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Fludarabine

(floo-dare-uh-bean)

Trade/other name(s): Fludara, 2-fluoro-ara-AMP, Oforta

Why would this drug be used?

Fludarabine is part of the general group of chemotherapy drugs known as anti-metabolites. It is used to treat chronic lymphocytic leukemia and other types of cancer.

How does this drug work?

Fludarabine prevents cells from making DNA and RNA, which stops cell growth and causes the cells to die.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, infections, or if you have had kidney stones. These conditions may require that your medicine dose, regimen, or timing be changed.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy, and for up to 6 months afterward. Check with your doctor about what kinds of birth control can be used with this medicine.
  • If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it could harm the baby.
  • If you think you might want to have children in the future. Some drugs can cause sterility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • If you have ever been treated for cancer with radiation or chemotherapy as these may influence how much of these treatments you can have again.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

If fludarabine is given with pentostatin (another chemotherapy drug), it can greatly increase the risk of severe lung damage.

Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with fludarabine. These include:

  • vitamin E
  • non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others
  • warfarin (Coumadin)
  • ticlopidine (Ticlid)
  • clopidogrel (Plavix)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren't sure what's in the medicines you take.

Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether any foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Fludarabine is given intravenously over 30 minutes once a day for 5 days. It also comes in pill form. The dose depends on several factors: your size, how well your kidneys are working, and your blood counts.

The pill form of the drug is taken once a day for 5 days, and not taken for the next 23 days. This cycle is usually repeated for 2 more 28-day cycles.

Do not remove pills from foil blister packs until you are ready to take them. Be sure your hands are dry, and do not melt, break, crush, or chew tablets. Swallow the pills whole with water. If you touch a broken pill, wash your hands in running water for 15 minutes. Avoid inhaling the dust from a broken tablet, and keep it away from your eyes. If you think it may have gotten in your eyes, flush with water for 15 minutes then call your doctor.

Take this drug exactly as your doctor tells you to. If you do not understand the instructions, talk to your doctor or nurse.

Keep the pills in their original package, away from heat and moisture and away from children and pets. Do not let others handle your medicine. Talk to your doctor or pharmacist about how to dispose of any unused pills -- don't put with household trash.

Precautions

Fludarabine can cause the rapid killing of tumor cells, which in some cases has led to serious kidney damage within the first 24 hours of treatment (a condition known as tumor lysis syndrome). This is more likely if you have a very large number of cancer cells in the body. If your doctor feels you might be at risk, he or she will give you medicines and/or fluids to help prevent this. If you notice pain in the back or sides of your chest, or see blood in your urine, let your doctor know right away.

Fludarabine may make you less able to drive or use machines, since weakness, problems with vision, confusion, agitation, and seizures have happened in some people.

Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether. Keep all your appointments for lab tests and doctor visits.

This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

Fludarabine may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. Fludarabine may affect your immune system. This could make vaccinations ineffective, or could even lead to serious infections if you get a live virus vaccine during or soon after treatment. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

This drug can make the body to destroy its own red blood cells (hemolytic anemia), which can cause tiredness, headache, chest pain, fast heartbeat, and shortness of breath. This problem can make you dizzy (especially when you stand up), pale, and cause cold hands or feet. It can also make your skin or eyes turn yellow and your urine dark in color. If you notice any of these symptoms, call your doctor right away.

If you notice tingling of your hands or feet, confusion, problems with your vision, seizures, or clumsiness (poor coordination), contact your doctor right away. These symptoms may appear a few weeks or even a couple of months after treatment.

While taking this medicine, and for a few days after, there is a slight chance of a serious skin reaction. It can start as a skin rash with redness or blistering in the mouth, nose, or eyes, along with fever and body aches. If this happens, call your doctor right away.

Men and women should avoid pregnancy during and for at least 6 months after treatment. Talk with your doctor about this.

You may develop a serious or life-threatening reaction if you get a blood transfusion during or after treatment with this drug. Be sure to tell your doctor that you have had fludarabine in the past before you take a blood transfusion.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • low white blood cell count with increased risk of infection*
  • low platelet count with increased risk of bleeding*
  • low red blood cell count (anemia) with tiredness and weakness
  • tiredness (fatigue)
  • nausea
  • vomiting
  • fever and chills
  • infection*

Less common

  • pneumonia
  • diarrhea
  • loss of appetite
  • weakness
  • pain

Rare

  • numbness and tingling in hands and/or feet related to irritation of nerves*
  • changes in vision*
  • agitation
  • confusion*
  • clumsiness*
  • seizures*
  • coma*
  • cough
  • trouble breathing
  • intestinal bleeding
  • weakness
  • death due to effects on the brain, infection, bleeding, severe anemia, skin blistering, or other causes

*See "Precautions" section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 1991.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 02/01/2010
Last Revised: 02/01/2010