Article Contents ::

Details About Generic Salt ::  Cytarab1

Main Medicine Class::    

(SITE-ah-rah-been)
DepoCyt
Suspension
equivalent to 10 mg/mL cytarabine
Class: Pyrimidine antimetabolite

 Indications

Adult

Lymphomatous meningitis.

 Contraindications Active meningeal infection hypersensitivity to cytarabine or any other ingredient in the formulation.

 Route/Dosage

Liposomal Cytarabine Dose

The dose of liposomal cytarabine is different from the dose of conventional cytarabine.

Induction Therapy

ADULTS: Intrathecally 50 mg q 14 days for 2 doses, during weeks 1 and 3.

Consolidation Therapy

ADULTS: Intrathecally 50 mg q 14 days for 3 doses, during weeks 5, 7, and 9. Then, give an additional 50 mg dose during week 13.

Maintenance Regimen

ADULTS: Intrathecally 50 mg q 28 days for 4 doses, during weeks 17, 21, 25, and 29.

Dosage Adjustment for Neurologic Toxicity

ADULTS: Intrathecally If neurologic toxicity occurs, reduce the dose to 25 mg. Discontinue if toxicity persists.

Pretreatment Regimen

ADULTS: Intrathecally To reduce the incidence of chemical arachnoiditis, treat all patients with 4 mg dexamethasone orally or IV twice daily for 5 days starting the day of liposomal cytarabine administration. Inject via an intraventricular reservoir or directly into the lumbar sac. The patient should lie flat for ³ 1 hr after the injection. Do not use in-line filters.

Interactions

Antineoplastics

Coadministration may increase the risk of neurotoxicity.

Gentamicin

Gentamicin effectiveness against K. pneumoniae strains may be decreased.

Lab Test Interferences Because liposomal cytarabine particles are similar in size and appearance to white blood cells, take care in interpreting CSF examinations following liposomal cytarabine administration.

 Adverse Reactions

CNS: Headache; asthenia; confusion; somnolence; Transient elevations in cerebrospinal fluid (CSF) protein and white blood (cell) count (WBC); encephalopathy; gait disturbance; neurotoxicity; meningismus; paresthesia. GI: Nausea; vomiting; constipation. HEMATOLOGIC: Neutropenia; thrombocytopenia MUSCULOSKELETAL: Myelopathy; back pain; pain. OTHER: Chemical arachnoiditis syndrome; nausea; vomiting; headache; feverneck rigidity; neck pain; meningismus; back pain; CSF pleocytosis.

 Precautions

Pregnancy: Category D. Children: Safety and efficacy have not ben established. Chemical arachnoiditis: A syndrome manifested primarily by nausea, vomiting, headache, and fever, has been a common adverse event in all studies. If left untreated, chemical arachnoiditis may be fatal. The incidence and severity of chemical arachnoiditis can be reduced by coadministration of dexamethasone. CSF examination interpretation: Liposomal cytarabine particles and white blood cells are similar in appearance and size. Use caution when interpreting CSF examinations after administration of liposomal cytarabine. Extravasation risk: Liposomal cytarabine is an irritant and can cause local irritation or phlebitis. Refer to your institution specific protocol. Hypersensitivity: Cases of anaphylaxis have occurred resulting in acute cardiopulmonary arrest which required resuscitation. This occurred immediately after IV administration. Infection: Viral, bacterial, fungal, parasitic, or saprophytic infections in any location in the body may be associated with the use of cytarabine alone or in combination with other immunosuppressive agents. Intrathecal use: If used intrathecally, do not use a diluent with benzyl alcohol. Myelosuppression/Hematologic: Anemia, leukopenia, thrombocytopenia, megaloblastosis, and reduced reticulocytes can be expected. The severity of these reactions is dose- and schedule-dependent. Neuropathies: Peripheral motor and sensory neuropathies have occurred. Neurotoxicity: Enhanced neurotoxicity has been associated with concurrent use of intrathecal cytarabine and other cytotoxic agents administered intrathecally. Renal/hepatic function impairment: Patients with renal or hepatic function impairment may have a higher likelihood of CNS toxicity after high-dose cytarabine. Use the drug with caution and possibly at reduced doses in patients with poor liver or kidney function.

PATIENT CARE CONSIDERATIONS


 Administration/Storage

  • Refrigerate unopened vials; do not freeze. Avoid shaking vials vigorously. Unopened vials are stable at room temperature for up to 72 hr.
  • Warm the vial to room temperature. Gently swirl or invert the vial to suspend the particles.
  • Do not dilute.
  • Liposomal cytarabine is preservative-free. Use the suspension within 4 hr after removing it from the vial.
  • Administer by intrathecal injection over 1 to 5 min.

 Assessment/Interventions

  • Monitor neurologic function at baseline and periodically throughout treatment.
  • During induction therapy, perform leukocyte and platelet counts daily. Perform bone marrow examinations frequently after blasts have disappeared from the peripheral blood.
  • Suspend or modify therapy when drug-induced marrow depression results in a platelet count < 50,000/mm3 or a polymorphonuclear granulocyte count < 1000/mm3.
  • Perform periodic checks of bone marrow, liver, and kidney functions.
  • Observe patients in high-dose cytarabine for neuropathy.

 Patient/Family Education

  • Inform patients about the expected adverse events of headache, nausea, vomiting and fever, and about the early signs and symptoms of neurotoxicity.
  • Emphasize the importance of dexamethasone coadministration at the initiation of each cycle of liposomal cytarabine treatment. Instruct patients to seek medical attention if signs or symptoms of neurotoxicity develop, or if oral dexamethasone is not well tolerated.

