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Overview

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This medicine contains an important and useful components, as it consists of
Borneol, Camphene, Cineol, Levomenthol, Menthone, Pinene (? + ?)is available in the market in concentration

Name

Cytarabine

Precaution

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.

Indication

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.

Contra indication

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.

Side Effect

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.

Pregnancy Category ID

4

Mode of Action

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.

Interaction

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.

Pregnancy Category Note

Information not available

Adult Dose

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.

Child Dose

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.

Renal Dose

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.

Administration

Information not available