Home Drug Guide Cladribine

Drug Guide

Generic Name

Cladribine

Brand Names Leustatin, Mavenclad

Classification

Therapeutic: Antineoplastic agent, Immunosuppressant

Pharmacological: Purine analog, Antimetabolite

FDA Approved Indications

  • Hairy cell leukemia
  • Relapsing multiple sclerosis (MS)

Mechanism of Action

Cladribine is a purine analog that inhibits DNA synthesis and repair, leading to apoptosis of lymphocytes, especially targeting B and T lymphocytes, thus exerting immunosuppressive and antineoplastic effects.

Dosage and Administration

Adult: Leustatin: 0.1 mg/kg IV daily for 7 days, repeated after 4-8 weeks. Mavenclad: 3.5 mg/kg orally over 2 years (specific dosing schedule varies).

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; no specific dose adjustments but monitor renal and hepatic function.

Renal Impairment: Adjust dosing based on severity of impairment; specific guidelines recommended.

Hepatic Impairment: No specific adjustments; monitor hepatic function.

Pharmacokinetics

Absorption: Orally absorbed (Mavenclad); IV administration (Leustatin).

Distribution: Widely distributed; crosses blood-brain barrier.

Metabolism: Metabolized via deamination; not liver CYP450 involved.

Excretion: Primarily via the kidneys.

Half Life: Approx. 3-20 hours; longer in lymphocytes.

Contraindications

  • Hypersensitivity to cladribine or any component.
  • Active infections.

Precautions

  • Use with caution in patients with renal impairment, hepatic impairment, or active infections. Monitoring lymphocyte counts is essential due to immunosuppressive effects. Pregnancy and breastfeeding are contraindicated; effective contraception needed during and for 6 months after therapy.

Adverse Reactions - Common

  • Neutropenia (Common)
  • Thrombocytopenia (Common)
  • Anemia (Common)
  • Infections (viral, bacterial, fungal) (Common)

Adverse Reactions - Serious

  • Severe infections (Uncommon)
  • Progressive multifocal leukoencephalopathy (PML) (Rare)
  • Malignancies (excluding skin cancers) (Reported)

Drug-Drug Interactions

  • Immunosuppressants
  • Other lymphocyte-depleting agents

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood counts (CBC), renal and hepatic function, and for signs of infection.

Diagnoses:

  • Risk for infection
  • Impaired immune response
  • Risk for bleeding due to thrombocytopenia

Implementation: Administer as scheduled, monitor for adverse effects, educate patient on infection prevention.

Evaluation: Effectiveness in controlling MS symptoms or leukemia, no signs of infection, recovery of blood counts.

Patient/Family Teaching

  • Report signs of infection (fever, chills, sore throat).
  • Avoid live vaccines during and after therapy.
  • Maintain good hygiene and hygiene practices.

Special Considerations

Black Box Warnings:

  • Malignant neoplasms, including melanoma and other skin cancers.
  • Potential for severe infections.
  • Progressive multifocal leukoencephalopathy (PML).

Genetic Factors: No specific genetic testing required.

Lab Test Interference: May cause lymphopenia, monitor blood counts regularly.

Overdose Management

Signs/Symptoms: Severe cytopenias, infections, bleeding.

Treatment: Supportive care; no specific antidote. Hematopoietic growth factors may be considered; consult poison control if overdose suspected.

Storage and Handling

Storage: Store at controlled room temperature 20-25°C (68-77°F).

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.