Fludarabine (oral)

Overview

Fludarabine belongs to the group of medications which are known as antimetabolites. They are used to treat B-cell chronic lymphocytic leukemia (CLL), which is a cancer of the white blood cells. This medication is used in patients with CLL who have already been treated with an alkylating agent that hasn't been successful.

Fludarabine works by interfering with the growth of cancer cells, which are then destroyed eventually. Since this medication can also affect the growth of normal cells, other effects may also occur. Some of these could be serious and you will need to report them to your doctor, whereas others may not be as serious but could still cause concern. Some of the side effects you experience may occur even after treatment with this drug has finished.

Before you start treatment with fludarabine, you should discuss with your doctor about the risks and benefits of taking this medication.

This medication is only available via a doctor's prescription and it is available in the dosage form of tablet for oral consumption.

Conditions treated?

  • Progressive Chronic Lymphocytic Leukemia

Type of medication?

  • Antimetabolite

Side effects

Along with the intended effects of this drug, it can produce some unwanted effects. Not all of these side effects may be present, but if any are, you may need to seek medical attention.

Inform your doctor or healthcare professional immediately if you suffer from any of the following side effects whilst taking this drug:

More common side effects

  • Burning or stinging of the skin

Less common side effects

  • Bloody or cloudy urine

Incidence not known

  • Bloody, black, or tarry stools

Some of the side effects of fludarabine that occur usually do not require any medical attention. Usually, these side effects begin to subside during treatment as your body begins adjusting to the medication. If you are finding they are bothersome, you should contact your local pharmacist or healthcare professional for advice on ways to prevent or reduce these side effects.

More common side effects

  • Increased sweating

Less common side effects

  • Rash

Remember you can report all side effects to the FDA. You may also experience side effects that are not listed above. If you notice anything different, seek advice from a doctor or healthcare professional.

Dosage

The final dose of any medication will depend on various factors. This includes your weight, height, and age. It will also take into consideration any other medications you are taking, what specific condition you are being treated for and your reaction to the first dose of the medication. All medications are determined on an individual basis so you should never stop or alter your dose without speaking with your doctor or a healthcare professional first. Stopping your medication could reduce its effectiveness and taking too much medication could increase your risk of serious side effects. The following dose recommendations are only a guide. Do not be alarmed if your final dose is different.

Typical adult dose for chronic lymphocytic leukemia:

The final dose is based on body surface area and will be determined by your doctor. Typically, however, the dose is usually 40 mg once daily for a period of five days. This five-day treatment is given again every twenty-eight days until your body responds to the medication.

For use in children, the dose will be determined by your doctor.

This medication needs to be given on a fixed schedule. So, if you miss any dose, you will need to call your doctor, a healthcare professional or treatment clinic for advice on what to do next. If you vomit after taking your medication, call your doctor immediately for advice. Don't double dose.

Proper Use: Swallow the tablet whole alongside a glass of water. Do not crush, split or chew this tablet. You can take this medication with or without the consumption of food.

Be careful when handling this medication. If any of this medication gets in your eyes or on skin, nose, eyes, or mouth, wash it with water and soap or wash the eyes right away with gently flowing water for at least fifteenth minutes. Consult with your doctor right away you suffer from a skin reaction.

Interactions

Drug interactions can reduce the effectiveness of either drug you are using and cause severe reactions. To limit the risk of interactions, it's important to give your doctor or healthcare professional a full list of all the current and past medications you are taking. You should also inform your doctor of any other medical conditions you may suffer from as this could increase your risk of interactions. Include any medical conditions that run in the family.

The use of this medication alongside any of the following medications is not usually recommended. Your doctor may avoid treating you with this drug and alter some of the other medicines you are taking.

  • Mumps Virus Vaccine, Live

The use of this medication alongside any of the following medications is not usually recommended, but in some cases, it may be required. If you are prescribed both medications your doctor may change your dose of either medication or change how often you use them.

  • Yellow Fever Vaccine

There are a number of other drugs that interact with fludarabine. It's important you let your doctor or healthcare professional know if you are taking any of the following drugs.

