cladribine at a glance
Medicine class
Purine nucleoside analogue with immunosuppressive and antineoplastic effects.
Licensed roles
Active relapsing multiple sclerosis in adults, hairy cell leukaemia and, for selected Leustat products, previously treated B-cell chronic lymphocytic leukaemia.
What is cladribine used for?
Selected UK products are licensed for:
Tablets: adults with relapsing multiple sclerosis with active disease defined by clinical or imaging features.
LITAK and Leustat injections: primary or secondary treatment of hairy cell leukaemia.
Selected Leustat injections: B-cell chronic lymphocytic leukaemia that has not responded to, or has progressed during or after, an alkylating-agent-containing regimen.
How does cladribine work?
Cladribine is converted inside cells to an active nucleotide that blocks DNA production and repair, causing susceptible cells to die. Its marked effects on lymphocytes modify inflammatory activity in multiple sclerosis and destroy abnormal white cells in susceptible leukaemias.
cladribine preparations and strengths
Tablet
Route: Oral
Strengths: 10 mg
Injection
Route: Parenteral
Strengths: 2 mg/mL
How to take cladribine
Follow the product-specific instructions supplied by the specialist team.
Swallow tablets whole with water, with or without food. Handle them with dry hands and wash your hands afterwards.
Do not leave uncoated tablets on surfaces. If one breaks or is exposed, wash the area thoroughly.
Take other oral medicines separately if directed by the specialist team.
Intravenous cladribine is diluted and administered by trained healthcare professionals.
Subcutaneous products are ready to use. Self-inject only after training, and do not use cloudy solution or solution containing particles.
Avoid skin or eye contact with injectable cladribine. Rinse accidental contact immediately with plenty of water. Pregnant people should not handle it.
cladribine side effects
Common or expected effects
- Reduced lymphocyte or other blood-cell counts
- Infections, including cold sores or shingles with tablets
- Fever, tiredness or weakness
- Headache or dizziness
- Nausea, vomiting, diarrhoea or reduced appetite
- Rash or itching
- Hair loss with tablets
- Pain, redness or swelling at an injection site
Get urgent medical advice
- Severe or opportunistic infection, including sepsis
- Marked bone-marrow suppression causing bleeding, anaemia or neutropenic fever
- New neurological, visual, cognitive or behavioural symptoms suggesting progressive multifocal leukoencephalopathy
- Liver injury, particularly jaundice, dark urine or persistent abdominal symptoms
- Severe allergic reaction or blistering skin reaction
- Tumour lysis syndrome in patients treated for leukaemia
cladribine in pregnancy
Cladribine is contraindicated during pregnancy and may seriously harm a developing baby. Pregnancy must be excluded before tablet treatment. Effective contraception is required during treatment and afterwards for the product-specific period; men may also need contraception and fertility-preservation counselling. Contact the specialist team promptly if pregnancy occurs.
cladribine while breastfeeding
Breastfeeding is contraindicated because cladribine passes into human milk and could seriously affect an infant. The required period after treatment differs between tablets and injections; confirm it with the specialist team.
cladribine interactions
The specialist team should review all prescription, non-prescription and herbal products before treatment.
Immunosuppressive or myelosuppressive medicines
Concurrent use can add to immune and bone-marrow suppression and is contraindicated or unsuitable with several formulations.
Interferon beta and other MS disease-modifying therapies
Combination treatment may increase lymphopenia, and routine concomitant use is not recommended.
Common questions about cladribine
Answers are fully visible for fast scanning and source review.
Is cladribine chemotherapy or an immune treatment?
It has both properties. Injections are used as cytotoxic treatment for susceptible leukaemias, while tablets modify immune activity in multiple sclerosis by reducing lymphocytes.
Why are blood tests needed?
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.