cytarabine: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
cytarabine: clinical details
Prescribing considerations
- Use only under clinicians experienced in cytotoxic therapy, with facilities to manage infection, haemorrhage and other complications of marrow suppression.
- Assess pre-existing marrow suppression, hepatic impairment, previous central nervous system treatment and concurrent neurotoxic therapies.
- Avoid live vaccines and concurrent granulocyte transfusion unless specialist assessment determines otherwise.
- Consider fertility preservation and provide product-specific contraception counselling before treatment.
- Watch for cytarabine syndrome, characterised by fever, myalgia, bone pain, rash, conjunctivitis, nausea and malaise.
Contraindications and cautions
- Hypersensitivity to cytarabine or an excipient.
- Anaemia, leukopenia or thrombocytopenia of non-malignant origin unless the expected benefit outweighs the risk.
- Degenerative or toxic encephalopathy, particularly following methotrexate or ionising radiation.
Monitoring
- Frequent full blood counts and clinical surveillance for infection or bleeding.
- Bone-marrow assessment where clinically indicated.
- Liver and kidney function.
- Serum uric acid and features of tumour lysis.
- Neurological function, especially with intensive exposure, older age, organ impairment or previous central nervous system therapy.
- Ocular symptoms; preventative corticosteroid eye drops may be used in higher-intensity treatment contexts.
Clinical pharmacology
Cytarabine is activated intracellularly to cytarabine triphosphate, which inhibits DNA polymerase and is incorporated into DNA. It is S-phase specific, is rapidly deaminated, crosses the blood–brain barrier and placenta, and is eliminated mainly in urine as inactive metabolite or unchanged medicine.
Formulation and product differences
- The selected ready-to-use solution may be administered intravenously or subcutaneously.
- It must not be administered intrathecally because it is slightly hypertonic.
- It is essentially sodium-free and contains water for injections with agents for pH adjustment.
- Compatibility must be checked before mixing with another injectable medicine.
cytarabine preparations and strengths
Injection
Route: Parenteral
Strengths: 20 mg/mL, 100 mg/mL
cytarabine interactions
The treatment team should review prescribed, non-prescription and complementary products before cytarabine is given.
Methotrexate
Combined treatment may increase the risk of encephalopathy and requires careful neurological assessment.
Digoxin
Combination chemotherapy containing cytarabine may reduce absorption of oral digoxin, so clinical response and blood concentrations may need review.
Flucytosine
Cytarabine may abolish its antifungal effectiveness, so concomitant use should be avoided.
Gentamicin
Laboratory evidence suggests reduced activity against Klebsiella pneumoniae; inadequate clinical response should prompt reassessment of antibacterial therapy.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.