Article Contents ::

Details About Generic Salt ::  Fludarab

Main Medicine Class::    

(flew-DAR-uh-BEAN)
Fludara
Powder for injection
50 mg
Class: Purine antimetabolite

 Indications Refractory or progressive chronic B-cell lymphocytic leukemia.

Leukemias, non-Hodgkin’s lymphoma.

 Contraindications Standard considerations.

 Route/Dosage

Chronic Lymphocytic Leukemia

ADULTS: IV 25 to 30 mg/m2/day in single daily doses for 5 consecutive days. Repeat course of therapy q 21 to 28 days for 3 additional courses after maximal response is achieved.

Adjustment in Renal Insufficiency

ADULTS: IV May require dosage reduction. No specific guidelines published.

Interactions

Pentostatin

Concomitant therapy may cause severe or fatal pulmonary toxicity.

Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Edema. CNS: Malaise, fatigue, weakness (common); delayed, potentially fatal, neurotoxicity consisting of seizures, blindness, and coma associated with high dose fludarabine; incontinence, paresthesias. DERMATOLOGIC: Maculopapular rash; seborrhea; pruritus. GI: Anorexia; diarrhea; mucositis; GI bleeding; altered taste sensation. HEMATOLOGIC: Bone marrow suppression, neutrophil nadir at 13 days, platelet nadir at 16 days. METABOLIC: Fever; chills; hyperglycemia; tumor lysis syndrome manifested as hyperphosphatemia; hyperkalemia, hyperuricemia, hypocalcemia, metabolic acidosis, and flank pain. MUSCULOSKELETAL: Myalgia. RENAL: Renal dysfunction and hematuria related to tumor lysis syndrome. RESPIRATORY: Cough; dyspnea; diffuse interstitial pneumonitis. SPECIALSENSES: Visual disturbances; hearing loss; auditory hallucinations.

 Precautions

Pregnancy: Category D. Lactation: Undetermined. Children: Safety and efficacy not established. Dose-dependent toxicity: There are clear dose-dependent toxic effects seen with fludarabine. Bone marrow suppression: Severe bone marrow suppression, notably anemia, thrombocytopenia, and neutropenia, occurred. Renal function: Administer cautiously. Tumor lysis syndrome: Tumor lysis syndrome has occurred.

PATIENT CARE CONSIDERATIONS


 Administration/Storage

  • Refrigerate powder for injection. Solutions contain no preservatives; use within 24 hr of reconstitution. The manufacturer recommends use within 8 hr of reconstitution.
  • Reconstitute by adding 2 mL of Sterile Water for Injection to a 50 mg vial; yields a 25 mg/mL solution. Agitate the vial to dissolve the drug.
  • Prior to administration, dilute with 100 to 125 mL of 5% Dextrose or 0.9% Sodium Chloride.
  • Administer by IV infusion over 30 min, IV bolus over 15 min, or continuous IV infusion over 2 days.
  • Follow procedures for proper handling and disposal of anticancer drugs. Wear gloves and avoid skin exposure and inhalation of fumes.

 Assessment/Interventions

  • Closely monitor patients with a Ccr less than 50 mL/min for increased toxicity, such as bone marrow suppression.
  • Monitor CBC, differential, and platelet counts at baseline and periodically throughout each course of fludarabine.
  • Monitor neurologic status because neurotoxicity can occur even with low doses.
  • Monitor electrolytes at baseline and throughout each course, especially during the first week of therapy when tumor lysis is more likely to occur.
  • Monitor urine for red blood cells, often the first sign of tumor lysis syndrome.
  • Hyperuricemia may occur because of rapid cell lysis; monitor serum uric acid. Minimize effects of hyperuricemia with hydration, urinary alkalinization, and allopurinol.
OVERDOSAGE: SIGNS & SYMPTOMS
  Irreversible CNS toxicity characterized by delayed blindness, coma and death; severe thrombocytopenia and neutropenia

 Patient/Family Education

  • Explain name, action, and potential side effects of drug.
  • Advise patient, family, or caregiver that medication will be prepared and administered by health care provider in a health care setting.
  • Advise patient, family, or caregiver that medication may be used in combination with other agents to achieve maximum benefit possible.
  • Review dosing schedule with patient, family, or caregiver.
  • Advise patient, family, or caregiver to immediately report any of the following symptoms to health care provider: rash; fever, chills or other signs of infection; sores in mouth; unusual bleeding or bruising; dark urine; yellowing of skin or eyes.
  • Advise patient, family, or caregiver to report any of the following symptoms to health care provider: persistent nausea, vomiting or appetite loss; persistent or worsening general body weakness.
  • Instruct patient to not take any prescription or otc medications or dietary supplements unless advised by health care provider.
  • Caution women of childbearing potential to avoid becoming pregnant while being treated.
  • Instruct women of childbearing potential to notify health care provider if they become pregnant, plan on becoming pregnant, or are breastfeeding.
  • Advise patient that frequent follow-up visits and laboratory tests will be required to monitor therapy and to be sure to keep appointments.

Medicscientist Drug Facts

 

Drugs Class ::

(flew-DAR-uh-BEAN)
Fludara
Powder for injection
50 mg
Class: Purine antimetabolite

Indications for Drugs ::

 Indications Refractory or progressive chronic B-cell lymphocytic leukemia.

