Cytarabine (Oral)

Cytarabine is a cancer treatment or chemotherapy drug that is part of a family of medications known as antimetabolites and works by interfering with the growth of the cancer cells, eventually causing them to be destroyed.

Overview

What is Cytarabine?

Cytarabine is a chemotherapy drug, part of a drug group known as antimetabolites. Cytarabine is used to treat various forms of blood cancers including:

  • CML: Chronic Myelogenous Leukemia
  • AML: Acute Myeloid Leukemia
  • ALL: Acute Lymphocytic Leukemia
  • Non-Hodgkin's Lymphoma

Cytarabine is administered to patients as an injection under the skin or in an intravenous line or, sometimes, directly into the spine. When cancer is found in the cerebrospinal fluid, the drug needs to reach it immediately, hence the reason it is sometimes given to patients as a spinal injection. Prior to being given Cytarabine during a day unit stay or overnight stay in a hospital, patients are typically given a blood test to clear them for chemotherapy treatment. Patients will be given an anti-nausea drug and, possibly, a steroid. Cytarabine dosage amount and duration of infusion is determined by your cancer team.

While being treated with Cytarabine, your team of cancer treatment specialists will monitor you through blood and urine testing for side effects as well as your response to this drug and if it is affecting your cancer. Your doctors will also monitor your vital organ function to determine that no damage is being caused to your lungs, liver or kidneys during treatment.

How does Cytarabine work?

Cancer cells have the distinct feature of being able to divide without control, whereas healthy tissue has controlled division in that they stop dividing when they contact cells just like themselves. Cancer cells aren't kept in check by any means in the body and therefore divide with no limits.

Cytarabine is an antimetabolite drug, which disguises itself as one of the elements of DNA and stops the process of cell division and development, prevents the cancer cell from repairing itself and bonds with the cancer cell DNA, creating a toxic environment that kills the cancer.

Unfortunately, by working to bond with and kill cancer cells, Cytarabine and other antimetabolite drugs also bond with and kill healthy cells. The goal is to kill the cancer and allow the healthy cells to grow back over time.

Conditions treated

  • Acute lymphocytic leukemia, chronic myelocytic leukemia, acute myeloid leukemia, non-Hodgkin's lymphoma

Type of medicine

  • Chemotherapy

Side effects

By bonding with cells and affecting their DNA and the process by which they divide, Cytarabine may also cause damage to healthy cells and give patients unwanted effects that could range from annoying to severe. During chemotherapy with Cytarabine, you will be closely monitored by a team of specialists, including blood work and the function of your kidneys and liver.

If the following unwanted health issues appear after treatment with Cytarabine, check with your physician right away:

  • Stools which appear black or tar-like
  • Urine with signs of blood
  • Hoarse voice or coughing
  • Chills, fever
  • Pain in lower back or side
  • Pain or difficulty when urinating
  • Tiny red dots on the skin
  • Bruising or bleeding that is unexpected
  • Mouth and lip sores
  • Pain in joints
  • Tingling or numbness in toes, face or fingers
  • Swollen legs or feet
  • Fatigue
  • Pain in muscles or bones
  • Pain in chest
  • Lowered amount of urine
  • Swallowing is difficult
  • Fainting
  • Ill, weak, uncomfortable feeling
  • Heartburn
  • Erratic heart rhythm
  • Injection site pain
  • Bloodshot eyes
  • Gasping breath
  • Rash on skin
  • Muscle weakness
  • Skin or eyes appear yellow

During treatment, Cytarabine may give you the following symptoms, which typically go away after treatment is complete. For more information on how to ease or eliminate these symptoms, check with your cancer treatment staff and report any signs such as:

  • Vomiting
  • Nausea
  • Lost appetite
  • Diarrhea
  • Dizzy
  • Headache
  • Skin itching
  • Appearance of freckles

Cytarabine treatment may also cause you to lose your hair temporarily; normally, hair grows back after treatment has ended. Some side effects of Cytarabine linger after treatment and require medical attention, so contact your doctor if any symptoms are still being felt.

