Fludarabine

Fludarabine is a synthetic purine nucleoside antineoplastic agent. It belongs to the antimetabolite class of neoplastics and is similar in spectrum of activity and adverse effects to cladribine or pentostatin. Fludarabine is structurally similar to vidarabine (an antiviral agent) and cytarabine. Fludarabine is used for chronic low-grade lymphocytic malignancies. Fludarabine is licensed for the initial treatment of advanced β-cell chronic lymphocytic leukaemia (CLL).

Brands
FLUDARA FLUBEN FLURADOSA FLUDAKEBIR
Adult Dose
Dose: 25 mg/ sq.meter
Single Dose: 46 (46)
Frequency: As recommended.
Route: Slow IV
Instructions: For 5 days
Neonatal
Paedriatic
Characteristics
Fludarabine also known as Fludara. Fludarabine Phosphate is the derivative of Fludarabine. It is of Synthetic origin and belongs to Purine analogue. . The Molecular Weight of Fludarabine is 365.20. Its pKa is 3.2.
Contraindications
Fludarabine is contraindicated in conditions like Peripheral neuropathy,HIV infection,Central neuropathy,Renal impairment.
Effects
The severe or irreversible adverse effects of Fludarabine, which give rise to further complications include Hyperkalemia, Skin rashes, Blindness, Coma, Seizures, Neurotoxicity, Deaths, Hyperuricemia, Hyperphosphatemia, Urate nephropathy, Hemorrhagic cystitis.Fludarabine produces potentially life-threatening effects which include Coma, Seizures, Thrombocytopenia, Neurotoxicity, Blindness, Lymphocytopenia, Immunosuppression, Myelotoxicity. which are responsible for the discontinuation of Fludarabine therapy.The signs and symptoms that are produced after the acute overdosage of Fludarabine include Death, Coma, Seizures, Neurotoxicity, Thrombocytopenia, Neutropenia, Blindness, Myelotoxicity.The symptomatic adverse reactions produced by Fludarabine are more or less tolerable and if they become severe, they can be treated symptomatically, these include Fatigue, Nausea, Fever, Dyspnea, Weight LossX, Somnolence, Cough, StomatitisX, Neurotoxicity, Pulmonary hypersensitivity.
Indications
Fludarabine is primarily indicated in conditions like Chronic lymphocytic leukaemia, Lymphoid malgnancies, and can also be given in adjunctive therapy as an alternative drug of choice in Acute leukemia, Fever, Fever, fever, fever, Indolent lymphoma, Myclodysplastic syndrome, Myelodysplastic syndrome, Myeloid leukaemia.
Interactions
Fludarabine is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAmikacin (Sulphate)DipyridamolePentostatinThe concomitant administration of fludarabine and pentostatin may increase the risk of potentially fatal pulmonary toxicity.MajorConcurrent use should be avoided.StreptomycinFludarabine may increase the actions and side effects of Streptomycin. These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.
Interfrence
Monitoring of hematologic profile
Risks
Drug should not be given to Paediatrics, Pregnant Mothers, and patients suffering from Kidney dysfunction.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.
Storage
Inj (reconstituted soln) Store in refrigerator. Use within 8 hrs if kept at room temperature.
Warnings
Blood counts and measurement of hemoglobulin should be carried out regularly to assist the onset of bone marrow depression. Great care is required when marrow is already depressed following radiotherapy or therapy with other anticancer drugs. Drug must be handled with great care and contact with skin and eye avoided and should not be inhaled. Dosage should be reduced by up to 50% in patient iwth mild to moderate renal impairment and should not be given if creatinine clearance is less than 30 mL/min.
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