Cytarabine

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Generic Name of Cytarabine - Learn More

Cytarabine

Cytarabine Precaution - What You Need to Know

Before starting Cytarabine therapy, patients should consult their healthcare provider to ensure that this medication is suitable for their specific medical condition. Some important precautions include:

- Bone Marrow Suppression: Cytarabine can cause severe bone marrow suppression, leading to leukopenia, thrombocytopenia, and anemia. Regular blood monitoring is necessary, especially during prolonged therapy, as this can increase the risk of infections and bleeding.
- Hepatic and Renal Impairment: Patients with liver or kidney impairment should be closely monitored, as reduced liver or kidney function can lead to slower drug clearance and increased toxicity. Dose adjustments may be required.
- Infections: Since Cytarabine suppresses the immune system, patients are more susceptible to infections. Prophylactic treatment and careful monitoring for infections should be considered during therapy.
- Gastrointestinal Effects: Cytarabine can cause nausea, vomiting, and mucositis (inflammation of the mucous membranes), leading to mouth sores and difficulty swallowing. Supportive care may be necessary to manage these side effects.
- Pregnancy and Breastfeeding: Cytarabine is a Category D drug, meaning it can cause harm to the fetus. It should be avoided during pregnancy unless absolutely necessary. It is also contraindicated during breastfeeding because it may pass into breast milk and harm the infant.
- Neurotoxicity: High doses of Cytarabine may cause neurotoxicity, including ataxia, drowsiness, confusion, and seizures. Neurological status should be monitored throughout treatment.

Cytarabine Indication - Uses and Benefits

Cytarabine is a chemotherapeutic agent primarily used for the treatment of various cancers and certain hematologic disorders. Its key indications include:

- Acute Leukemias: Cytarabine is commonly used for the treatment of acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), often as part of combination chemotherapy regimens.
- Chronic Myelogenous Leukemia (CML): In certain cases, Cytarabine may be used in the treatment of CML during the blast phase.
- Lymphoma: Cytarabine is sometimes used for the treatment of lymphoma, particularly in cases of non-Hodgkin's lymphoma.
- Other Hematologic Malignancies: Cytarabine may be used in the management of Hodgkin’s lymphoma and other hematological malignancies, either alone or in combination with other chemotherapeutic agents.
- Bone Marrow Disorders: Cytarabine is also used in bone marrow transplant regimens and myelodysplastic syndromes as part of conditioning therapy.

Cytarabine Contraindications - Important Warnings

Cytarabine should be avoided in certain situations where it may pose risks to patients:

- Hypersensitivity: Patients with a known hypersensitivity to Cytarabine or any of its components should not use this medication.
- Severe Bone Marrow Suppression: Cytarabine is contraindicated in patients with severe bone marrow suppression or bone marrow failure, as it can further worsen these conditions.
- Severe Liver or Kidney Disease: Patients with significant liver or kidney dysfunction should avoid Cytarabine, as it may lead to toxic accumulation of the drug.
- Pregnancy: Cytarabine is contraindicated in pregnancy due to its teratogenic effects. It is recommended for use only when the potential benefit justifies the potential fetal risk.
- Breastfeeding: Cytarabine is contraindicated for use in breastfeeding women as it can pass into breast milk and harm the infant.

Cytarabine Side Effects - What to Expect

Cytarabine is associated with a range of side effects, which can be mild to severe:

- Common Side Effects:
- Nausea and vomiting
- Fatigue and weakness
- Hair loss (alopecia)
- Mouth sores (mucositis), causing pain and difficulty swallowing
- Diarrhea
- Fever and chills (due to bone marrow suppression)

- Serious Side Effects:
- Bone Marrow Suppression: Leading to leukopenia, anemia, and thrombocytopenia, increasing the risk of infections and bleeding.
- Neurotoxicity: Especially with high doses, it can cause confusion, drowsiness, ataxia, and seizures.
- Hepatotoxicity: Cytarabine can cause elevations in liver enzymes and may lead to liver damage in some patients.
- Pulmonary Toxicity: Rare but severe cases of pneumonitis or interstitial lung disease can occur, leading to symptoms like shortness of breath and cough.
- Cerebellar Toxicity: Particularly in high-dose regimens, patients may develop ataxia and gait instability, which may be signs of cerebellar toxicity.
- Secondary Malignancies: Long-term use of Cytarabine has been linked to the development of secondary malignancies, including leukemia.

