clofarabine is given through a needle placed in one of your veins.

While you are receiving clofarabine, it is important that you drink extra fluids so you will pass more urine. This will help prevent unwanted effects on the kidney.

Precautions While Using clofarabine

It is very important that your doctor check the progress of you or your child at regular visits to make sure that clofarabine is working properly. Blood and urine tests may be needed to check for unwanted effects.

Using clofarabine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.

Clofarabine can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

  • If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you have fever or chills, a cough or hoarseness, lower back or side pain, or painful or difficult urination.
  • Check with your doctor immediately if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin.
  • Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
  • Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
  • Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail and toenail cutters.
  • Avoid contact sports or other situations where bruising or injury could occur.

clofarabine may cause a serious type of reaction called the tumor lysis syndrome. This syndrome may cause you to have high amounts of uric acid in the blood (hyperuricemia). Your doctor may give you a medicine to help prevent this. Call your doctor right away if you have a decrease or change in urine amount; joint pain, stiffness, or swelling; lower back, side, or stomach pain; rapid weight gain; swelling of the feet or lower legs; or unusual tiredness or weakness.

Call your doctor right away if you have dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position; a fast or irregular heartbeat; shortness of breath; or swelling of the hands, ankles, feet, or lower legs. These may be symptoms of rare but serious conditions called capillary leak syndrome or systemic inflammatory response syndrome (SIRS).

Check with your doctor right away if you have stomach pain, pale stools, or dark urine; a loss of appetite; or yellow eyes or skin. These could be symptoms of a serious liver problem.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

clofarabine Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common
  • Abdominal or stomach pain or tenderness
  • area rash
  • black, tarry stools
  • bleeding gums
  • blood in the urine or stools
  • bloody nose
  • blurred vision
  • burning or stinging of the skin
  • chest pain
  • chills
  • clay-colored stools
  • cold or flu-like symptoms
  • confusion
  • cough or hoarseness
  • dark urine
  • decreased urine output
  • diarrhea
  • difficult or labored breathing
  • dilated neck veins
  • dizziness
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • facial swelling
  • fainting
  • fast, pounding, or irregular heartbeat or pulse
  • feeling of warmth
  • fever
  • flushing, redness of the skin
  • headache
  • irregular breathing
  • itching
  • itching in the genital area
  • joint pain, stiffness, or swelling
  • lightheadedness
  • loss of appetite
  • lower back or side pain
  • nausea
  • nervousness
  • pain
  • painful cold sores or blisters on the lips, nose, eyes, or genitals
  • painful or difficult urination
  • pale skin
  • pinpoint red spots on the skin
  • pounding in the ears
  • rapid, shallow breathing
  • redness of the face, neck, arms, and occasionally, upper chest
  • redness, swelling, or skin pain
  • scaling of the skin on the hands and feet
  • severe abdominal or stomach cramps with pain
  • skin rash
  • slow or fast heartbeat
  • small red or purple spots on the skin
  • sneezing
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • sweating
  • swelling of the ankles, feet, or lower legs
  • swelling or inflammation of the mouth
  • swollen glands
  • tenderness
  • tightness in the chest
  • tingling of the hands and feet
  • troubled breathing with exertion
  • ulcers, sores, or white spots in the mouth
  • unpleasant breath odor
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • unusually warm skin
  • vomiting
  • vomiting of blood
  • warmth on the skin
  • watery and severe diarrhea, which may also be bloody
  • weight gain
  • yellow eyes or skin
Less common
  • Agitation
  • bloating
  • blue lips and fingernails
  • chest pain or discomfort
  • cloudy urine
  • constipation
  • coughing that sometimes produces a pink frothy sputum
  • darkened urine
  • decrease or increase in the amount of urine
  • decreased level of consciousness
  • depression
  • difficult, fast, or noisy breathing, sometimes with wheezing
  • dry mouth
  • general feeling of discomfort or illness
  • hives
  • hostility
  • hyperventilation
  • increased sweating
  • indigestion
  • irritability
  • muscle aches and pains
  • muscle twitching
  • pain or tenderness around the eyes and cheekbones
  • pains in the stomach, side, or abdomen, possibly radiating to the back
  • rapid weight gain
  • restlessness
  • seizures (convulsions)
  • shaking
  • shivering
  • stuffy or runny nose
  • swelling of the eyelids, face, lips, or hands
  • trouble sleeping
Incidence not known
  • Blistering, peeling, or loosening of the skin
  • red irritated eyes
  • red skin lesions, often with a purple center

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Back pain
  • bone pain
  • bruises on the skin
  • cracked lips
  • difficulty with moving
  • difficulty with swallowing
  • discouragement
  • dry skin
  • fear
  • feeling sad or empty
  • feeling unusually cold
  • injection site pain
  • itching, pain, redness, swelling, tenderness, or warmth on the skin at the injection site
  • lack or loss of strength
  • loss of interest or pleasure
  • muscle pain or stiffness
  • pain in the limbs
  • pain in the rectum
  • right upper stomach pain and fullness
  • skin discoloration
  • sore mouth or tongue
  • swollen joints
  • tiredness
  • trouble concentrating
  • unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
  • unusually warm skin
  • weight loss
  • white patches with diaper rash

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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