Classifications: antineoplastic; antimetabolite, purine antagonist; Therapeutic: antineoplastic; antimetabolite
Pregnancy Category: D
10 mg/mL liposomal, 20 mg/mL, 100 mg, 500 mg, 1 g, 2 g injection
Pyrimidine analog with cell phase specificity affecting rapidly dividing cells in S phase (DNA synthesis). In certain conditions
prevents development of cell from G1 to S phase. Interferes with DNA and RNA synthesis in rapidly growing cells.
Antineoplastic agent which has strong myelosuppressant activity. Immunosuppressant properties are exhibited by obliterated
cell-mediated immune responses, such as delayed hypersensitivity skin reactions.
To induce and maintain remission in acute myelocytic leukemia, acute lymphocytic leukemia, and meningeal leukemia and for
treatment of lymphomas. Used in combination with other antineoplastics in established chemotherapeutic protocols.
History of drug-induced myelosuppression; immunization procedures; pregnancy (category D) particularly during first trimester,
lactation. Safe use in infants not established.
Impaired renal or hepatic function, elderly; neurologic disease; gout, drug-induced myelosuppression.
Route & Dosage
Adult/Child: IV 100200 mg/m2 by continuous infusion over 24 h SC 1 mg/kg 12 times/wk Intrathecal 575 mg once q4d or once/d for 4 d
Serum Cr of 1.51.9 mg/dL (or from baseline of 0.51.2 mg/dL): reduce to 1 g/m2/dose. Serum Cr of 2 or more (or >1.2 mg/dL change): do not exceed 100 mg/m2/d.
- For intrathecal injection, reconstitute with an isotonic, buffered diluent without preservatives. Follow manufacturer's
PREPARE: Direct: Reconstitute with bacteriostatic water for injection (without benzyl alcohol for neonates) as follows: add 5 mL to the 100-mg
vial to yield 20 mg/mL; add 10 mL to the 500 mg vial to yield 50 mg/mL. IV Infusion: May be further diluted with 100 mL or more of D5W or NS.
ADMINISTER: Direct: Give at a rate of 100 mg or a fraction thereof over 3 min. IV Infusion: Give over 30 min or longer depending on the total volume of IV solution to be infused.
INCOMPATIBILITIES Solution/additive: Fluorouracil, gentamicin, heparin, hydrocortisone, insulin, nafcillin, oxacillin, penicillin G. Y-site: Allopurinol, amphotericin B cholesteryl sulfate complex, gallium, ganciclovir, lansoprazole, TPN.
- Store cytarabine in refrigerator until reconstituted. Reconstituted solutions may be stored at 15°30° C (59°86°
F) for 48 h. Discard solutions with a slight haze.
Adverse Effects (≥1%)Body as a Whole:
Weight loss, sore throat
, fever, thrombophlebitis and pain at injection site; pericarditis, bleeding (any site), pneumonia
Potentially carcinogenic and mutagenic. GI: Nausea, vomiting, diarrhea
, oral or anal inflammation or ulceration, esophagitis, anorexia, hemorrhage,
. Hematologic: Leukopenia, thrombocytopenia, anemia
, megaloblastosis, myelosuppression
(reversible); transient hyperuricemia. CNS:
; peripheral neuropathy
, brachial plexus neuropathy
, personality change, neuritis
, vertigo, lethargy, somnolence, confusion. Skin:
, freckling, cellulitis, skin ulcerations, pruritus, urticaria, bulla formation, desquamation. Special Senses: Conjunctivitis
, keratitis, photophobia. Urogenital: Renal
dysfunction, urinary retention.
may decrease digoxin
absorption; decreases aminoglycosides
activity against Klebsiella pneumoniae
2060 min SC. Distribution:
Crosses blood-brain barrier and placenta. Metabolism:
In liver. Elimination:
80% in urine in 24 h. Half-Life:
Assessment & Drug Effects
- Inspect patient's mouth before the administration of each dose. Toxicity necessitating dosage alterations almost always
occurs. Report adverse reactions immediately.
- Lab tests: Hct and platelet counts and total and differential leukocyte counts should be evaluated daily during initial therapy.
Serum uric acid and hepatic function tests should be performed at regular intervals throughout treatment period.
- Hyperuricemia due to rapid destruction of neoplastic cells may accompany cytarabine therapy. A regimen that includes a uricosuric
agent such as allopurinol, urine alkalinization, and adequate hydration may be started. To reduce potential for urate stone
formation, fluids are forced in excess of 2 L, if tolerated. Consult physician.
- Monitor I&O ratio and pattern.
- Monitor body temperature. Be alert to the most subtle signs of infection, especially low-grade fever, and report promptly.
- When platelet count falls below 50,000/mm3 and polymorphonuclear leukocytes to below 1000/mm3, therapy may be suspended. WBC nadir is usually reached in 57 d after therapy has been stopped. Therapy is restarted
with appearance of bone marrow recovery and when preceding cell counts are reached.
- Provide good oral hygiene to diminish adverse effects and chance of superinfection. Stomatitis and cheilosis usually appear
510 d into the therapy.
Patient & Family Education
- Report promptly protracted vomiting or signs of nephrotoxicity (see Appendix F).
- Flu-like syndrome occurs usually within 612 wk after drug administration and may recur with successive therapy. Report
chills, fever, achy joints and muscles.
- Report any S&S of superinfection (see Appendix F).