Fludarabine

DEA Class; Rx

Common Brand Names; Fludara, Oforta

Purine nucleoside antineoplastic agent
Used for the treatment of adult patients with B-cell chronic lymphocytic leukemia who have not responded to or whose disease has progressed during treatment with at least 1 standard alkylating agent-containing regimen
Life-threatening or fatal autoimmune reactions have been reported; monitor for hemolysis

Hypersensitivity

Concomitant pentostatin: risk of fatal pulmonary toxicity

IV: severe renal impairment

• Fever (69%)
• Objective weakness (65%)
• Anemia (60%)
• Neutropenia (60%)
• Thrombocytopenia (55%)
• Leukopenia (partly therapeutic)
• Infection (44%-not necessarily drug-induced)
• Cough (44%)
• Pain (44%)
• Fatigue (38%)
• N/V (36%)
• Anorexia (34%)
• Malaise (22%)
• Dyspnea (22%)
• Pneumonia (9-22%)
• Edema (19%)
• Myalgia (16%)
• URI (16%)
• UTI (15%)
• Rash (15%)
• Diarrhea (15%)
• Visual disturbances (15%)
• Diaphoresis (13%)
• GI bleeding (13%)
• Paresthesia (12%)

Bone marrow depression, renal impairment, elderly

Allopurinol and hydration recommended for patients newly diagnosed with CLL or those at risk of tumor lysis syndrome

Very high doses (and rarely, normal doses) have caused irreversible or fatal neurotoxicity manifesting after 21-60 days

Risk of potentially fatal autoimmune hemolytic anemia

Avoid pregnancy

No efficacy in children

Pregnancy Category: D

Lactation: not known if excreted in breast milk, do not nurse