Fludarabine  

Brand name: Fludara  

Generic name: Fludarabine 

Other names: 2-Fluoro-ara-A Monophosphate, 2-Fluoro-ara AMP, FAMP 

Therapeutic Class: antimetabolite  

Manufacturer / Distributor:  Schering SA 

Availability: Fludarabine is available by prescription only  

Dosage form: Fludarabine is given through a vein (IV injection) 

Indications: Fludarabine is used in the treatment of the following medical conditions: 

• chronic lymphocytic leukemia (CLL), in patients for whom other forms of treatment have not worked  

• Indolent or low-grade non-Hodgkin's lymphomas in patients that have been unsuccessfully treated with other forms of treatment.    

Fludarabine may also be prescribed for other medical conditions not mentioned in this article; talk to your doctor or pharmacist for more information.  

Dosage: to determine an effective dosage to combat the cancer, your doctor will consider your general health, whether you are taking other chemotherapy drugs or not, the severity of the tumor and your body mass index. Basing on these criteria, you health care provider will recommend the dosage most capable of fighting the tumor. It is important that you take the medication as indicated by your oncologist.  

Fludarabine comes as a powder to be added to a medical fluid and injected intravenously. Usually, the appropriate dose is taken once daily for five consecutive days, every 28 days. The injection takes about 30 minutes to be over.  

Fludarabine can damage organs in your body. It is very important during the treatment that you drink plenty of water to help your body get rid of the toxic effects of the drug. This helps prevent kidney problems and improve the curative effects of the drug.  

Overdose: Fludarabine overdose can be dangerous. Even at normal dose, Fludarabine can lead to a decrease in white blood cells and platelets, which can cause serious infections; therefore, avoid anything that might weaken your immune system and the risk of infection while taking Fludarabine.  

In addition, Fludarabine can also damage your nervous system, and lead to seizures, restlessness, and even coma. In some patients, Fludarabine can cause lung damage, and other unpredictable life threatening health problems. During the treatment, respect all appointments you have with your doctor. If you think you have taken an overdose, contact your doctor or the poison control center nearest you as soon as possible.   

Missing dose: It is basically difficult to miss a dose of Fludarabine if you are present for your appointment. Do not neglect your appointment; one missed dose of Fludarabine can affect the entire treatment. If for some reasons you cannot be present at the hospital for the treatment, contact your health care provider. Do not stay home because you are experience side effects; Fludarabine cause adverse effects in most patients.   

Contraindication : Fludarabine is contraindicated in the following conditions : 

• allergy to Fludarabine or any of its constituents 
• chronic kidney failure 
• hemolytic anemia 
• pregnancy or breastfeeding  
• vaccination with live attenuated vaccine  
• severe liver failure 
• Taking Pentostatine (deoxycoformycin).    

Fludarabine is not recommended or should be used with caution in patients whose general condition is poor, mainly those suffering from: 

• immune deficiency  
• thrombocytopenia  
• neutropenia  
• anemia  
• Opportunistic infections.   

Mechanism of action (MOA): Fludarabine is the antimetabolite; it kills cancer cells by inhibiting their growth and preventing them from multiplying.  

Interactions: b efore beginning a Fludarabine treatment, tell your doctor about all medications you are taking, whether prescription or non prescription. Talk to your doctor before taking vitamins and nutritional supplements. Contact your doctor before using the following medications:

• Azathioprine
• Colchicine
• Dipyridamole
• Flucytosine
• Ganciclovir
• interferon
• Pentostatin
• Plicamycin
• Zidovudine.

Side effects:  Fludarabine tends to cause adverse effects in most patients; the most common Fludarabine side effects include:  

• nausea and vomiting 
• anxiety  
• constipation
• hair loss
• cough 
• diarrhea 
• drowsiness  
• muscle pain 
• rash or itching 
• Tiredness or weakness. 

If the side effects above persist for weeks, contact your oncologist. In addition, see your doctor if you experience any of these symptoms:   

• confusion
• hearing loss
• depression
• chest pain
• difficulty swallowing
• difficulty breathing
• chest pain or discomfort
• fast or irregular heartbeat
• persistent cough
• yellowing of the skin or eyes
• swelling of the arms, hands, feet, ankles, or lower legs
• Numbness, pain or tingling in the hands, arms, feet, or legs.