Fludarabine (intravenous)

Overview

Fludarabine is a chemotherapy drug that is administered in a hospital or professional medical setting via intravenous methods. It is specifically designed to target cancer cells of one specific type of hematologic cancer known as CLL.

Typically the patient has already been under treatment with other drugs and has not shown any improvement in their condition before Fludarabine is tried as a last resort. Fludarabine is an antimetabolic type of drug that works directly on the DNA of the cancer cells.

Fludarabine is both an intravenous medication as well as available as an oral route drug. While there are no statistical differences in the use of either route, discussed here is the intravenous route for patients who have been specifically prescribed that method of administration by their cancer care team.

Fludarabine copies the make-up of organic metabolic compounds known as purines, which are part of the DNA cellular structure of cancer cells. Fludarabine works by disguising itself as another cancer cell, and instead of replicating as the other cells do, it instead prevents them from synthesizing themselves and spreading.

CLL, or chronic lymphoid leukemia, is the primary disease that Fludarabine is prescribed for. It is a bone marrow cancer that is characterized by an elevated level of white blood cells. Early detection is nearly impossible and without symptoms. As the disease progresses, swollen lymph glands, fatigue, weight loss and fever may be signs and symptoms to the sufferer.

Fludarabine works specifically on these abnormal white blood cells found in CLL. It is, however, also prescribed for other types of cancers including non-Hodgkin's lymphoma, acute lymphocytic leukemia as well as acute myeloid leukemia.

Conditions Treated

• Acute lymphocytic leukemia
• B-cell chronic lymphocytic leukemia
• Prolymphocytic leukemia
• Acute myeloid leukemia
• Small lymphocytic lymphoma refractory
• Non-Hodgkin's lymphoma

Type Of Medicine

• Chemotherapy

Side Effects

Fludarabine binds to white blood cells in an effort to kill off the cancerous ones and stop the spread of the disease. By doing so, it may be indiscriminate as to killing healthy cells. This can cause adverse health effects that are wide-ranging and sometimes dangerous to your health. If you have any of the following unwanted symptoms while taking Fludarabine, notify your doctor right away:

• Pain in jaw, back or arm
• Stools are tar-like or black
• Stool or urine with blood
• Discomfort or pain in the chest
• Heavy, tight chest feeling
• Constipation
• Coughing, hoarse voice
• Productive cough with signs of blood
• Rapid heart rhythm
• Chills
• Fever
• Generally uncomfortable or ill
• Pain in your side or lower back
• Nausea
• Pain
• Urination is difficult, burns or is painful
• Skin is pale
• Tiny red skin dots
• Gasping for breath
• Sneezing
• Throat soreness
• Ulcerated spots that appear white in the mouth or on the lips
• Severe abdominal pain
• Sweating
• Swollen areas
• Neck glands are swollen or tender
• Thick mucus
• Unable to breathe
• Fatigue
• Weak muscles
• Vomit showing blood or appearing as coffee grounds
• Agitated mood
• Wheezing
• Aneurysm
• Gums that bleed
• Vision changes or blindness
• Confused demeanor
• Less urine than normal
• Swallowing and breathing are difficult
• Neck veins are dilated
• Dizzy spells
• Fainting
• Headache
• Menstrual bleeding increased
• Aural symptoms or hearing loss
• Nosebleeds
• Tingly, numb toes, face or fingers
• Swollen, red and painful legs or arms
• Inability to move
• Wounds or bruises that do not heal
• Seizures
• Speech changes
• Severe speaking inability
• Severe weakness in the body
• Gaining weight
• Inability to stop vomiting
• Urine that is dark in color
• Lethargy
• Frequently urinating
• Hives on skin
• Itchy skin
• Stools are light in color
• Appetite loss
• Passing out or losing consciousness
• Cramping in the lower abdomen
• Tremors in muscles
• Swollen, puffy eyes, lips, tongue or face
• Taking deep, rapid breaths
• Restless demeanor
• Rashes on skin
• Abdominal pain
• Walking, speaking or thinking has become difficult
• Yellow tinge to skin or eyes

Other side effects, while annoying, aren't necessarily dangerous to patients. Contact your cancer care team if you experience the following adverse symptoms, as they may be able to advise you on methods that will ease or eliminate them:

