Key Terms: Anemia, Chemotherapy, Deoxynucleic acid, Electrolytes, Food and Drug Administration, Gout, Intravenous, Neutropenia.
Definition
Fludarabine is a chemotherapy medicine used to treat certain types of cancer by destroying cancerous cells. It is known as the brand name Fludara. Fludarabine may also be referred to as Fludarabine phosphate, 2-fluoroadenine aribinoside 5-phosphate, and FAMP.
Purpose
Fludarabine is approved by the Food and Drug Administration (FDA) to treat refractory chronic lymphocytic leukemia (CLL). Patients must have a disease that did not respond to other treatment or a disease that became worse during other treatment. Fludarabine has also been used to treat Hodgkin's and non-Hodgkin's lymphoma, cutaneous T-cell lymphoma, macroglobulinemic lymphoma, mycosis fungoides, and hairy cell leukemia.
Description
Fludarabine has been available for use since the early 1990s, and is a member of the group of chemotherapy drugs known as antimetabolites. Antimetabolites interfere with the genetic material (DNA) inside the cancer cells and prevent them from further dividing and growing more cancer cells.
Recommended Dosage
Fludarabine is a clear solution that is administered through a vein.
A fludarabine dose can be determined using a mathematical calculation that measures a person's body surface area (BSA). This number is dependent upon a patient's height and weight. The larger the person, the greater the body surface area. BSA is measured in the units known as square meter (m2). The body surface area is calculated and then multiplied by the drug dosage in milligrams per square meter (mg/m2). This calculates the actual dose a patient is to receive.
The approved dose for chronic lymphocytic leukemia is 25 milligrams per square meter per day for 5 days in a row. The fludarabine is given intravenously into a vein over a 30-minute to 2-hour time period. This 5-day cycle is repeated every 4 weeks.
The dose of fludarabine may need to be decreased in patients who have kidney problems.
Precautions
Blood counts will be monitored regularly while on fludarabine therapy. During a certain time period after receiving fludarabine, there is an increased risk of getting infections. Caution should be taken to avoid unnecessary exposure to crowds and people with infections.
Patients with a known previous allergic reaction to chemotherapy drugs should tell their doctor.
Patients who may be pregnant or are trying to become pregnant should tell their doctor before receiving fludarabine. Chemotherapy can cause men and women to be sterile, or unable to have children. It is unknown if fludarabine has this effect on humans.
Patients should check with their doctors before receiving live virus vaccines while on chemotherapy.
Side Effects
The most common side effect expected from taking fludarabine is low blood counts (myelosuppression). When the white blood cell count is lower than normal (neutropenia), patients are at an increased risk of developing a fever and infections. Patients may need to be treated with antibiotics at this point. The platelet blood count can also be decreased due to fludarabine administration, but generally returns to normal within 2 weeks after the end of the infusion. Platelets are blood cells that cause clots to form to stop bleeding. When the platelet count is low, patients are at an increased risk for bruising and bleeding. Fludarabine causes low red blood cell counts (anemia). Low red counts make people feel tired and dizzy.
Fludarabine can cause the development of autoimmune hemolytic anemia, which occurs when the body begins to destroy its own red blood cells. It is an uncommon side effect, but very serious when it occurs.
Common side effects from fludarabine include nausea and vomiting. If nausea and vomiting are a problem, patients can be given antiemetics before receiving fludarabine. This medication helps prevent or decrease these side effects. Other common side effects include fever, chills, joint pain, fluid gain, fatigue, sleepiness, pain, muscle ache, weakness, and infection. Other less common side effects include loss of appetite (anorexia), diarrhea, abnormal touch sensation, cough, pneumonia, and shortness of breath.
Damage to the nerves and nervous system tissues can occur with fludarabine. Side effects due to this nerve damage include sleepiness, confusion, weakness, fatigue, irritability, numbness or tingling in the hands and feet, visual changes, and difficulty walking.
Infrequent side effects of fludarabine are skin rashes, pain, itching, fever, lung problems, insomnia, headache, muscle and joint aches, swelling, and decreased blood pressure.
Rare side effects of fludarabine include mouth sores, constipation and abdominal cramping, bleeding from the bladder, hair loss, hearing problems, and liver and kidney problems.
Fludarabine can cause the rapid breakdown of cancer cells. Patients who have large numbers of cancer cells in their bloodstream can develop a problem known as tumor lysis syndrome. The symptoms of this syndrome include pain in the lower back and blood in the urine. A patient can develop high or low levels of electrolytes and high levels of uric acid, which can lead to gout and kidney damage. The drug allopurinol may be given to patients prior to fludarabine treatment to prevent this from occurring. Drinking an increased amount of liquids also may help prevent the kidney damage.
All side effects a patient experiences should be reported to the doctor.
Interactions
Fludarabine should not be used in combination with the drug pentostatin. The combination causes severe lung damage.
—Nancy J. Beaulieu, R.Ph., B.C.O.P.