Medicscientist Drug Facts

 

Drugs Class ::

(SITE-ah-rah-been)
DepoCyt
Suspension
equivalent to 10 mg/mL cytarabine
Class: Pyrimidine antimetabolite

Indications for Drugs ::

 Indications

Adult

Lymphomatous meningitis.

Drug Dose ::

 Route/Dosage

Liposomal Cytarabine Dose

The dose of liposomal cytarabine is different from the dose of conventional cytarabine.

Induction Therapy

ADULTS: Intrathecally 50 mg q 14 days for 2 doses, during weeks 1 and 3.

Consolidation Therapy

ADULTS: Intrathecally 50 mg q 14 days for 3 doses, during weeks 5, 7, and 9. Then, give an additional 50 mg dose during week 13.

Maintenance Regimen

ADULTS: Intrathecally 50 mg q 28 days for 4 doses, during weeks 17, 21, 25, and 29.

Dosage Adjustment for Neurologic Toxicity

ADULTS: Intrathecally If neurologic toxicity occurs, reduce the dose to 25 mg. Discontinue if toxicity persists.

Pretreatment Regimen

ADULTS: Intrathecally To reduce the incidence of chemical arachnoiditis, treat all patients with 4 mg dexamethasone orally or IV twice daily for 5 days starting the day of liposomal cytarabine administration. Inject via an intraventricular reservoir or directly into the lumbar sac. The patient should lie flat for ³ 1 hr after the injection. Do not use in-line filters.

Contraindication ::

 Contraindications Active meningeal infection hypersensitivity to cytarabine or any other ingredient in the formulation.

Drug Precautions ::

 Precautions

Pregnancy: Category D. Children: Safety and efficacy have not ben established. Chemical arachnoiditis: A syndrome manifested primarily by nausea, vomiting, headache, and fever, has been a common adverse event in all studies. If left untreated, chemical arachnoiditis may be fatal. The incidence and severity of chemical arachnoiditis can be reduced by coadministration of dexamethasone. CSF examination interpretation: Liposomal cytarabine particles and white blood cells are similar in appearance and size. Use caution when interpreting CSF examinations after administration of liposomal cytarabine. Extravasation risk: Liposomal cytarabine is an irritant and can cause local irritation or phlebitis. Refer to your institution specific protocol. Hypersensitivity: Cases of anaphylaxis have occurred resulting in acute cardiopulmonary arrest which required resuscitation. This occurred immediately after IV administration. Infection: Viral, bacterial, fungal, parasitic, or saprophytic infections in any location in the body may be associated with the use of cytarabine alone or in combination with other immunosuppressive agents. Intrathecal use: If used intrathecally, do not use a diluent with benzyl alcohol. Myelosuppression/Hematologic: Anemia, leukopenia, thrombocytopenia, megaloblastosis, and reduced reticulocytes can be expected. The severity of these reactions is dose- and schedule-dependent. Neuropathies: Peripheral motor and sensory neuropathies have occurred. Neurotoxicity: Enhanced neurotoxicity has been associated with concurrent use of intrathecal cytarabine and other cytotoxic agents administered intrathecally. Renal/hepatic function impairment: Patients with renal or hepatic function impairment may have a higher likelihood of CNS toxicity after high-dose cytarabine. Use the drug with caution and possibly at reduced doses in patients with poor liver or kidney function.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CNS: Headache; asthenia; confusion; somnolence; Transient elevations in cerebrospinal fluid (CSF) protein and white blood (cell) count (WBC); encephalopathy; gait disturbance; neurotoxicity; meningismus; paresthesia. GI: Nausea; vomiting; constipation. HEMATOLOGIC: Neutropenia; thrombocytopenia MUSCULOSKELETAL: Myelopathy; back pain; pain. OTHER: Chemical arachnoiditis syndrome; nausea; vomiting; headache; feverneck rigidity; neck pain; meningismus; back pain; CSF pleocytosis.

Drug Mode of Action ::  

(SITE-ah-rah-been)
DepoCyt
Suspension
equivalent to 10 mg/mL cytarabine
Class: Pyrimidine antimetabolite

Drug Interactions ::

Interactions

Antineoplastics

Coadministration may increase the risk of neurotoxicity.

Gentamicin

Gentamicin effectiveness against K. pneumoniae strains may be decreased.

Drug Assesment ::

 Assessment/Interventions

  • Monitor neurologic function at baseline and periodically throughout treatment.
  • During induction therapy, perform leukocyte and platelet counts daily. Perform bone marrow examinations frequently after blasts have disappeared from the peripheral blood.
  • Suspend or modify therapy when drug-induced marrow depression results in a platelet count < 50,000/mm3 or a polymorphonuclear granulocyte count < 1000/mm3.
  • Perform periodic checks of bone marrow, liver, and kidney functions.
  • Observe patients in high-dose cytarabine for neuropathy.

Drug Storage/Management ::

 Administration/Storage

  • Refrigerate unopened vials; do not freeze. Avoid shaking vials vigorously. Unopened vials are stable at room temperature for up to 72 hr.
  • Warm the vial to room temperature. Gently swirl or invert the vial to suspend the particles.
  • Do not dilute.
  • Liposomal cytarabine is preservative-free. Use the suspension within 4 hr after removing it from the vial.
  • Administer by intrathecal injection over 1 to 5 min.

Drug Notes ::

 Patient/Family Education

  • Inform patients about the expected adverse events of headache, nausea, vomiting and fever, and about the early signs and symptoms of neurotoxicity.
  • Emphasize the importance of dexamethasone coadministration at the initiation of each cycle of liposomal cytarabine treatment. Instruct patients to seek medical attention if signs or symptoms of neurotoxicity develop, or if oral dexamethasone is not well tolerated.

Medicscientist Drug Facts

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