Home Drug Guide Clofarabine

Drug Guide

Generic Name

Clofarabine

Brand Names Clolar

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Nucleoside analog (Purine nucleoside antimetabolite)

FDA Approved Indications

  • Treatment of relapsed or refractory acute lymphoblastic leukemia (ALL) in patients age 1 year and older

Mechanism of Action

Clofarabine is incorporated into DNA and RNA and inhibits DNA synthesis, leading to apoptosis of leukemia cells. It inhibits ribonucleotide reductase and DNA polymerase, disrupting DNA replication and repair.

Dosage and Administration

Adult: Typically 20 mg/m² IV on days 1-5 of each 28-day cycle, but doses may vary based on clinical protocol.

Pediatric: Dosing based on body surface area, generally 20 mg/m² IV on days 1-5 of each 28-day cycle.

Geriatric: Adjust doses based on renal function and tolerability.

Renal Impairment: Reduced doses may be necessary; renal function should be evaluated prior to therapy.

Hepatic Impairment: No specific guidelines; use caution and monitor closely.

Pharmacokinetics

Absorption: Administered intravenously; bioavailability is not applicable.

Distribution: Widely distributed in body tissues; volume of distribution varies.

Metabolism: Primarily metabolized in the liver; exact pathways not fully elucidated.

Excretion: Excreted predominantly in urine as metabolites.

Half Life: Approximately 8-21 hours, depending on renal function.

Contraindications

  • Hypersensitivity to clofarabine or any component of the formulation.

Precautions

  • Use with caution in patients with compromised renal or hepatic function, active infections, or hematologic conditions. Monitor for myelosuppression, infections, and hepatic toxicity.

Adverse Reactions - Common

  • Myelosuppression (neutropenia, anemia, thrombocytopenia) (Common)
  • Nausea, vomiting (Common)
  • Mucositis (Common)
  • Elevated liver enzymes (Common)

Adverse Reactions - Serious

  • Severe infections (Serious)
  • Hepatic failure (Serious)
  • Renal toxicity (Serious)
  • Hemorrhage (Serious)

Drug-Drug Interactions

  • Other myelosuppressive agents (e.g., fludarabine, cytarabine)
  • Immunosuppressants

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood counts, renal and hepatic function, signs of infection.

Diagnoses:

  • Risk for infection
  • Risk for bleeding
  • Imbalanced nutrition: less than body requirements

Implementation: Administer IV as scheduled, monitor for adverse effects, provide supportive care.

Evaluation: Ensure blood counts recover post-treatment, monitor for adverse reactions.

Patient/Family Teaching

  • Report signs of infection, bleeding, or unusual fatigue.
  • Follow infection control precautions.
  • Maintain good hydration and nutrition.
  • Inform about potential side effects and when to seek medical attention.

Special Considerations

Black Box Warnings:

  • Potential for severe myelosuppression leading to infections, bleeding, and anemia.
  • Risk of hepatotoxicity and hepatic failure.

Genetic Factors: N/A

Lab Test Interference: May cause false elevation of serum bilirubin due to hepatic effects.

Overdose Management

Signs/Symptoms: Severe myelosuppression, bleeding, infections, hepatic toxicity.

Treatment: Supportive care, monitor blood counts, provide blood products if needed, and supportive measures in intensive care setting.

Storage and Handling

Storage: Store at 2-8°C in a refrigerator.

Stability: Stability for up to 24 hours at room temperature after reconstitution depending on the product label.

🛡️ 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.