Cytarabine

Cytarabine is indicated in Leukaemic meningitis, Induction and maintenance of remission in acute leukaemias

Cytarabine inhibits deoxyribonucleic acid (DNA) synthesis specifically at the S-phase of the cell cycle. It also has an antiviral and immunosuppressant activity.

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.

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).

Patient with previous drug-induced bone marrow suppression. Renal or hepatic impairment. Pregnancy and lactation.

Symptoms: Irreversible CNS toxicity and death. Severe arachnoiditis including encephalopathy.

Management: Therapy cessation followed by treatment of ensuing bone marrow depression including whole blood or platelet transfusion and antibiotics. Maintain vital functions.

Cytotoxic Chemotherapy

IV/SC: Store between 15-25°C. Intrathecal: Store between 2-8°C. Avoid freezing.