Cladribine - Subcutaneous

Patient Medicine Information
Why do I need this medicine?
Cladribine is used to treat hairy cell leukaemia and Waldenstrom's macroglobulinemia. These are certain types of blood cancer where the bone marrow produces too many white blood cells called lymphocytes.

This medicine may be used to treat other conditions as decided by your doctor.
How do I use this medicine?
Cladribine is to be injected subcutaneously (into the fatty layer under the skin, usually in the thigh, upper arm or abdomen area) at about the same time each day.

Your doctor or nurse will administer the injection for you. If you or your caregiver had been given the proper training on the preparation and injection techniques of this medicine, you or your caregiver may do the administration.

Use Cladribine exactly as directed by your doctor or according to the instructions on the label. Do not use more or less than instructed by your doctor.

How to use this medicine:
  1. Ensure that you have all the supplies that you need (e.g. vial, cotton balls, alcohol wipes, syringe, needle, puncture-proof container).
  2. Wash your hands with soap and water.
  3. Allow the vial to warm up to room temperature before administration.
  4. Remove the protective cap of the vial and clean the rubber stopper with a sterile alcohol wipe.
  5. Carefully screw the injection needle on the tip of the sterile syringe. Pull the plunger back and fill the syringe with air.
  6. Hold the vial firmly and push the needle through the rubber stopper. Inject the air from the syringe into the vial.
  7. Turn the vial upside down. Keep the tip of the needle in the solution and slowly pull the plunger back to fill the syringe with your prescribed dose.
  8. Pull the needle out of the vial and hold the syringe with the needle pointing straight up. To remove air bubbles, gently tap the side of the syringe with your fingertip then slowly push the plunger up.
  9. Clean the selected injection site with alcohol wipes and let it dry. Gently pinch the skin with one hand and pick up the syringe using the other hand.
  10. Insert the needle in the pinched area of the skin at a 45-degree angle using a dart-like motion. Push the plunger down slowly and evenly to inject your dose.
  11. Slowly let go of the skin and gently pull the needle out. Place a cotton ball over the injection site and press for several seconds.
  12. Dispose your used needles and syringes according to your doctor or pharmacist’s instructions. Do not throw away in household trash. Use a new needle and syringe for each injection.
If you have problems or do not understand the instructions, ask your doctor or pharmacist.

Remember to rotate the injection sites. Do not inject into the same area all the time. New injection sites should be at least 1.5 inches away from the previous injection site. Do not inject near the navel (belly button).

The dose of this medicine will be decided by your doctor based on your weight. Your doctor will advise you on the course of treatment depending on your condition.
What should I do if I have forgotten to use this medicine?
Ensure that you keep all appointments with your doctor so that you do not miss any doses. Your doctor also needs to regularly monitor your response to Cladribine.

If you miss an appointment or miss an injection, alert your doctor or nurse. A replacement appointment or injection should be given as soon as possible.

If you or your caregiver have been trained to administer this medicine and missed a dose, alert your doctor immediately.

DO NOT double a dose under any circumstances.
When should I not use this medicine?
Alert your doctor if you have the following conditions:
  • moderate to severe liver disease
  • moderate to severe kidney disease
as Cladribine may not be suitable for you.

Do not use this medicine if you are pregnant. If you become pregnant while on Cladribine therapy, alert your doctor immediately. This medicine may cause harm to your unborn child.

Men should not father a child while being treated with this medicine. Both men and women must use proven birth control methods during Cladribine therapy and for at least 6 months after stopping the treatment. You may wish to discuss reliable methods of birth control with your doctor.

Do not breastfeed while you are being treated with Cladribine and for at least 6 months after your last dose.

Alert your doctor if you have been recently vaccinated. You must avoid any vaccinations without consulting with your doctor.

Do not use Cladribine with other medicines that affect the production of blood cells in the bone marrow.
What should I take note of while using this medicine?
Inform your doctor if you have the following conditions:
  • active infection or at risk of infection
  • blood or immune system disorders
  • at risk of having excess uric acid in the blood
  • mild liver disease
  • mild kidney disease
Why is it important to keep my appointments with the doctor?

Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.
  • Pregnancy test must be done before treatment to know if this medicine is suited for you to use.
  • Routine tests (e.g. complete blood counts, liver and kidney function) may be done before and during your treatment with Cladribine. Your doctor will advise you about how often you need to have these tests.
  • Regular monitoring for signs of infection and changes in urination may also be needed.
What side effects could I experience?
Cladribine may cause dizziness or drowsiness. If affected, do not drive or take part in any activity in which you need to be alert.

Other side effects include any of the following: headache, abnormal breath sounds, cough, chills, excessive sweating, weakness, nausea, vomiting, abdominal pain, stomach wind, diarrhoea, constipation, decreased appetite, muscle or joint pain, difficulty sleeping, anxiety, skin rash, and pain, redness or swelling at the injection site.

Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:
  • yellowing of the skin or eyes, dark coloured urine, tiredness, swelling in the legs and ankles
  • changes in urination e.g. pain or discomfort when urinating, unable to pass urine
  • blurred or double vision, confusion, memory loss, problems with balance, trouble speaking or thinking, persistent numbness, weakness in arms or legs, loss of sensation
This medicine will cause the level of your red blood cells, white blood cells and platelets to drop.

Red blood cells carry oxygen around your body. A fall in the level of red blood cells may make you feel tired and worn out.

White blood cells help your body to fight infections. A fall in the level of your white blood cells may put you at higher risk for infections, such as coughs, colds and flu, which may lead to more serious infections. Avoid crowded places and people who are sick. Alert your doctor if you have a fever, or a cough or flu that does not go away.

Platelets help your blood to clot when there is a cut in the skin. A fall in the level of your platelets may put you at risk of bleeding more than usual. Do not take part in activities where you may fall or get injured, such as contact sports. Alert your doctor if you get any unusual bruising (large bruises or several bruises, especially if the bruises appeared on their own) or bleeding that takes a long time to stop (for example, too much bleeding when you floss or brush your teeth).

Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.
Can I use this with other medicines?
Avoid vaccinations during treatment with Cladribine. Alert your doctor if you have been recently vaccinated or if you are planning to get vaccinated.

Do not use Cladribine with other medicines that affect the production of blood cells in the bone marrow.

Always notify your doctor and pharmacist if you are taking or using any other medicines, including herbal tonics such as traditional Chinese medicines, supplements and medicines that you buy without a prescription.
What special dietary instructions should I follow?
Avoid alcohol.
How should I store this medicine?
Store in the refrigerator, between 2-8°C. Do not allow to freeze. If frozen, this medicine will become ineffective and should not be used.

Keep away from the reach of children.

Medicines must not be used past the expiry date.

As Cladribine is a cancer medicine, always return any unused or expired medicine to the clinic, hospital or pharmacy for disposal. Do not throw it away in the household waste.
This information is independently developed by MIMS based on Cladribine - Subcutaneous and is provided for your reference only. It is not a replacement for and should only be used in conjunction with full consultation with a licensed healthcare professional, the information provided by your pharmacist and/or the manufacturer of the medication. It may not contain all the available information you require and cannot substitute professional medical care, nor does it take into account all individual circumstances. Although great effort has been made to ensure content accuracy, we shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2022 MIMS. All rights reserved. Powered by
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