Nelarabine

Class
Antimetabolites
Subclass
Purine analogs
Substance name
Nelarabine
Brand names
Arranon®
Common formulations
Solution for injection
Safety risks
Warnings and precautions
Coma
•
Use caution who have received prior intrathecal chemotherapy or craniospinal radiation therapy, a history of neurologic events (neurotoxicity) and geriatric population.
Hematologic disorder
•
Use caution with a history of anemia, neutropenia, or thrombocytopenia.
Seizures
•
Use caution with a history of seizure disorder.
Tumor lysis syndrome
•
Use caution with large tumor burden and risk factors for tumor lysis syndrome or hyperuricemia.
Specific populations
Renal impairment
eGFR 30-50 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Monitor serum concentrations. Monitor for neurotoxicity.
eGFR 10-30 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Monitor serum concentrations. Monitor for neurotoxicity.
eGFR < 10 mL/min/1.73 m²
•
Use with caution. Monitor serum concentrations. Monitor for neurotoxicity.
Renal replacement therapy
Continuous renal replacement
•
Use acceptable. No dose adjustment required. Monitor serum concentrations. Monitor for neurotoxicity.
Intermittent hemodialysis
•
Use with caution. Dose as in eGFR < 10 mL/min/1.73 m². Monitor serum concentrations. Monitor for neurotoxicity.
Peritoneal dialysis
•
Use with caution. Dose as in eGFR < 10 mL/min/1.73 m². Monitor serum concentrations. Monitor for neurotoxicity.
Hepatic impairment
Child-Pugh A (mild)
•
Use acceptable. No dose adjustment required.
Child-Pugh B (moderate)
•
Use acceptable. No dose adjustment required.
Child-Pugh C (severe)
•
Use with caution. Monitor for toxicity.
Pregnancy and breastfeeding
Pregnancy
All trimesters
•
Avoid use. Evidence of fetal harm in humans. This drug can harm a developing fetus.
•
Both sexually active women and men (even those who have had a vasectomy) should use effective methods of contraception during therapy and for at least 3 months following cessation of therapy.
•
If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential harm to the fetus.
Breastfeeding
Little information available on breastfeeding safety.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Anemia, ↓ WBC count, ↓ blood neutrophil count, ↓ platelet count, ↓ serum potassium, edema, febrile neutropenia, peripheral edema, peripheral neuropathy, petechiae, asthenia, constipation, cough, diarrhea, dizziness, dyspnea, fatigue, fever, headache, hypoesthesia, muscle weakness, myalgia, nausea, pain, paresthesia, somnolence
Common 1-10%
•
Abdominal swelling, ataxia, cerebral hemorrhage, ↓ blood glucose, ↓ serum calcium, ↓ serum magnesium, dehydration, hypoalbuminemia, hypotension, ↑ blood glucose, ↑ liver enzymes, ↑ serum TBIL, ↑ serum creatinine, pleural effusion, pneumonia, abdominal pain, arthralgia, back pain, chest pain, confusion, depression, exertional dyspnea, insomnia, loss of appetite, muscle weakness, nosebleed, rigors, vomiting, rhabdomyolysis, sinus tachycardia, sinusitis, status epilepticus, stomatitis, tremor, wheezing
Unknown frequency
•
↑ serum CK, opportunistic infections, progressive multifocal leukoencephalopathy, tumor lysis syndrome
Interactions
Drug(s)
Check Interactions
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