• Bladder pain
• Aches and body pain
• Pain in the abdominal area
• Itchy, numb feeling
• Urine appears cloudy
• Chest or nasal congestion
• Loose stool or diarrhea
• Moving is hard
• Dryness in throat or mouth
• Skin is dry and appears flushed
• Urination urge is more frequent than normal
• Breath smells of fruit
• Hunger rages and thirst has increased
• Amount of urine is more than normal
• Pain in joints
• Achy, cramped muscles are stiff or painful
• Nose runs
• Joints are swollen
• Swallowing is hard
• Changes in voice
• Loss of weight, sudden and unexpected
• Abdomen feels full or bloated
• Skin has a blue tinge
• Color of skin has changed
• Lips are dry and cracked
• Dry scalp or dandruff
• Shrinking in height
• Amount or frequency of urine has become less
• Insomnia
• Discouraged mood
• Depression
• Excess gas leading to pain in the abdominal area
• Heartburn or acid reflux
• Irritable mood
• No interest in pleasurable things
• Feeling faint or lightheaded
• Skin feels oily
• Tender cheekbones or eyes
• Panting or gasping for breath
• Elevated temperature
• Nasal congestion
• Eyes appear sunken
• Difficulty concentrating
• Skin appears wrinkled

Still, other health concerns may arise when you are being treated with Fludarabine. Any changes to your overall health should be communicated to your team of cancer care specialists and doctors right away so that assistance can be provided to you and your overall safety can be assured while taking this medication.

Dosage

Your dosage of Fludarabine injection will be given to you by a medical professional while you are admitted to a cancer center or hospital. Typically, a five-day course of this medication will be given in a 28-day cycle until your cancer responds to the treatment. The injection is through an intravenous line in your arm or chest and takes about 30 minutes.

Adult patients are typically given 25 micrograms of Fludarabine as multiplied by the patient's body surface area and diluted in a sodium chloride solution to a volume of 100 milliliters. The medication will be administered intravenously over a 30-minute time span. This dosage amount will be repeated for five days straight, with a rest period to follow. After testing for the condition of your cancer cells and your overall health, another course will be given after 28 days. This treatment can be repeated up to six times.

This medication has a high risk of causing you to be nauseated and to also make you vomit. It is, however, important to continue through the treatment schedule despite these ill effects. Your physician can assist you with ways to ease these symptoms during your treatment periods.

Interactions

All drug therapies come with risk factors that will be explained to you by your cancer treatment team of professionals. You will also be given a patient leaflet that you should read completely. Ask questions about any information contained in this leaflet that you don't understand.

Hypersensitivity to other medications, certain foods, animals, artificial additives and dyes should be communicated to your health care provider to avoid any unwanted reactions to Fludarabine. Inform your healthcare provider if you are taking any other medications including those that are available over the counter, vitamin and herbal therapies or holistic remedies.

Some medications are able to be used together without harm or reduced effectiveness of either drug. Combination therapies are a way to combat symptoms and make the patient more able to live a normal life. However, there are some drugs that should not be combined. The following vaccinations should never be given while you are being treated with Fludarabine:

• Live vaccination for measles
• Live vaccination for mumps
• Live vaccination for rotavirus
• Live vaccination for rubella
• Live vaccination for varicella

Still, other medications should not be used with Fludarabine, but they may be the only choice for your treatment. Your physician may adjust your dosage amount or frequency if you are currently receiving:

• Live vaccine for adenovirus
• Live vaccine for Guerin and bacillus of calmette
• Live vaccine for cholera
• Flu vaccination
• Penostatin
• Live vaccination for the polio virus
• Smallpox vaccination
• Typhoid vaccination
• Vaccination for yellow fever

Consult with your physician on whether to eat prior or during your treatment with Fludarabine or whether certain foods should be eliminated from your diet altogether. You should also inform your doctor if you are a regular user of tobacco products or alcoholic beverages, as these could affect the way Fludarabine works for you.

Your full medical history should be communicated to your physician in case you have diseases that would be dangerously affected by chemotherapy treatment such as Fludarabine. Specifically, the following health conditions have been known to become worse or limit the effectiveness of this medication:

• Anemia
• Neutropenia
• Thrombocytopenia
• Bone marrow diseases
• Chickenpox
• Herpes zoster or shingles
• Gout
• Infections of any kind
• Kidney disease
• Kidney stones
• Blood transfusion that has not been irradiated

Warnings

As part of your chemotherapy regimen, you will be constantly monitored and tested for adverse health effects caused by Fludarabine as well as the effectiveness of the drug in fighting your cancer. Any appointments made for you after your discharge should be kept and any instructions given to you by your cancer treatment team with regard to your diet, activity level and other recommendations should be followed without hesitation.

Avoid vaccinations with live vaccine ingredients unless specifically instructed to undergo these medications by your health care provider. Fludarabine lowers your ability to fight off infections and diseases; therefore a live vaccination may give you the disease that you are supposed to be protected from. If you live with someone who has had the oral vaccination for the polio virus, avoid them completely if possible as they could pass on the virus to you. If you cannot avoid this living situation, wear protective medical masks over your mouth and nose and take precautions not to share eating utensils or living spaces if possible.