Cytarabine increases your risk of infections due to the reduced quantity of white blood cells in your blood because of its action to treat cancer. Your window of developing infections due to this condition continues up to 14 days after treatment. Notify the hospital if you experience these conditions:

  • Your body temperature is over 99.5 or 100.4, depending on your medical team's advice
  • Sudden, unwell feeling
  • Trembling, sore throat, coughing
  • Frequent urination

You may also feel tired or breathless or bleed and bruise easily including nose bleeds and bleeding gums when performing dental hygiene.

Less common, but still possible, are long term changes to the tissues of the lungs, which are typically a higher risk with a higher dose of Cytarabine. If you develop coughing or show signs of a fever, if you feel short of breath or experience wheezing, your cancer team should be notified right away in order to perform tests on your lungs.

Dosage

The amount of Cytarabine you receive depends on different factors including your physical size, your overall health condition, other medical issues and the type of cancer you have. Your schedule and the method with which you are administered Cytarabine are also determined by your cancer treatment team of doctors and other professionals.

Interactions

Cytarabine will most likely be combined with other drugs in order to attack your cancer effectively. You may also receive other drugs to prevent unwanted symptoms or for other health reasons. It is of great importance to disclose all of the medications you are currently taking, including over-the-counter and prescription drugs as well as holistic or vitamin supplements, to your team of cancer care specialists.

Use of Cytarabine with the following vaccinations is specifically not recommended due to your lowered ability to fight off infections during treatment with this drug. Avoid being exposed in any way to:

  • Live vaccine for measles virus
  • Live vaccine for rotavirus
  • Live vaccine for mumps virus
  • Live vaccine for varicella virus
  • Live vaccine for rubella virus

Additionally, the vaccinations below should be avoided while being treated with Cytarabine, but may be necessary for your own protection. Your doctor will want to be informed if you are going to be exposed to:

Guerin vaccine or bacillus of calmette live vaccine

  • Adenovirus live vaccine
  • Cholera live vaccine
  • Poliovirus live vaccine
  • Influenza live vaccine
  • Smallpox vaccine
  • Yellow fever vaccine
  • Typhoid vaccine

Check with your team of cancer care specialists for any warnings or concerns with regard to certain foods, use of tobacco and consumption of alcohol.

Certain pre-existing medical conditions and diseases may have an effect on how Cytarabine works in your system or may become worse with use of this drug treatment. If you have the diseases shown below, discuss your treatment options with your medical team:

  • Gout
  • Infections
  • Shingles, Chickenpox (herpes zoster)
  • Kidney stones
  • Liver or kidney disease

Warnings

Any unusual reaction you've experienced during treatment with other drugs or allergies to preservatives, colorings, foods, animals or environments should be discussed with your cancer treatment team prior to your drug therapy with Cytarabine.

No studies have provided sufficient data with regard for increased risks or diminished effectiveness of Cytarabine in use in pediatric patients. The side effects, warnings and precautions for this age group are the same as for adult patients.

Geriatric patients have not been the subject of studies that have provided date to prove that they are at a greater risk for side effects than other age groups. Older patients should expect the same risks and warnings from the use of Cytarabine with the same recommendations for dosage size, duration and other factors.

There is a significant risk to fetal well-being and, therefore, women who are pregnant are advised to avoid treatment with Cytarabine, if possible. Your cancer care team will most likely advise you to use a form of birth control during treatment with Cytarabine to prevent pregnancy in your or your partner. Breastfeeding risks have not been studied, so the possible risks should be considered thoroughly before being treated with Cytarabine while breastfeeding.

