nelarabine

Absorption: IV administration results in complete bioavailability. Intracellular conversion is required for activation of prodrug.

Distribution: Extensively distributed.

Metabolism/Excretion: Mostly metabolized intracellularly. Partially eliminated by the kidneys as nelarabine and ara-G.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
IV	unknown	end of infusion	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
CCr <50 mL/min;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Severe hepatic impairment (bilirubin >3.0 mg/dL);
Rep: Women of reproductive potential and men with female partners of reproductive potential;
Geri: Risk of neurologic events may be in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

Hemat: anemia, leukopenia, neutropenia, thrombocytopenia

Neuro: coma, craniospinal demyelination, dizziness, drowsiness, headache, paresthesia, status epilepticus, amnesia, ataxia, balance disorder, dysgeusia, neuropathy, tremor

Interactions ⬆ ⬇

Drug-drug:

↓antibody response to and ↑ risk of adverse reactions from live-virus vaccines.

Route/Dosage ⬆ ⬇

IV (Adults ): 1500 mg/m² on Days 1, 3 and 5 of every 21-day cycle.
IV (Children ≥1 yr): 650 mg/m²/day for first 5 days of every 21-day cycle.

Availability ⬆ ⬇

(Generic available)

Solution for injection: 5 mg/mL

Assessment ⬆ ⬇

Assess neurologic status frequently. May cause altered mental states (severe somnolence, confusion, coma), CNS effects (convulsions, status epilepticus) and peripheral neuropathy (numbness, paresthesia, motor weakness, ataxia, hypoesthesia, craniospinal demyelination, ascending neuropathy, paralysis). Risk is increased in patients treated previously or concurrently with intrathecal chemotherapy or previously with craniospinal irradiation. May be irreversible. Discontinue nelarabine if neurologic toxicity is severe (NCI Grade 2 or greater).

Lab Test Considerations:

Obtain a negative pregnancy test before starting therapy.
- Monitor CBC regularly. May cause leukopenia, thrombocytopenia, anemia, neutropenia, including febrile neutropenia.
- May cause hyperuricemia.
- May cause ↑ transaminase, serum bilirubin, and serum creatinine levels, and ↓ serum potassium, calcium, magnesium, glucose, and albumin levels.

Implementation ⬆ ⬇

Fatalities have occurred with chemotherapeutic agents. Before administering, clarify all ambiguous orders; double-check single, daily, and course-of-therapy dose limits; have second practitioner independently double-check original order, calculations, and infusion-pump settings.
Nelarabine should be administered under the supervision of a physician experienced in antineoplastic therapy.
- Administer IV hydration to prevent hyperuricemia. Consider allopurinol administration.

IV Administration:

Prepare solution for IV administration in a biologic cabinet. Wear gloves, gown, and mask while handling IV medication. Discard IV equipment in specially designated containers.
Intermittent Infusion: Diluent: Do not dilute prior to administration. Transfer the dose into PVC infusion bags or glass containers. Do not administer solution that is discolored or contains particulate matter.
Rate: Administer over 2 hr for adults and over 1 hr in children.

Patient/Family Teaching ⬆ ⬇

Instruct patient and parents to read the Patient Information Leaflet before starting treatment and with each treatment.
May cause somnolence. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
Advise patient to notify health care professional promptly if new or worsening symptoms of peripheral neuropathy (tingling or numbness in fingers, hands, toes, or feet; difficulty with fine motor coordination tasks such as buttoning clothing; unsteadiness while walking; weakness arising from a low chair or climbing stairs; increased tripping while walking over uneven surfaces) occur or if seizures or fever or signs of infection occur.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Caution patient not to receive vaccines made with live viruses during therapy.
Rep: May cause fetal harm. Advise females of reproductive potential and males with female partners of reproductive potential to use effective contraception during and for 3 mo after last dose and to avoid breastfeeding during therapy.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