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|Cytarabine

CYTARABINE (Systemic)

Some commonly used brand names are:

In the U.S.—

• Cytosar-U

In Canada—

• Cytosar

Generic name product may be available in the U.S.

Other commonly used names are ara-C and cytosine arabinoside .

Category

• Antineoplastic

Description

Cytarabine (sye-TARE-a-been) belongs to the group of medicines called antimetabolites. It is used to treat some kinds of cancers of the blood. It may also be used to treat other kinds of cancer, as determined by your doctor.

Cytarabine interferes with the growth of cancer cells, which are eventually destroyed. Since the growth of normal body cells may also be affected by cytarabine, other effects will also occur. Some of these may be serious and must be reported to your doctor. Other effects, like hair loss, may not be serious but may cause concern. Some effects may not occur for months or years after the medicine is used.

Before you begin treatment with cytarabine, you and your doctor should talk about the good this medicine will do as well as the risks of using it.

Cytarabine is to be administered only by or under the immediate supervision of your doctor. It is available in the following dosage form:

• Parenteral
• Injection (U.S. and Canada)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For cytarabine, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to cytarabine.

Pregnancy—This medicine may cause birth defects (such as defects of the arms, legs, or ears, which occurred in two babies) if either the male or female is taking it at the time of conception or if it is taken during pregnancy. In addition, many cancer medicines may cause sterility. Although sterility has been reported with this medicine, it is usually only temporary.

Be sure that you have discussed this with your doctor before taking this medicine. It is best to use some kind of birth control while you are receiving cytarabine. Tell your doctor right away if you think you have become pregnant while receiving cytarabine.

Breast-feeding—Because cytarabine may cause serious side effects, breast-feeding is generally not recommended while you are receiving it.

Children—Although there is no specific information comparing use of cytarabine in children with use in other age groups, this medicine is not expected to cause different side effects or problems in children than it does in adults.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults. Although there is no specific information comparing use of cytarabine in the elderly with use in other age groups, this medicine is not expected to cause different side effects or problems in older people than it does in younger adults.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving cytarabine, it is especially important that your health care professional know if you are taking any of the following:

• Amphotericin B by injection (e.g., Fungizone) or
• Antithyroid agents (medicine for overactive thyroid) or
• Azathioprine (e.g., Imuran) or
• Chloramphenicol (e.g., Chloromycetin) or
• Colchicine or
• Flucytosine (e.g., Ancobon) or
• Ganciclovir (e.g., Cytovene) or
• Interferon (e.g., Intron A, Roferon-A) or
• Plicamycin (e.g., Mithracin) or
• Zidovudine (e.g., AZT, Retrovir) or
• If you have ever been treated with radiation or cancer medicines—Cytarabine may increase the effects of these medicines or radiation therapy on the blood

• Azathioprine (e.g., Imuran) or
• Chlorambucil (e.g., Leukeran) or
• Corticosteroids (cortisone-like medicine) or
• Cyclosporine (e.g., Sandimmune) or
• Mercaptopurine (e.g., Purinethol) or
• Muromonab-CD3 (monoclonal antibody) (e.g., Orthoclone OKT3) or
• Tacrolimus (e.g., Prograf)—There may be an increased risk of infection because cytarabine decreases your body"s ability to fight it

• Probenecid (e.g., Benemid) or
• Sulfinpyrazone (e.g., Anturane)—Cytarabine may raise the concentration of uric acid in the blood. Since these medicines are used to lower uric acid levels, they may not work as well in patients receiving cytarabine

Other medical problems—The presence of other medical problems may affect the use of cytarabine. Make sure you tell your doctor if you have any other medical problems, especially:

• Chickenpox (including recent exposure) or
• Herpes zoster (shingles)—Risk of severe disease affecting other parts of the body

• Gout (history of) or
• Kidney stones (history of)—Cytarabine may increase levels of uric acid in the body, which can cause gout or kidney stones

• Infection—Cytarabine can decrease your body"s ability to fight infection

• Kidney disease or
• Liver disease—Effects of cytarabine may be increased because of slower removal from the body

Proper Use of This Medicine

This medicine is sometimes given together with certain other medicines. If you are using a combination of medicines, it is important that you receive each one at the proper time. If you are taking some of these medicines by mouth, ask your health care professional to help you plan a way to take them at the right times.

While you are receiving this medicine, your doctor may want you to drink extra fluids so that you will pass more urine. This will help prevent kidney problems and keep your kidneys working well.

This medicine often causes nausea and vomiting. However, it is very important that you continue to receive the medicine even if you begin to feel ill. Ask your health care professional for ways to lessen these effects.

Dosing—The dose of cytarabine will be different for different patients. The dose that is used may depend on a number of things, including what the medicine is being used for, the patient"s weight, and whether or not other medicines are also being taken. If you are receiving cytarabine at home, follow your doctor"s orders or the directions on the label . If you have any questions about the proper dose of cytarabine, ask your doctor.

Precautions While Using This Medicine

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to check for unwanted effects.

While you are being treated with cytarabine, and after you stop treatment with it, do not have any immunizations (vaccinations) without your doctor"s approval . Cytarabine may lower your body"s resistance and there is a chance you might get the infection the immunization is meant to prevent. In addition, other persons living in your household should not take oral polio vaccine since there is a chance they could pass the polio virus on to you. Also, avoid persons who have taken oral polio vaccine. Do not get close to them and do not stay in the same room with them for very long. If you cannot take these precautions, you should consider wearing a protective face mask that covers the nose and mouth.

Cytarabine can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

• If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
• Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in urine or stools; or pinpoint red spots on your skin.
• Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
• Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
• Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
• Avoid contact sports or other situations where bruising or injury could occur.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Also, because of the way these medicines act on the body, there is a chance that they might cause other unwanted effects that may not occur until months or years after the medicine is used. These delayed effects may include certain types of cancer, such as leukemia. Discuss these possible effects with your doctor.

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

This medicine may cause a temporary loss of hair in some people. After treatment with cytarabine has ended, normal hair growth should return.

After you stop receiving cytarabine, it may still produce some side effects that need attention. During this period of time check with your doctor if you notice any of the following:

Black, tarry stools; blood in urine or stools; cough or hoarseness; fever or chills; lower back or side pain; painful or difficult urination; pinpoint red spots on skin; unusual bleeding or bruising

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Additional Information

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, cytarabine is used in certain patients with the following medical conditions:

• Cancer of the lymph system
• Cancer of the brain and spinal cord
• Myelodysplastic syndromes (MDS)

Other than the above information, there is no additional information relating to proper use, precautions, or side effects for these uses.

Revised: 02/25/2004

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