Adult: 25 mg/m2 daily via bolus inj or infusion over 30 min for 5 consecutive days. Courses may be repeated every 28 days, usually for up to 6 cycles. Dosage may be adjusted based on evidence of haematologic or non-haematologic toxicity.
Oral B cell chronic lymphocytic leukaemia
Adult: 40 mg/m2 daily for 5 consecutive days. Courses may be repeated every 28 days, usually for up to 6 cycles. Dosage may be adjusted based on evidence of haematologic or non-haematologic toxicity.
Reduce dose by up to 50%.
Dilute the required dose in 10 mL and 100 mL of NaCl 0.9% soln for inj or dextrose 5% to prepare a soln for bolus inj and infusion, respectively.
This drug may cause confusion, fatigue and visual disturbances, if affected, do not drive or operate machinery.
Monitor CBC w/ differential and platelet count, serum creatinine and albumin, uric acid, AST, ALT; signs of infection, neurotoxicity and tumour lysis syndrome.
Symptoms: Leukoencephalopathy (including nausea, vomiting, headache, visual disturbances, seizures), optic neuritis, papillitis, somnolence, confusion, agitation, para-/quadriparesis, incontinence, muscle spasm, irreversible CNS toxicity (characterised by delayed blindness, coma), severe thrombocytopenia, neutropenia. Management: Supportive treatment. Blood transfusion may be necessary in managing myelosuppression.
Reduced therapeutic effect w/ dipyridamole and other inhibitors of adenosine uptake. Cytarabine may reduce the metabolic activation of fludarabine. May diminish the effect of live vaccines.
Potentially Fatal: Increased risk of severe pulmonary toxicity when used in combination w/ pentostatin.
Description: Fludarabine, a purine antagonist metabolite, is rapidly dephosphorylated to 2-fluoro-ara-A and then converted intracellularly by deoxycytidine kinase to the active triphosphate, 2-fluoro-ara-ATP which inhibits α-DNA polymerase, ribonucleotide reductase, and DNA primase, resulting in inhibition of DNA synthesis leading to cell death. Pharmacokinetics: Absorption: Bioavailability: Approx 50-65% (oral). Time to peak plasma concentration: Approx 4 hr. Distribution: Plasma protein binding: Approx 19-29%. Metabolism: Fludarabine phosphate is rapidly dephosphorylated in the serum to fludarabine which enters the tumour cells to be rephosphorylated by deoxycytidine kinase enzyme to the active triphosphate derivative. Excretion: Mainly via urine (40-60%). Terminal elimination half-life: Approx 20 hr.
Tab: Store between 15-30°C. IV soln: Store between 2-8°C. Protect from light.
This is a cytotoxic drug. Use appropriate personal protective equipment (e.g. gloves) for receiving, handling, admin and disposal.
L01BB05 - fludarabine ; Belongs to the class of antimetabolites, purine analogues. Used in the treatment of cancer.
Anon. Fludarabine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com
. Accessed 08/03/2017.Buckingham R (ed). Fludarabine Phosphate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/03/2017.Fludarabine Phosphate Injection, Solution (Fresenius Kabi USA, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 07/03/2017.Fludarabine Phosphate Tablet, Film Coated (Antisoma Research Limited). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 07/03/2017.Joint Formulary Committee. Fludarabine Phosphate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/03/2017.McEvoy GK, Snow EK, Miller J et al (eds). Fludarabine Phosphate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 07/03/2017.