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Pharmacologic class: Antimetabolite
Therapeutic class: Antineoplastic
Pregnancy risk category D
FDA Box Warning
• Give under supervision of physician experienced in cancer chemotherapy, in facility with adequate diagnostic and treatment resources.
• Use of higher dosages than those specified isn't recommended, as dose-limiting severe renal, liver, pulmonary, and CNS toxicities may occur.
• In study of patients with refractory chronic lymphocytic leukemia receiving drug at recommended dosage in combination with fludarabine, four of six patients had severe or fatal pulmonary toxicity. Use in combination with fludarabine isn't recommended.
Unknown. Thought to inhibit adenosine deaminase, thereby increasing levels of deoxyadenosine triphosphate in cells, blocking DNA synthesis, and inhibiting ribonucleotide reductase.
Powder for injection: 10-mg vials
Indications and dosages
➣ Hairy cell leukemia
Adults: 4 mg/m2 I.V. every other week
• Hypersensitivity to drug
Use cautiously in:
• renal disease, bone marrow depression
• pregnant or breastfeeding patients
• Before giving, hydrate patient with 500 to 1,000 ml of dextrose 5% and normal saline solution (or its equivalent). After administering, give 500 ml of dextrose 5% in water (D5W) or its equivalent.
☞ Follow facility protocol for handling, administering, and disposing of chemotherapeutic drugs.
• Give by direct I.V. bolus injection or dilute with 25 to 50 ml of D5W or normal saline solution; infuse over 20 to 30 minutes.
CNS: headache, malaise, anxiety, confusion, depression, dizziness, insomnia, nervousness, paresthesia, drowsiness, abnormal thinking, fatigue, asthenia, hallucinations, hostility, amnesia
CV: peripheral edema, cellulitis, vasculitis, hypotension, angina, tachycardia, bradycardia, phlebitis, thrombophlebitis, cardiac arrest, heart failure, hemorrhage, ventricular asystole, pericardial effusion, sinus arrest
EENT: abnormal vision, nonreactive pupils, photophobia, retinopathy, eye pain, conjunctivitis, dry or watery eyes, hearing loss, tinnitus, ear pain, epistaxis, pharyngitis, rhinitis
GI: nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, ileus, flatulence, stomatitis, glossitis, anorexia
GU: amenorrhea, breast lump, erectile dysfunction, decreased libido, renal calculi, renal dysfunction, renal insufficiency, renal failure
Hematologic: ecchymosis, anemia, hemolytic anemia, agranulocytosis, aplastic anemia, leukopenia, thrombocytopenia
Metabolic: hyperuricemia, hypercalcemia, hyponatremia
Musculoskeletal: myalgia, joint pain
Respiratory: cough, dyspnea, respiratory tract infection, pulmonary embolism
Skin: rash, eczema, petechiae, dry skin, pruritus, skin disorder, furunculosis, acne, alopecia, diaphoresis, photosensitivity
Other: unusual taste, gingivitis, fever, chills, pain, facial edema, lymphadenopathy, herpes simplex or herpes zoster infection, flulike symptoms, viral or bacterial infection, allergic reaction, sepsis, neoplasm
Drug-drug. Allopurinol: hypersensitiv-ity vasculitis
Carmustine, cyclophosphamide, etoposide: potentially fatal acute pulmonary edema and hypotension
Fludarabine: severe or fatal pulmonary toxicity.
Vidarabine: increased risk and severity of adverse reactions
Drug-diagnostic tests. Calcium, liver
function tests, serum uric acid: increased values
Granulocytes, platelets, sodium, white blood cells: decreased levels
☞ Monitor CBC (including platelet count). Watch for evidence of blood dyscrasias.
• Assess kidney and liver function tests. Stay alert for evidence of organ dysfunction.
• Monitor temperature. Watch for signs and symptoms of bacterial and viral infection.
• Closely monitor vital signs and ECG, particularly for life-threatening arrhythmias, heart failure, and pulmonary edema.
☞ Tell patient drug lowers resistance to infection. Instruct him to avoid crowds and to immediately report fever, cough, sore throat, and other infection symptoms.
• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
• Instruct female patient of childbearing age to avoid pregnancy during drug therapy and to seek medical advice before becoming pregnant.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.