Posted on April 28th, 2009 by
Generic Name: Cytarabine (sigh-TARE-a-been), Ara-C, Arabinosylcytosine
Trade Name: Cytosar-U®
For which conditions is this drug approved? Cytarabine is FDA approved in combination with other anticancer drugs for the treatment of acute myelogenous leukemia, acute lymphocytic leukemia, and the blast phase of chronic myelocytic leukemia. It is also indicated for intrathecal administration in the prevention and treatment of meningeal leukemia. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Cytarabine belongs to a group of drugs called antimetabolites. Cytarabine produces its anti-cancer effects by inhibiting the ability of a cell to produce DNA or repair DNA. By inhibiting the production and repair of DNA, cytarabine suppresses the ability of a cell to replicate or repair itself, ultimately causing cellular death.
How is cytarabine typically given (administered)? Cytarabine may be administered intravenously (into a vein), subcutaneously (injection under the skin), intramuscularly (injection into a muscle), or intrathecally (into the spinal fluid). Cytarabine also comes in a long-acting form (DepoCyt™) that may be placed under the skin in a reservoir, with a catheter leading to the brain. The route, dose and scheduling in which cytarabine is administered is dependent upon many factors, including the condition being treated, the particular treatment regimen being utilized, the patient’s height and weight, overall health, and the patient’s tolerance of therapy.
How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with cytarabine. Typically, blood may be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Physical examinations, scans, or other measures may also be utilized to assess side effects and response to therapy.
In addition, some patients are susceptible to developing a condition called tumor lysis syndrome, in which electrolyte and metabolic disturbances occur. Tumor lysis syndrome can be prevented if managed aggressively at the beginning of treatment. Blood tests will measures levels of electrolyte and metabolic products, and patients should contact their healthcare provider if they experience symptoms such as nausea and vomiting, shortness of breath, an irregular heartbeat, clouding of urine, lethargy and/or joint discomfort.
What are the common (occur in 30% or more of patients) side effects of treatment with cytarabine?
• Low levels of white blood cells – increases risk of infection
• Low levels of red blood cells – increases risk of anemia and blood transfusions
• Low levels of platelets – increases risk of bleeding
• Nausea and vomiting
• Abnormalities in liver function levels, as determined by blood tests
• Mouth sores
• Increase in levels of uric acid – can lead to a condition called tumor lysis syndrome if not treated
What are the less common (occur in 10% to 29% of patients) side effects of treatment with cytarabine?
• Loss of appetite
• Skin reactions, rash
• Hand-foot syndrome (skin peeling, pain, redness of the palms of the hands or soles of the feet)
• Central neurotoxicity characterized by confusion, loss of balance, headache, dizziness, excessive drowsiness
• Eye reactions characterized by vision changes, tearing, pain, or sensitivity to light, eye irritation
• Hair loss
• Bone pain
• Abdominal pain
This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.
Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.
What can patients do to help alleviate or prevent discomfort and side effects?
• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Keep hands and feet moisturized to help prevent hand-foot syndrome – patients should speak with their physician regarding the best products to use for this side effect.
• Minimize friction, excessive heat and cold to the palms of the hands and soles of the feet to help reduce the incidence and severity of hand-foot syndrome.
• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• Eat small meals frequently to help alleviate nausea.
• For mouth sores, patients should rinse their mouth three times a day with a salt and soda solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If patients have been prescribed an anti-nausea medication, they should be sure to take the prescribed doses.
Are there any special precautions patients should be aware of before starting treatment?
• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
When should patients notify their physician?
• Sore throat
• Flu or cold-like symptoms
• Signs of infection (redness, swelling, tenderness, drainage, painful or frequent urination)
• Excessive and persistent fatigue
• Unexplained bleeding (nosebleeds, bruising, blood in urine, black tarry stools, etc.)
• Symptoms that may be indicative of tumor lysis syndrome – nausea, joint pain, lethargy, irregular heartbeat, shortness of breath and/or cloudy urine
• Mouth sores
• Yellowing of skin or eyes
• Shortness of breath, difficulty breathing
• Inability to urinate
• Abdominal pain
• Loss of balance and coordination, dizziness, extreme lethargy, confusion, headache, mood swings
• Severe or persistant diarrhea
• Severe or persistant nausea or vomiting
• Mouth sores (painful redness, swelling or ulcers)
• Excessive sleepiness or confusion
• Changes in vision or burning/or tearing of eyes, sensitivity to light, dry,irritated eyes
• Swelling, redness and pain in one leg or arm and not the other
• Slurred speech
• Numbness, tingling or pain in fingers, toes
• Bone, muscle or chest pain
• Change in heart rhythm
• Swelling of feet or lower legs
• Skin rash or itching
What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.
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