NELARABINE

NELARABINE
Arranon
Classifications: antineoplastic; pyrimidine, antimetabolite;
Therapeutic: antineoplastic
; antimetabolite
Prototype: 5-Fluorouracil
Pregnancy Category: D

Availability

5 mg/mL solution

Action

Nelarabine inhibits DNA synthesis in lymphoblastic T-cells of acute leukemia and lymphoma.

Therapeutic Effect

The incorporation of a nelarabine metabolite in the leukemic blast cells halts DNA synthesis and causes cell death.

Uses

Treatment of patients with T-cell acute lymphoblastic leukemia and T-cell lymphoblastic lymphoma.

Contraindications

Severe bone marrow suppression; older adults; pregnancy (category D); lactation.

Cautious Use

Severe renal impairment, renal failure; hepatic impairment.

Route & Dosage

Adult T-Cell Leukemia/Lymphoma
Adult: IV 1500 mg/m2 over 2 h on days 1, 3, and 5, repeated every 21 d
Child: IV 650 mg/m2 over 1 h for 5 d, repeated every 21 d

Administration

  • Standard IV hydration, urine alkalinization, and prophylaxis with allopurinol are advised to manage hyperuricemia in those at risk for tumor lysis syndrome.
  • Use gloves and protective clothing to prevent skin contact.
Intravenous

PREPARE: IV Infusion: Do not dilute. Transfer the required dose to a PVC or glass container for infusion.  

ADMINISTER: IV Infusion for Adult: Give over 2 h.  IV Infusion for Child: Give over 1 h. ??Discontinue IV and notify physician for neurologic adverse events of NCI Common Toxicity Criteria grade 2 or greater. 

  • Store vials at 15°–30° C (59°–86° F). Nelarabine is stable in PVC bags or glass infusion containers for 8 h up to 30° C.

Adverse Effects (≥1%)

Body as a Whole: Abnormal gait, fatigue, pyrexia, rigors. CNS: Asthenia, ataxia, dizziness, headache, hypoesthesia, neuropathy, paresthesia, somnolence, tremor. CV: Chest pain, edema, hypotension, petechiae, sinus tachycardia. GI: Abdominal pain, constipation, diarrhea, nausea, vomiting, stomatitis. Hematologic/Lymphatic: Anemia, neutropenia, thrombocytopenia, increased risk of infection. Hepatic: AST levels increased. Metabolic: Anorexia, dehydration, hyperglycemia. Musculoskeletal: Arthralgia, back pain, muscular weakness, myalgia, pain in extremities. Respiratory: Cough, dyspnea, pleural effusion, epistaxis, wheezing.

Pharmacokinetics

Distribution: Extensive. Metabolism: Bioactivation to ara-GTP, oxidized to uric acid. Elimination: Renal. Half-Life: 3 h (active metabolite).

Nursing Implications

Assessment & Drug Effects

  • Monitor for and report immediately S&S of adverse CNS effects, including altered mental status (e.g., confusion, severe somnolence), seizures, and peripheral neuropathy (e.g., numbness, paresthesias, motor weakness, ataxia, paralysis). Note: Previous or concurrent treatment with intrathecal chemotherapy or previous craniospinal irradiation may increase risk of CNS toxicity.
  • Monitor for S&S of bleeding, especially with platelet counts <50,000/mm3.
  • Lab tests: Baseline and periodic CBC with differential and platelet count; periodic serum electrolytes, serum uric acid, LFTs, and renal function test.
  • Monitor diabetics for loss of glycemic control.
  • Note: Previous or concurrent treatment with intrathecal chemotherapy or previous craniospinal irradiation may increase risk of CNS toxicity.

Patient & Family Education

  • Do not drive or engage in potentially hazardous activities until response to drug is known.
  • Report any of the following to a health care provider: seizures; tingling or numbness in hands and feet; problems with fine motor coordination; unsteady gait and increased weakness with ambulating; fever or other signs of infections; black tarry stools, blood tinged urine, or other signs of bleeding.
  • Use effective contraceptive measures to avoid pregnancy while taking this drug.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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