  • Daunorubicin liposomal

Several other medical conditions can interact with this drug. Let your doctor know if you suffer from any of the following medical conditions.

  • Transfusions

Certain medications should not be used around or at the time of eating food or some types of food since this can cause interactions. The use of tobacco or alcohol with some medications can also cause interactions. You should discuss with your healthcare professional or doctor about the use of this medication alongside alcohol, food or tobacco.

Warnings

Allergies

Let your doctor or healthcare professional know if you have ever had an allergic or unusual reaction to this medication or any similar medications. You should also let your doctor know of any other allergies you may suffer from such as to animals, preservatives, dyes, foods etc.

Pediatric - Appropriate studies have not been conducted studying the relationship of age to the effects of fludarabine in the younger population. Therefore efficacy and safety have not yet been established.

Geriatric - Appropriate studies conducted to date have not indicated a geriatric-specific problem that could limit the usefulness of this drug in the older population.

This drug is under FDA pregnancy category D. Under no circumstances should you use fludarabine if you are pregnant. It could harm the unborn child and produce birth defects.

Use effective forms of birth control to prevent pregnancy whilst receiving this drug, whether you are women or a man. Continue to use effective birth control for at least a six-month period after you have finished treatment.

It is unknown whether fludarabine can pass into breast milk and harm a nursing infant. You should avoid breastfeeding while you are receiving this medication.

It is extremely important that your doctor monitors your progress whilst you are taking this medication to ensure it is working properly. Your doctor can test for side effects via blood tests.

Fludarabine can temporarily lower the number of white blood cells in your blood thus increasing your chance of getting an infection. It can also lower the number of platelets in your blood. If this happens, there are some precautions you can take to reduce the risk of bleeding or an infection.

When possible you should avoid people with infections. Consult with your doctor immediately if you think you are contracting an infection or if you have chills or fever, cough or hoarseness, painful or difficult urination, lower back or side pain, shortness of breath or unusual bruising or bleeding.

Check with your doctor right away if you notice any unusual bruising or bleeding, black, tarry stools, blood in the stools or urine or pinpoint red spots on your skin.

Be careful when using dental floss, a regular toothbrush or toothpick. Your medical dentist or doctor may recommend alternative ways to clean your gums and teeth. Consult with your medical doctor before having any dental treatment done.

Don't touch the inside of your nose or your eyes unless you have just washed your hands and haven't touched anything else. Be cautious not to cut yourself when you are using sharp objects such as fingernail cutters or a safety razor.

Avoid contact sports and similar situations where injury or bruising could occur. You should not use this medication if you are also taking pentostatin as this could increase your risk of serious side effects.

This medication can cause a reaction known as tumor lysis syndrome which is serious. Your healthcare professional or doctor may suggest a medication to help prevent this. Inform your doctor immediately if you have a change or decrease in urine amount, stiffness or joint pain, or swelling in body parts, stomach pain or increased weight gain at a rapid pace, swelling of the lower legs or feet or lower legs or unusual weakness or tiredness.

Storage

This medication should be stored in a closed container at room temperature. Keep this medication away from direct light, heat, and moisture. Ensure this medication does not freeze. Keep this medication out of the reach of children and dispose of any outdated medicine or medications that are no longer required. Seek advice from a pharmacist or healthcare professional for advice on how to dispose of this medication safely.

Summary

When used correctly, this drug is successful in aiding the treatment of B-cell chronic lymphocytic leukemia (CLL). Due to a large number of interactions possible, it's important that you give your doctor a complete list of all current medications you are taking. This should include all prescription, nonprescription drugs, vitamins and herbal products and remedies. Take this medication exactly as directed and do not stop taking this medication without speaking with your doctor first. The safety and efficacy of this drug has not yet been established in children. If you have any question or queries about the use of this medication then contact your doctor or healthcare professional. If you think you or someone has overdosed and has serious symptoms such as trouble breathing or passing out then call 911 immediately. Do not share this medication with any other person and attend all appointments to monitor your progress and to check for side effects. This medication is also available in injection form.