sye-TARE-a-been
High Alert
Absorption: Absorption occurs from SUBQ sites, but blood levels are lower than with IV administration; IT administration results in negligible systemic exposure.
Distribution: Widely distributed; IV- and SUBQ-administered cytarabine crosses the blood-brain barrier but not in significant quantities.
Half-Life: IV, SUBQ: 1–3 hr; IT: 100–236 hr.
(IV, SUBQ: Effects on WBCs; IT: Concentrations in CSF)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| SUBQ, IV (1st phase) | 24 hr | 7–9 days | 12 days |
| SUBQ, IV (2nd phase) | 15–24 days | 15–24 days | 25–34 days |
| IT | rapid | 5 hr | 14–28 days |
Contraindicated in:
Use Cautiously in:
CV: edema
Derm: alopecia, rash
EENT: corneal toxicity (high dose), hemorrhagic conjunctivitis (high dose), visual disturbances (including blindness)
, , GI ulceration (high dose), HEPATOTOXICITY,GU: sterility, urinary incontinence
Hemat: (less with IT use) anemia leukopenia thrombocytopenia
Neuro: ITabnormal gait, CHEMICAL ARACHNOIDITIS, CNS dysfunction (high dose), confusion, drowsiness, headache
Resp: PULMONARY EDEMA (HIGH DOSE)
Misc: cytarabine syndrome, fever
Drug-drug:
Monitor for signs of bone marrow depression (↑ bleeding and bruising; petechiae; blood in stool, urine, or emesis). Avoid IM injections and rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of neutropenia and anemia (infection, fatigue, dyspnea, orthostatic hypotension).
Lab Test Considerations:
Monitor CBC with differential before and frequently during therapy. WBC count ↓ 24 hr after dose; 1st nadir occurs in 7–9 days, and 2nd deeper nadir occurs in 15–24 days. Platelets ↓ 5 days after dose, with a nadir at 12–15 days. WBC and platelet counts usually ↑ 10 days after the nadirs. If WBC count <1000/mm3 or platelet count <50,000/mm3, consider stopping therapy. Bone marrow aspirations are recommended every 2 wk until remission occurs.
Rate: Inject slowly over 1–5 min.
Administer under supervision of a physician experienced in use of cancer chemotherapeutic agents.
For induction therapy, patients should be treated in a facility with laboratory and supportive resources sufficient to monitor drug tolerance and protect and maintain a patient compromised by drug toxicity.
The health care provider must judge possible benefit to the patient against known toxic effects of this drug in considering the advisability of therapy with cytarabine.
IV Administration: