How does it work?

Cytarabine is a type of chemotherapy medicine to treat cancer known as a 'cytotoxic antimetabolite'.

Cancers form when some cells within the body multiply uncontrollably and abnormally. These cells spread, destroying nearby tissues. Cytarabine works by stopping the cancer cells from multiplying. It does this by inhibiting the production of the cells' genetic material, DNA and RNA. Both DNA and RNA are needed for growth and multiplication of cells. Cytarabine causes a deficiency of DNA and RNA in the cancer cells, and this causes the cells to grow in an unbalanced way, resulting in the death of the cells.

Cytarabine is used in the treatment of a wide variety of cancers affecting the blood cells (leukaemias). It may be used alone or in combination with other anti-cancer medicines.

Unfortunately, cytarabine can also affect normal, healthy cells, particularly those that multiply quickly, such as blood cells and hair cells. The most important side effect is on the bone marrow where blood cells are made. Cytarabine can decrease the production of healthy blood cells, leaving people susceptible to infection. Regular blood tests are therefore needed to monitor the levels of blood cells.

In most chemotherapy regimens, doses are administered in courses at various intervals to allow normal cells to recover from the adverse effects of the anticancer medicines between doses. However, during this period, cancer cells will also recover and start to replicate again. Successful treatment depends on the administration of the next course of therapy before the cancer has regrown to its previous size and the net effect is to decrease the amount of cancer with each successive course.

Cytarabine is given by injection or drip into a vein (intravenously) or by injection under the skin (subcutaneously). The dose and length of treatment used will depend on the nature of the cancer being treated.

What is it used for?

• Various types of leukaemia, particularly acute myeloid leukaemia.
• Cancer of the lymph nodes (lymphoma).

Cytarabine is often used in combination with other chemotherapy medicines.

Warning!

• Chemotherapy medicines can decrease the number of blood cells in your blood. A low white blood cell count can increase your susceptibility to infections; a low red blood cell count causes anaemia and a low platelet count can cause problems with blood clotting. For this reason, you will need regular blood tests to monitor your blood cells during treatment with this medicine. Tell your doctor immediately if you experience any of the following symptoms during your treatment, as they may indicate problems with your blood cells: unexplained bruising or bleeding, purple spots, sore mouth or throat, mouth ulcers, high temperature (fever) or other signs of infection, or suddenly feeling tired, breathless, or generally unwell.
• This medicine may be harmful to an unborn baby, and for this reason you should use effective contraception to avoid becoming pregnant or fathering a child during treatment. You should continue to use contraception to prevent pregnancy for at least a few months after treatment with this medicine is stopped, but discuss this with your doctor. Women should consult their doctor immediately if they get pregnant during treatment.
• Your ability to become pregnant or father a child may be affected by this medicine. It is important to discuss fertility with your doctor before starting treatment.

Use with caution in

• Decreased liver function.
• People with low numbers of white blood cells in the blood (leucopenia or neutropenia).
• People with low numbers of platelets in the blood (thrombocytopenia).

Not to be used in

• People with a severe reduction in blood cell production in the bone marrow, resulting in low levels of white blood cells or platelets in the blood (for example due to radiotherapy or previous courses of chemotherapy).
• Pregnancy.
• Breastfeeding.

This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

• This medicine should not be used in pregnancy, unless considered essential by your doctor due to life-threatening disease, because it may be harmful to a developing baby.
• Women who could get pregnant should use effective contraception to prevent pregnancy, and men should use effective contraception to prevent fathering a child, both during treatment, and for at least a few months after treatment is finished. Seek further medical advice from your doctor.
• It is not known if this medicine passes into breast milk. Mothers who need treatment with this medicine should not breastfeed. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Decrease in the number of white blood cells in the blood (leukopenia and neutropenia), resulting in neutropenia, anaemia and thrombocytopenia – see warning section above.
• Nausea and vomiting.
• Diarrhoea.
• Loss of appetite.
• Inflammation and ulcers in the mouth.
• Abdominal pain.
• Sore throat.
• Inflammation or ulceration in the foodpipe.
• Bleeding in the gut.
• Dizziness.
• Fever.
• Hair loss.
• Skin reactions such as rash or ulceration.
• Inflammation of the eyes (conjunctivitis), causing sore or gritty feeling eyes.
• Inflammation at site of injection.
• Difficulty passing urine.
• Pain in the joints.
• Jaundice.
• Liver problems.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicinesyou are already taking, including those bought without a prescription andherbal medicines, before you start treatment with this medicine. Similarly,check with your doctor or pharmacist before taking any new medicines duringtreatment this one, to ensure that thecombination is safe.

Chemotherapy decreases the body's immune response. This meansthat vaccines may be less effective if given during treatment, and livevaccines may cause serious infections. Live vaccines include: measles, mumps,rubella, MMR, oral polio, oral typhoid and yellow fever. If live vaccines areneeded they should be postponed until at least six months after finishingchemotherapy.

This medicine can decrease the amount of digoxin absorbed into the bloodstream from the gut. If you are taking digoxin while having treatment with this medicine your doctor may want to monitor the level of digoxin in your blood.

Cytarabine can reduce the effectiveness of gentamicin and flucytosine.

Other medicines containing the same active ingredient

DepoCyte injections contain cytarabine and are administered into the spinal cord (intrathecally).