ectable Administration
Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.
Intravenous Administration
Administer as an intravenous infusion.
Do not dilute prior to administration. Transfer the appropriate amount of nelarabine into polyvinylchloride (PVC) infusion bags or glass containers.
Nelarabine injection is stable in PVC bags or glass containers for up to 8 hours at up to 30 degrees C.
Intravenous infusion:
Adults: Infuse nelarabine intravenously over 2 hours.
Pediatrics: Infuse nelarabine intravenously over 1 hour.
STORAGE
Arranon:
- Discard product if it contains particulate matter, is cloudy, or discolored
- Store at 77 degrees F; excursions permitted to 59-86 degrees F
CONTRAINDICATIONS / PRECAUTIONS
Chemotherapy, driving or operating machinery, geriatric, neurological disease, peripheral neuropathy, radiation therapy, seizures
Patients should be closely monitored for signs and symptoms of neurological disease toxicity during nelarabine therapy. Severe neurologic events have been reported during nelarabine therapy such as altered mental status, severe somnolence, CNS effects including seizures, peripheral neuropathies ranging from numbness and paresthesias to motor weakness and paralysis, demyelination, and ascending peripheral neuropathies similar to Guillain-Barre syndrome. Full recovery from these events has not always occurred with nelarabine cessation. Patients previously treated with or concurrently receiving intrathecal chemotherapy or previously treated with craniospinal radiation therapy may be at increased risk for neurologic adverse events. If patients develop neurotoxicity consistent with National Cancer Institute (NCI) Common Toxicity Criteria grade 2 or greater, nelarabine therapy should be discontinued. Patients should contact their healthcare provider if they experience new or worsening peripheral neuropathy. As nelarabine may cause somnolence, patients should be cautioned about driving or operating machinery during nelarabine therapy. Geriatric patients (> 65 years) may experience an increased incidence of neurologic toxicities.
Bone marrow suppression, fungal infection, herpes infection, infection, varicella, viral infection
Nelarabine should be used cautiously in patients who have had previous myelosuppressive therapy such as chemotherapy or radiation therapy. Patients with severe bone marrow suppression, including neutropenia and thrombocytopenia, should not use nelarabine. Patients with aggressive leukemia or lymphoma may require treatment with nelarabine despite severe bone marrow suppression. Therefore, this drug should be used only by clinicians experienced in the use of cancer or immune suppression therapy. Patients with active infection, including fungal infection, should be treated prior to receiving nelarabine. Patients with a history of varicella zoster, other herpes infection (e.g., herpes simplex), or other viral infection are at risk for reactivation of the infection when treated with chemotherapy.
Dental disease, dental work
Myelosuppressive effects of nelarabine can increase the risk of infection or bleeding; therefore, dental work should be delayed until blood counts have returned to normal. Patients, especially those with dental disease, should be instructed in proper oral hygiene, including caution in use of regular to |