Pneumonia risk is elevated during your treatment with Fludarabine, as your white blood cell count will be depleted. Your blood clotting ability will also be diminished during your treatment with this drug. Take the following steps to protect your health during and after your treatment:

• Avoid people with known infections of any kind.
• Contact your physician if you have chills, fever, hoarse voice, cough, body aches, pains, urination difficulty, breathing difficulty or bruises and bleeding that are unusual.
• Any sign of blood in your stool or urine, stools that appear black in color or tiny red spots on your skin should be reported to your cancer treatment team right away.
• Take care when practicing dental hygiene and use soft implements only. Your dentist can be helpful in suggesting ways to practice good dental care during your cancer treatment without causing harm.
• Avoid touching your nasal passages or your eyes during cancer treatment unless your hands are freshly washed.
• Take care using sharp implements such as kitchen utensils, razors or nail cutters.
• Do not participate in aggressive, dangerous activities or sports that could put you in a situation that could cause injury.

Pentostatin drugs such as Nipent should be avoided during your treatment with Fludarabine. This drug, also a chemotherapeutic antimetabolite drug like Fludarabine, can combine and increase the risk of adverse health effects during your treatment. If you have been treated with Penostatin, make sure your cancer care team knows the period of treatment time to avoid any risks to your overall health.

Medication will be prescribed to you that will specifically help you avoid a syndrome known as tumor lysis. Signs of this condition include joint pain, change in urine amount or frequency, rapid gaining of weight, joint swelling, stiffness or painful condition, pain in the abdomen, lower back or side, swollen lower legs or feet, fatigue that is unusual or muscle weakness for no apparent reason. These conditions should be reported to your physician right away if experienced.

Fludarabine use during pregnancy puts the fetus at risk for birth defects. Women who are pregnant may not be able to be treated with this medication. Women who may become pregnant should practice effective forms of birth control while in chemotherapy treatment with Fludarabine. Notify your cancer treatment team if you suspect you are pregnant while being treated with this medication. Women who are breastfeeding should notify their doctor of this prior to entering chemotherapy treatment.

Being treated with Fludarabine may make you feel extraordinarily weak, muddle your ability to think or give you vision problems. Before driving, using power tools or heavy machinery, make sure you are aware of how this drug has affected you and that you can be sure of your own safety as well as that of others before you engage in these activities.

Fludarabine has not been determined to be safe or effective for pediatric patients. Use of this medication in this age group is at the discretion of the cancer treatment team. Geriatric patients can expect the same risk and effectiveness as adult patients, the exception being if they have underlying health issues, renal impairment, for example, that will interact with the drug.

Storage

Fludarabine will be stored and administered in a hospital or cancer center setting only, with storage according to the manufacturer's instructions carried out by the professional staff.

After dilution of the powdered form of Fludarabine, it should be used within 24 hours. No special conditions need to be provided for the storage of the undiluted solution; once diluted, if not used immediately, this medication should be refrigerated and discarded after one day if not used.

Summary

Fludarabine is a chemotherapy treatment administered intravenously in a professional medical setting such as a hospital or cancer treatment center. Fludarabine is known as an antimetabolitic type of drug that works to attack the cancer cells by mimicking them, fooling them into non-synthesis so that they die off and stop spreading.

During treatment, the patient will experience a depletion of white blood cells as well as platelet cells, which cause blood to clot. For this reason, exposure to infection and injury is dangerous and can prove fatal. Patients should avoid vaccinations for diseases that contain a live version of the virus they are vaccinating against as these could turn into the full-blown disease. Additionally, patients should also avoid individuals who have had live vaccinations, especially the oral polio vaccine. Avoid persons with infections and any activities that put you in danger for cuts, bruising or bleeding.

Adverse health effects, including severe nausea and vomiting, should not deter patients from completely finishing their chemotherapy treatment with Fludarabine. This treatment is typically a five-day course of a one-half hour intravenous administration of the powdered medication mixed into a solution. This five-day course will be repeated every 28 days a total of six times. You will be tested on a regular basis for the effectiveness and risks to your health while you are being treated with Fludarabine.

Health risks such as tumor lysis syndrome and interactions with other medications or pre-existing medical conditions are numerous under treatment with Fludarabine. For this reason, it is of primary importance to keep all medical appointments and be sure you have disclosed any medications or treatments you are currently having to your cancer care team as well as any other physicians who will be treating you during this time including dentists.

Report any ill effects on your health or wellbeing to your physician right away to protect yourself from any life-threatening situations. Do not take any medications without first consulting with your cancer care team. This includes prescription, over-the-counter, vitamin and herbal supplements as well as vaccinations and holistic treatments.