nelarabine

Contraindicated in:

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.

Availability ⬆ ⬇

(Generic available)

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.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Converted intracellularly to ara-G and then to ara-GTP. In leukemic cells, it is incorporated into DNA, leading to inhibition of DNA synthesis and cell death.

Therapeutic effects:

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: antimetabolites

Pharmacokinetics ⬆ ⬇

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.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
IV	unknown	end of infusion	unknown

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.