CV: edema.
Derm: alopecia, rash.
EENT: corneal toxicity (high dose), hemorrhagic conjunctivitis (high dose), visual disturbances (including blindness).
GI: GI ulceration (high dose), HEPATOTOXICITY, nausea, vomiting, stomatitis.
GU: sterility, urinary incontinence.
Hemat: (less with IT use): anemia, leukopenia, thrombocytopenia.
Metab: hyperuricemia.
Neuro: IT: abnormal gait, CHEMICAL ARACHNOIDITIS, CNS dysfunction (high dose), confusion, drowsiness, headache.
Resp: PULMONARY EDEMA (HIGH DOSE).
Misc: cytarabine syndrome, fever.
Dose regimens vary widely
- IV (Adults): Induction dose: 200 mg/m2/day for 5 days every 2 wk as a single agent or 2–6 mg/kg/day (100–200 mg/m2/day) as a single daily dose or in 2–3 divided doses for 5–10 days or until remission occurs as part of combination chemotherapy. Maintenance: 70–200 mg/m2/day for 2–5 days monthly. Refractory leukemias/lymphomas: 3 g/m2 every 12 hr for up to 12 doses.
- SC (Adults): Maintenance: 1–1.5 mg/kg every 1–4 wk.
- IT (Adults): Usual dose = 30 mg/m2 every 4 days; range = 5–75 mg/m2 once daily for 4 days or every 4 days until CNS findings normalize, followed by one additional treatment.
Therapeutic Classification: antineoplastics
Pharmacologic Classification: antimetabolites
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 sufficient quantities.
Metabolism/Excretion: Metabolized mostly by the liver; <10% excreted unchanged by the kidneys. Metabolism to inactive drug in the CSF is negligible because the enzyme that metabolizes it is present in very low concentrations in the CSF.
Half-life: IV, SUBQ: 1–3 hr; IT: 100–236 hr.
(IV, SUBQ—effects on WBCs; IT—levels in CSF)