Cytarabine increases the risk of thrombosis or blood clots, so report symptoms such as elevated temperature accompanied by chills, skin rash or pain in the chest, stomach, bones or eyes. Your cancer care team should be notified immediately if you have any pain, swelling or redness in one or both of your legs or shortness of breath and chest pain. Blood clots are serious, but can be treated and the earliest treatment is the most effective.

Any skin changes or pain in muscles, joints or abdomen should be communicated to your team of cancer treatment professionals in case of long term health implications.

Avoid crowded places and people with colds and infections. Change your toothbrush to a soft bristle model and use an electric razor, if applicable, to avoid unwanted bleeding. Do not participate in high-risk sports or activities that could make you prone to injuries. Stay out of the sun, drink plenty of fluids and get a restful night's sleep. Good nutrition is also important during cancer treatment as well as good oral and physical hygiene. Rinse up to three times a day with one teaspoon baking soda or salt dissolved in a cup of water to prevent mouth sores.

Anti-nausea medication may be prescribed by your doctor, who may also instruct you to eat smaller meals on a more frequent basis. Keep your personal alcohol consumption to a minimum or avoid it, if possible. No questions or challenges are off limits to your cancer care professional team, so be sure to discuss any and all issues with them as soon as they come up.

Patients who receive high doses of Cytarabine are more likely to develop changes to the tissues of the lungs as well as experience changes to their nervous systems. If you are on a higher than normal dose, your doctor will disclose this information to you. Be aware of the side effects that indicate lung damage such as coughing, wheezing, shortness of breath and fever. Also be on alert for drowsiness, confusion or unsteadiness, as these symptoms should be reported immediately as well. These effects should prevent you from driving or operating tools or machinery.

Treatment with Cytarabine can affect your fertility in the future. Discuss the long term effects of treatment with Cytarabine with your team of cancer care specialists.

Always inform other physicians, dentists and pharmacists that you are being treated for cancer when seeing them for other medical reasons, as treatment with Cytarabine can cause health issues when combined with other drugs or treatments. Keep copies of your patient information paperwork with you when you visit other physicians including dentists.

If you experience a fever (typically accompanied by chills), rapid heartbeat or pains in your chest or your ability to pass urine has diminished, seek immediate medical attention and contact your physician urgently for immediate medical attention.

Storage

It is recommended that Cytarabine be stored at room temperature, not refrigerated, and kept in the original packaging. Once the vials have been opened and diluted, each vial must be used immediately, not stored, and discarded safely if not used.

Summary

Cytarabine is a chemotherapy drug that works by bonding with and inhibiting the division of cancer cells, with the goal of stopping the spread and killing the cancer. Cytarabine is typically prescribed for different forms of leukemia such as chronic and acute myelogenous types as well as acute lymphocytic and acute promyelocytic. It is also effective in the treatment of non-Hodgkin's lymphoma and other types of cancers.

Dosage of Cytarabine depends on the patient's age and overall health including physical statistics as well as the progression and severity of their type of cancer. Cytarabine may be given as an injection into a vein or directly into the spinal fluid. No pill form of Cytarabine exists because it does not survive the digestive process and for other reasons.

Side effects can be severe and include low white blood cell count, which can lead to infections and other diseases being able to flourish in the body because they cannot be fought off during treatment. Thrombosis or blood clots are also a risk. These effects are rare, however, with patients typically experiencing temporary loss of hair, vomiting, nausea, headaches and fatigue as more common side effects. Any side effects experienced during or after treatment should be reported to your cancer treatment professionals.

Good health and hygiene should be practiced during treatment with Cytarabine, switching your toothbrush to a softer bristled version to protect your gums and using an electric razor to avoid any shaving mishaps. Avoid crowds and people with colds or infections specifically and do not become exposed to any live virus vaccinations during treatment.

Patients with pre-existing medical conditions should disclose these to their team of cancer treatment professionals in case of any concerns over treatment with Cytarabine. Along the same line, any medications, over the counter or others should also be disclosed, including vitamins or herbal therapies.