Home Drug Guide Cytarabine

Drug Guide

Generic Name

Cytarabine

Brand Names Depocyt, Cytosar-U

Classification

Therapeutic: Antineoplastic agent, Antimetabolite

Pharmacological: Pyrimidine nucleoside analog

FDA Approved Indications

  • Acute myeloid leukemia (AML)
  • Lymphoma (e.g., non-Hodgkin lymphoma)
  • Central nervous system (CNS) prophylaxis and treatment in leukemia

Mechanism of Action

Cytarabine inhibits DNA synthesis by being incorporated into DNA during the S-phase of the cell cycle, leading to chain termination and cell death.

Dosage and Administration

Adult: Prescribed based on condition; for AML, typical IV doses range from 100-200 mg/m^2 daily for several days; intrathecal administration is used for CNS prophylaxis or treatment.

Pediatric: Dosing varies with age and weight; specific protocols must be followed.

Geriatric: Use cautiously; individualized dosing recommended due to potential toxicity.

Renal Impairment: Adjust dose accordingly; renal function affects clearance.

Hepatic Impairment: No specific adjustment; monitor closely.

Pharmacokinetics

Absorption: Poor oral bioavailability; administered intravenously, intrathecally, or via continuous infusion.

Distribution: Widely distributed, including CNS with intrathecal administration.

Metabolism: Limited hepatic metabolism; predominantly metabolized in tissues.

Excretion: Renally excreted; dose adjustment needed in renal impairment.

Half Life: Approximately 8-20 minutes for plasma; metabolites have longer half-lives.

Contraindications

  • Hypersensitivity to cytarabine or related compounds.

Precautions

  • Use with caution in renal or hepatic impairment, in patients with active infections, and in pregnant or breastfeeding women. Neurotoxicity risk with high doses. Potential for myelosuppression.

Adverse Reactions - Common

  • Myelosuppression (neutropenia, anemia, thrombocytopenia) (Very common)
  • Nausea and vomiting (Common)
  • Stomatitis (Common)
  • Conjunctivitis (Less common)

Adverse Reactions - Serious

  • Neurotoxicity (cerebellar toxicity, neuropsychological effects) (Rare at standard doses; increased risk with high doses)
  • Infections due to immunosuppression (Common)
  • Pulmonary toxicity (interstitial pneumonitis) (Rare)
  • Secondary malignancies (e.g., myelodysplastic syndromes) (Very rare)

Drug-Drug Interactions

  • May enhance myelosuppression when combined with other myelosuppressive agents (e.g., cyclophosphamide, carboplatin)

Drug-Food Interactions

  • No significant interactions reported.

Drug-Herb Interactions

  • Limited data; caution advised with herbs affecting liver enzymes or immune system.

Nursing Implications

Assessment: Monitor blood counts regularly; assess for signs of neurotoxicity, pulmonary toxicity, and infections.

Diagnoses:

  • Risk for infection related to immunosuppression.
  • Risk for bleeding related to thrombocytopenia.

Implementation: Administer as prescribed, monitor labs closely, educate patient about signs of adverse effects.

Evaluation: Efficacy assessed by disease response; toxicity monitored through labs and clinical assessment.

Patient/Family Teaching

  • Report symptoms of infection, neurotoxicity, or pulmonary issues immediately.
  • Avoid pregnancy; use effective contraception.
  • Maintain good hygiene and infection prevention measures.

Special Considerations

Black Box Warnings:

  • Neurotoxicity, especially with high doses or intrathecal administration.
  • Potential for severe myelosuppression leading to infections and bleeding.

Genetic Factors: Limited data on genetic influences.

Lab Test Interference: May cause cytopenias that affect lab results.

Overdose Management

Signs/Symptoms: Severe myelosuppression, neurotoxicity, seizures, coma.

Treatment: Supportive care; no specific antidote. Hematopoietic growth factors may be considered; hemodialysis not effective.

Storage and Handling

Storage: Store vials at 2-8°C, protected from light.

Stability: Stable until expiration date on package.

🛡️ 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.