Leukemias, non-Hodgkin’s lymphoma.

Drug Dose ::

 Route/Dosage

Chronic Lymphocytic Leukemia

ADULTS: IV 25 to 30 mg/m2/day in single daily doses for 5 consecutive days. Repeat course of therapy q 21 to 28 days for 3 additional courses after maximal response is achieved.

Adjustment in Renal Insufficiency

ADULTS: IV May require dosage reduction. No specific guidelines published.

Contraindication ::

 Contraindications Standard considerations.

Drug Precautions ::

 Precautions

Pregnancy: Category D. Lactation: Undetermined. Children: Safety and efficacy not established. Dose-dependent toxicity: There are clear dose-dependent toxic effects seen with fludarabine. Bone marrow suppression: Severe bone marrow suppression, notably anemia, thrombocytopenia, and neutropenia, occurred. Renal function: Administer cautiously. Tumor lysis syndrome: Tumor lysis syndrome has occurred.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CARDIOVASCULAR: Edema. CNS: Malaise, fatigue, weakness (common); delayed, potentially fatal, neurotoxicity consisting of seizures, blindness, and coma associated with high dose fludarabine; incontinence, paresthesias. DERMATOLOGIC: Maculopapular rash; seborrhea; pruritus. GI: Anorexia; diarrhea; mucositis; GI bleeding; altered taste sensation. HEMATOLOGIC: Bone marrow suppression, neutrophil nadir at 13 days, platelet nadir at 16 days. METABOLIC: Fever; chills; hyperglycemia; tumor lysis syndrome manifested as hyperphosphatemia; hyperkalemia, hyperuricemia, hypocalcemia, metabolic acidosis, and flank pain. MUSCULOSKELETAL: Myalgia. RENAL: Renal dysfunction and hematuria related to tumor lysis syndrome. RESPIRATORY: Cough; dyspnea; diffuse interstitial pneumonitis. SPECIALSENSES: Visual disturbances; hearing loss; auditory hallucinations.

Drug Mode of Action ::  

(flew-DAR-uh-BEAN)
Fludara
Powder for injection
50 mg
Class: Purine antimetabolite

Drug Interactions ::

Interactions

Pentostatin

Concomitant therapy may cause severe or fatal pulmonary toxicity.

Drug Assesment ::

 Assessment/Interventions

  • Closely monitor patients with a Ccr less than 50 mL/min for increased toxicity, such as bone marrow suppression.
  • Monitor CBC, differential, and platelet counts at baseline and periodically throughout each course of fludarabine.
  • Monitor neurologic status because neurotoxicity can occur even with low doses.
  • Monitor electrolytes at baseline and throughout each course, especially during the first week of therapy when tumor lysis is more likely to occur.
  • Monitor urine for red blood cells, often the first sign of tumor lysis syndrome.
  • Hyperuricemia may occur because of rapid cell lysis; monitor serum uric acid. Minimize effects of hyperuricemia with hydration, urinary alkalinization, and allopurinol.
OVERDOSAGE: SIGNS & SYMPTOMS
  Irreversible CNS toxicity characterized by delayed blindness, coma and death; severe thrombocytopenia and neutropenia

Drug Storage/Management ::

 Administration/Storage

  • Refrigerate powder for injection. Solutions contain no preservatives; use within 24 hr of reconstitution. The manufacturer recommends use within 8 hr of reconstitution.
  • Reconstitute by adding 2 mL of Sterile Water for Injection to a 50 mg vial; yields a 25 mg/mL solution. Agitate the vial to dissolve the drug.
  • Prior to administration, dilute with 100 to 125 mL of 5% Dextrose or 0.9% Sodium Chloride.
  • Administer by IV infusion over 30 min, IV bolus over 15 min, or continuous IV infusion over 2 days.
  • Follow procedures for proper handling and disposal of anticancer drugs. Wear gloves and avoid skin exposure and inhalation of fumes.

Drug Notes ::

 Patient/Family Education

  • Explain name, action, and potential side effects of drug.
  • Advise patient, family, or caregiver that medication will be prepared and administered by health care provider in a health care setting.
  • Advise patient, family, or caregiver that medication may be used in combination with other agents to achieve maximum benefit possible.
  • Review dosing schedule with patient, family, or caregiver.
  • Advise patient, family, or caregiver to immediately report any of the following symptoms to health care provider: rash; fever, chills or other signs of infection; sores in mouth; unusual bleeding or bruising; dark urine; yellowing of skin or eyes.
  • Advise patient, family, or caregiver to report any of the following symptoms to health care provider: persistent nausea, vomiting or appetite loss; persistent or worsening general body weakness.
  • Instruct patient to not take any prescription or otc medications or dietary supplements unless advised by health care provider.
  • Caution women of childbearing potential to avoid becoming pregnant while being treated.
  • Instruct women of childbearing potential to notify health care provider if they become pregnant, plan on becoming pregnant, or are breastfeeding.
  • Advise patient that frequent follow-up visits and laboratory tests will be required to monitor therapy and to be sure to keep appointments.

Medicscientist Drug Facts

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