Cladribine Disease Interactions

Because of their cytotoxic effects on rapidly proliferating tissues, antineoplastic agents frequently can, to varying extent, induce myelosuppression. The use of these drugs may be contraindicated in patients with known infectious diseases. All patients should be instructed to immediately report any signs or symptoms suggesting infection such as fever, sore throat, or local infection during antineoplastic therapy. Close clinical monitoring of hematopoietic function is recommended.

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Cladribine induces myelosuppression, primarily affecting lymphocytes and monocytes, however, neutropenia, anemia, and thrombocytopenia have been reported during cladribine therapy. Myelosuppressive effects are most notable the first month following therapy and may require red blood cell and/or platelet transfusions. Therapy with cladribine should be administered cautiously in patients whose bone marrow reserve may be severely depressed by prior chemotherapy or whose marrow function is recovering from previous cytotoxic therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitoring of hematopoietic function is recommended.

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Severe unspecified neurological toxicity has been reported rarely during cladribine therapy administered at therapeutic doses. Serious neurological toxicity such as irreversible paraparesis and quadriparesis has been reported in patients receiving four to nine times the recommended dosage of cladribine for hairy cell leukemia. Therapy with cladribine should be administered cautiously to patients with or predisposed to neurological impairment.

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The pharmacokinetic disposition of cladribine has not be fully assessed. The effect of hepatic impairment on the elimination of cladribine is not known. Therapy with cladribine should be administered cautiously in patient with existing or predisposition to compromised hepatic function. Clinical monitoring of hepatic function is recommended.

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The effect of renal impairment on the elimination of cladribine has not been assessed in humans. Renal toxicity such as acidosis, anuria, elevated serum creatinine has been reported with doses four to nine times the recommended dosage of cladribine for hairy cell leukemia. Therapy with cladribine should be administered cautiously in patient with compromised renal function. Clinical monitoring of renal function is recommended.

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