Cytarabine is indicated in Leukaemic meningitis, Induction and maintenance of remission in acute leukaemias.
Cytarabine is an antineoplastic agent. Cytarabine is a synthetic pyrimidine nucleoside, which is converted intracellularly to the nucleotide, cytarabine triphosphate. The exact mechanism of action of cytarabine is not fully understood, but cytarabine triphosphate appears to inhibit DNA synthesis by the inhibition of DNA polymerase. Cytarabine's actions are cell-cycle specific. Cytarabine is also immunosuppressant and has demonstrated antiviral activity in vitro.
Intrathecal (Adult)- Leukaemic meningitis: 5-75 mg/m2 or 30-100 mg once every 2-7 days to once daily for 4 or 5 days. For lymphomatous meningitis: 50 mg every 2 wk for 5 doses, then every 4 wk for 5 doses. Parenteral (Adult)- Induction and maintenance of remission in acute leukaemias: As monotherapy: 200 mg/m2 daily by continuous IV infusion for 5 days, at intervals of approx 2 wk. In combination therapy: 100 mg/m2 bid by rapid IV inj or 100 mg/m2 daily by continuous IV infusion both for 7 days. Maintenance: 1-1.5 mg/kg once or twice wkly via IV or SC.
May reduce efficacy of 5-fluorocytosine, digoxin, gentamicin. May increase risk of neurotoxicity with other cytotoxic agents (intrathecal).
Patient with active meningeal infection. Patient with previous drug-induced bone marrow suppression. Renal or hepatic impairment. Pregnancy and lactation.
Nausea, vomiting, fever, rash, diarrhoea, anorexia, oral and anal inflammation or ulceration, hepatic dysfunction, headache, weakness, confusion, thrombocytopenia, fatigue.
Pregnancy Category D. There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).
Severe bone marrow depression, gastrointestinal toxicity and vomiting are among the signs and symptoms expected. Treatment with cytarabine should be ceased and supportive measures instituted. In bone marrow depression, transfusions of blood products may be required and active measures may be necessary to combat infection. Hyperuricaemia is avoided by the addition of allopurinol to treatment schedules and measures such as alkalinisation of . the urine and hydration may also be adopted. Techniques attempting to prevent the occurrence of alopecia have met with varying success. Scalp tourniquets and ice packs have been used to minimize concentrations of antineoplastic agents in the scalp after intravenous injection. Such methods, however, may allow the development of a cancer-cell sanctuary and should not be used in patients with leukaemia or other conditions with circulating malignant cells. The treatment of extravasation is controversial. Warm moist soaks or ice packs have been applied and a corticosteroid may sometimes be instilled into the affected area. Antiemetic therapy should be given in an attempt to prevent or control nausea and vomiting.
Store the vial in original carton at 15°C to 30°C. Protect from light. Do not refrigerate. Keep out of the reach of children.
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