fludarabine (Oral route)

floo-DAYR-a-been

Oral route(Tablet)

Can severely suppress bone marrow function and when used at high doses in dose-ranging studies in patients with acute leukemia, was associated with severe neurologic effects, including blindness, coma, and death. Life-threatening and sometimes fatal autoimmune hemolytic anemia has been reported to occur after one or more cycles of treatment. Closely monitor patients for hemolysis. In a clinical investigation using fludarabine phosphate in combination with pentostatin (deoxycoformycin) for the treatment of refractory CLL, there was an unacceptably high incidence of fatal pulmonary toxicity. Therefore, the use of fludarabine phosphate in combination with pentostatin is not recommended .

Available Dosage Forms:

  • Tablet

Therapeutic Class: Antineoplastic Agent

Pharmacologic Class: Antimetabolite

Uses For fludarabine

Fludarabine belongs to the group of medicines called antimetabolites. It is used to treat a type of cancer of the white blood cells called B-cell chronic lymphocytic leukemia (CLL). fludarabine is used in patients with CLL who have already been treated with an alkylating agent (eg, bendamustine) that did not work well.

Fludarabine interferes with the growth of cancer cells, which are eventually destroyed. Since the growth of normal cells may also be affected by the medicine, other effects may also occur. Some of these may be serious and must be reported to your doctor. Other effects may not be serious but may cause concern. Some effects may occur after treatment with fludarabine has been stopped.

Before you begin treatment with fludarabine, you and your doctor should talk about the good fludarabine will do as well as the risks of using it.

fludarabine was available only with your doctor's prescription. Oral fludarabine was withdrawn from the US market in September 2011.

Before Using fludarabine

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 fludarabine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to fludarabine 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 have not been performed on the relationship of age to the effects of fludarabine in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of fludarabine in the elderly.

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. When you are taking fludarabine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using fludarabine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Rotavirus Vaccine, Live

Using fludarabine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Adenovirus Vaccine Type 4, Live
  • Adenovirus Vaccine Type 7, Live
  • Bacillus of Calmette and Guerin Vaccine, Live
  • Influenza Virus Vaccine, Live
  • Measles Virus Vaccine, Live
  • Mumps Virus Vaccine, Live
  • Pentostatin
  • Rubella Virus Vaccine, Live
  • Smallpox Vaccine
  • Typhoid Vaccine
  • Varicella Virus Vaccine
  • Yellow Fever Vaccine

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 fludarabine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Bone marrow problems (e.g., anemia, neutropenia, or thrombocytopenia)—Fludarabine may worsen these conditions.
  • Infection—Fludarabine may decrease your body's ability to fight infection.
  • Kidney disease—Use with caution. Effects may be increased because of the slower removal of the medicine from the body.
  • Transfusions—Non-irradiated blood transfusion may increase the risk of side effects of fludarabine.

Proper Use of fludarabine

Take fludarabine exactly as directed by your doctor. Do not take it more often, and do not take it for a longer time than your doctor ordered. Also, do not stop taking fludarabine without checking with your doctor first.

Swallow the tablet whole with a full glass of water. Do not split, crush, or chew it. You may take the tablet with or without food.

Be careful in handling fludarabine. Do not crush the tablets. If any of fludarabine gets on your skin or in your eyes, nose, or mouth, wash it with soap and water or wash the eyes immediately with gently flowing water for at least 15 minutes. Also, check with your doctor right away if a skin reaction occurs.

Dosing

The dose of fludarabine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of fludarabine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For chronic lymphocytic leukemia:
      • Adults—Dose is based on body surface area and must be determined by your doctor. However, the dose is usually 40 mg/m(2) once a day for 5 days. This 5-day treatment is given again every 28 days until your body responds to the medicine.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

fludarabine needs to be given on a fixed schedule. If you miss a dose, call your doctor, home health caregiver, or treatment clinic for instructions.

If you vomit after taking your medicine, call your doctor or pharmacist for instructions.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using fludarabine

It is very important that your doctor check your progress at regular visits to make sure that fludarabine is working properly. Blood tests may be needed to check for unwanted effects.

Fludarabine can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection (e.g., pneumonia). 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 an infection or bleeding:

  • If you can, avoid people with infections. Check with your doctor right away if you think you are getting an infection or if you have fever or chills; cough or hoarseness; lower back or side pain; painful or difficult urination; shortness of breath; or unusual bleeding or bruising.
  • 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 or toenail cutters.
  • Avoid contact sports or other situations where bruising or injury could occur.

You should not use fludarabine if you are also taking pentostatin (Nipent®). Taking it together with fludarabine may increase the chance of serious side effects.

fludarabine may cause a serious type of reaction called tumor lysis syndrome. 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; a rapid weight gain; swelling of the feet or lower legs; or unusual tiredness or weakness.

Using fludarabine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. You should not become pregnant while you are taking fludarabine and for 6 months after stopping it. If you think you have become pregnant while using the medicine, tell your doctor right away.

fludarabine 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 immediately if any of the following side effects occur:

More common
  • Bloating or swelling of the face, arms, hands, lower legs, or feet
  • body aches or pain
  • burning or stinging of the skin
  • chest pain
  • cough or hoarseness
  • cough producing mucus
  • diarrhea
  • difficult or labored breathing
  • difficulty in breathing
  • ear congestion
  • fever or chills
  • general feeling of discomfort or illness
  • headache
  • joint pain
  • loss of appetite
  • loss of voice
  • lower back or side pain
  • muscle aches and pains
  • nasal congestion
  • nausea
  • painful cold sores or blisters on the lips, nose, eyes, or genitals
  • painful or difficult urination
  • rapid weight gain
  • runny nose
  • shivering
  • shortness of breath
  • sneezing
  • sore throat
  • stuffy nose
  • sweating
  • tightness in the chest
  • tingling of hands or feet
  • trouble sleeping
  • troubled breathing
  • unusual tiredness or weakness
  • unusual weight gain or loss
  • vomiting
  • wheezing
Less common
  • Bladder pain
  • bloody or cloudy urine
  • difficult, burning, or painful urination
  • frequent urge to urinate
  • pain or tenderness around the eyes and cheekbones
Incidence not known
  • Back pain
  • bloody, black, or tarry stools
  • blue lips, fingernails, or skin
  • blurred vision
  • confusion
  • convulsions
  • coughing up blood
  • difficult or fast breathing
  • dizziness
  • drowsiness
  • high fever
  • irregular, fast or slow, or shallow breathing
  • pale skin
  • sores, ulcers, or white spots on the lips or in the mouth
  • swollen glands
  • unexplained bleeding or bruising
  • unusual bleeding or bruising

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
  • Abdominal pain
  • increased sweating
  • weight loss
Less common
  • 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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