Patients should notify their healthcare provider immediately if they experience any severe side effects, such as persistent fever, confusion, or signs of infection.

Cytarabine Pregnancy Category ID - Safety Information

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Cytarabine Mode of Action - How It Works

Cytarabine is an antimetabolite that works by interfering with DNA synthesis. Its mechanism of action involves:

- Inhibition of DNA Synthesis: Cytarabine is metabolized inside cells to ara-CTP (cytosine arabinoside triphosphate), which competes with deoxycytidine triphosphate for incorporation into the DNA strand. Once incorporated into the DNA, ara-CTP inhibits DNA polymerase, preventing the elongation of the DNA strand.
- Cell Cycle Arrest: Cytarabine predominantly affects the S-phase of the cell cycle, where DNA replication occurs. By inhibiting DNA synthesis, it leads to cell cycle arrest and apoptosis (programmed cell death) of rapidly dividing cancer cells.
- Selective Cytotoxicity: Though Cytarabine affects all rapidly dividing cells, it is particularly effective against hematologic malignancies due to their high rate of division.

Cytarabine Drug Interactions - What to Avoid

Cytarabine interacts with several medications and substances that can alter its efficacy and increase the risk of adverse effects:

- Bone Marrow Suppressants: Concurrent use with other myelosuppressive agents (e.g., methotrexate, vincristine, cyclophosphamide) can significantly increase the risk of severe bone marrow suppression.
- Radiation Therapy: When used in conjunction with radiation therapy, particularly in the treatment of CNS leukemias, the risk of neurotoxicity may be higher.
- Phenytoin: There is some evidence that phenytoin (an anticonvulsant) may interact with Cytarabine, potentially reducing its anticonvulsant effect. Close monitoring of serum drug levels may be required.
- Hydroxyurea: When used together with hydroxyurea, Cytarabine’s cytotoxic effects may be enhanced, leading to increased toxicity, particularly concerning myelosuppression.
- Live Vaccines: Patients undergoing treatment with Cytarabine should avoid receiving live vaccines (e.g., yellow fever, measles, mumps vaccines) as they may lead to severe infections due to the immunosuppressive effects of the drug.

Cytarabine Adult Dose - Recommended Dosage

The dosing of Cytarabine varies depending on the condition being treated and whether it is used as monotherapy or in combination:

- Acute Myeloid Leukemia (AML): The usual adult dose is 100-200 mg/m²/day administered as an intravenous infusion over 1-2 hours for 7 days (typically as part of a combination regimen).
- Acute Lymphoblastic Leukemia (ALL): In combination with other agents, the dose can be 1-3 g/m²/day administered by intravenous infusion or as a continuous infusion.
- Chronic Myelogenous Leukemia (CML): The recommended dose is typically 400-1000 mg/m²/day for the induction phase, followed by maintenance doses.
- Non-Hodgkin's Lymphoma: Doses vary widely, typically between 100 mg/m² and 200 mg/m² in combination chemotherapy regimens.

Cytarabine Child Dose - Dosage for Children

Pediatric doses of Cytarabine depend on the condition being treated and the specific age of the child:

- Acute Lymphoblastic Leukemia (ALL): Pediatric doses typically range from 100-200 mg/m²/day intravenously for 7 days as part of combination chemotherapy.
- Acute Myeloid Leukemia (AML): The recommended dose for pediatric patients is 100-200 mg/m²/day administered intravenously for 7 days.
- Chronic Myelogenous Leukemia (CML): For the induction phase, 400-1000 mg/m²/day is often used in combination with other agents.

As with adults, dosing adjustments may be required depending on the patient's renal and hepatic function. Pediatric doses should always be determined by a healthcare provider based on the child’s clinical condition and response to treatment.

Cytarabine Renal Dose - Dosage for Kidney Conditions

Cytarabine is primarily eliminated by the kidneys, so patients with renal impairment need careful monitoring and potential dose adjustments:

- Mild to Moderate Renal Impairment: For patients with creatinine clearance (CrCl) between 30-60 mL/min, the dose of Cytarabine may need to be reduced by 50% to avoid toxicity.
- Severe Renal Impairment: Cytarabine is not recommended in patients with CrCl < 30 mL/min due to the high risk of accumulation and severe toxicity.