See Available Brands of Cytarabine in India

P - Contraindicated in pregnancy
L - Contraindicated in lactation

Cytarabine, or cytosine arabinoside, is a chemotherapy agent used mainly in the treatment of hematological malignancies such as acute myeloid leukemia (AML) and non-Hodgkin lymphoma.

Pharmacodynamics

Pharmacokinetics

Cytarabine acts by interfering with DNA synthesis specifically at the S-phase of the cell cycle. It is a potent myelosuppressant and requires careful haematological monitoring during its use. It also has antiviral property.
Absorption: Poorly absorbed from the GI tract due to rapid deamination (oral).
Distribution: Crosses the placenta and blood-brain barrier.
Metabolism: Phosphorylation followed by deamination in the liver and kidneys.
Excretion: Urine (as inactive metabolites and unchanged drug). Elimination half-life: Initial: 10 min (IV inj), terminal: 1-3 hr (IV inj), 3.5 hr (infusion), 100-263 hr (intrathecal).

Cytarabine Indications / Cytarabine Uses

Information Not Available

Cytarabine Adverse Reactions / Cytarabine Side Effects

Dementia, GI disturbances, hepatic and renal dysfunction, neurotoxicity, rashes, oral and anal ulceration, GI haemorrhage, oesophagitis, conjunctivitis, flu-like syndrome, anaphylactoid reactions.
Potentially Fatal: Convulsions. Cerebellar dysfunction, respiratory distress syndrome, GI perforation, bone marrow suppression.

Precautions

Warnings
For induction therapy, treat patients in a facility with laboratory and supportive resources sufficient to monitor drug tolerance and protect and maintain a patient compromised by drug toxicity. Less serious toxicity includes nausea, vomiting, diarrhea, abdominal pain, oral ulceration, and hepatic function impairment. The physician must judge possible benefit to the patient against known toxic effects of the drug in considering the advisability of therapy.
Anemia, leukopenia, thrombocytopenia, megaloblastosis, and reduced reticulocytes can be expected. The severity of these reactions is dose- and schedule-dependent.

Monitor
Bone marrow examinations
During induction therapy, perform leukocyte and platelet counts daily. Perform bone marrow examinations frequently after blasts have disappeared from the peripheral blood.
Drug-induced marrow depression
Suspend or modify therapy when drug-induced marrow depression results in a platelet count less than 50,000/mm 3 or a polymorphonuclear granulocyte count less than 1,000/mm 3.
Overdosage
Overdose of IV (unencapsulated) cytarabine have been reported to cause excessive toxicity, including irreversible CNS toxicity and death while overdosage of liposomal cytarabine have been associated with severe chemical arachnoiditis, including encephalopathy. Treatment is supportive and directed at maintaining vital functions There is no known antidote. Exchange of CSF with isotonic saline solution may be performed for cytarabine given intrathecally.

Special Precautions

Hepatic and renal dysfunction, severe infections, preexisting drug-induced bone marrow suppression. Monitor WBC, platelet counts and blood uric acid frequently. Assess renal and hepatic function periodically.

Other Drug Interactions

May reduce efficacy of gentamicin, digoxin and flucytosine.
Potentially Fatal: Potentiates bone marrow depression with radiotherapy and other myelotoxic drugs.

Other Interactions

Information Not Available

Dosage

Parenteral
Induction and maintenance of remission in acute leukaemias
Adult: 100 mg/m2 BSA bid by rapid IV inj or 100 mg/m2 BSA daily by continuous IV infusion. Continue treatment for 5-10 days depending on therapeutic response and toxicity. Maintenance: 1-1.5 mg/kg 1-2 times wkly via IV or SC admin. For refractory disease: High dose regimen is used: Up to 3 g/m2 BSA every 12 hr for up to 6 days, given as an IV infusion over at least 1 hr.
Child: 100 mg/m2 BSA bid by rapid inj or 100 mg/m2 BSA daily by continuous infusion given for 5-10 days.
Intrathecal
Leukaemic meningitis
Adult: 10-30 mg/m2 BSA every 2-4 days. For lymphomatous meningitis: 50 mg every 2 wk for 5 doses, then every 4 wk for 5 doses.

Food(before/after)

Information Not Available

List of Contraindications

Cytarabine and Pregnancy

Contraindicated in pregnancy.
Category D: There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

Cytarabine and Lactation

Contraindicated in lactation

Cytarabine and Children

Information Not Available

Cytarabine and Geriatic

Information Not Available

Cytarabine and Other Contraindications

Hypersensitivity; pregnancy and lactation

Storage

Intrathecal: Soln for inj: Store at 15-30°C. Powd for inj: Store at 25°C.
Parenteral: Soln for inj: Store at 15-30°C. Powd for inj: Store at 25°C.

Lab interference

Information Not Available