Dangerous Drug: Cytarabine (Cytosine Arabinoside)(sye tare’ a been)
DepoCyt, Tarabine PFS
PREGNANCY CATEGORY D
Drug Classes
Antimetabolite
Antineoplastic
Therapeutic Actions
Inhibits DNA polymerase; cell cycle phase specific—S phase (stage of DNA synthesis); also blocks progression of cells from G1 to S.
Indications
Induction and maintenance of remission in AML (higher response rate in children than in adults)
Treatment of acute lymphocytic leukemia in adults and children; treatment of chronic myelocytic leukemia and erythroleukemia
Intrathecal use: Treatment of meningeal leukemia
Liposomal: Treatment of lymphomatous meningitis
In combination therapy: Treatment of non-Hodgkin lymphoma in children
Unlabeled uses: Hodgkin lymphoma, bone marrow transplantation
Contraindications and Cautions
Contraindicated with allergy to cytarabine, active meningeal infection (liposomal).
Use cautiously with hematopoietic depression secondary to radiation or chemotherapy; hepatic impairment, pregnancy, lactation, premature infants.
Available Forms
Powder for injection—100, 500 mg; 1 g; injection—20 mg/mL, 100 mg/mL, 10 mg/mL (liposomal)
Dosages
Doses vary based on protocol; consult a current chemotherapy reference.
Adults
AML induction of remission: 100 mg/m2/day by continuous IV infusion (days 1–7) or 100 mg/m2 IV every 12 hr (days 1–7). Individualize dosage based on hematologic response.
Maintenance of AML: Use same dosage and schedule as induction; often a longer rest period is allowed.
ALL: Dosage similar to AML.
Meningeal leukemia: 5 mg/m2 to 75 mg/m2 once daily for 4 days or once every 4 days. Most common dose is 30 mg/m2 every 4 days until CSF is normal, followed by one more treatment.
Treatment of lymphomatous meningitis: 50 mg liposomal cytarabine intrathecal every 14 days for two doses; then every 14 days for three doses; repeat every 28 days for four doses. Give dexamethasone 4 mg PO or IV bid before intrathecal cytarabine to reduce the incidence of chemical arachnoiditis.
Pediatric patients
Remission induction and maintenance of AML: Calculate dose by body weight or surface area.
ALL: Same dosage as AML.
Combination therapies
For persistent leukemias, give at 2- to 4-wk intervals.
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