Home Drug Guide Fludarabine Phosphate

Drug Guide

Generic Name

Fludarabine Phosphate

Brand Names Fludara, Oforta

Classification

Therapeutic: Antineoplastic Agent, Chemotherapy

Pharmacological: Nucleoside Analog

FDA Approved Indications

  • Chronic Lymphocytic Leukemia (CLL)

Mechanism of Action

Fludarabine is a purine analog that inhibits DNA synthesis by incorporating into DNA and RNA, leading to apoptosis of malignant cells.

Dosage and Administration

Adult: dose varies based on protocol, typically 25 mg/m² IV daily for 5 days in a 28-day cycle.

Pediatric: Limited data; use under specialist guidance.

Geriatric: Adjustments are necessary based on renal function and tolerability.

Renal Impairment: Use with caution; dose reduction may be necessary.

Hepatic Impairment: No specific guidance available; monitor closely.

Pharmacokinetics

Absorption: Administered intravenously; not absorbed orally.

Distribution: Extensively distributed throughout body tissues.

Metabolism: Metabolized intracellularly to active triphosphate form.

Excretion: Primarily excreted unchanged in urine.

Half Life: Approximately 3-7 hours.

Contraindications

  • Hypersensitivity to fludarabine.

Precautions

  • Use with caution in patients with renal impairment, active infections, or compromised immune systems. Pregnancy category D; avoid in pregnancy.

Adverse Reactions - Common

  • Myelosuppression (Very common)
  • Infections (Common)
  • Fatigue (Common)
  • Nausea/Vomiting (Common)

Adverse Reactions - Serious

  • Immunosuppression leading to opportunistic infections (Serious)
  • Hemolytic anemia (Rare)
  • Secondary malignancies (Rare)

Drug-Drug Interactions

  • Other immunosuppressants, live vaccines

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor complete blood counts regularly. Assess for signs of infection.

Diagnoses:

  • Risk for infection
  • Risk for bleeding due to thrombocytopenia

Implementation: Administer as prescribed; implement infection control measures.

Evaluation: Monitor blood counts; assess for adverse effects.

Patient/Family Teaching

  • Report fever, chills, sore throat immediately.
  • Use precautions to prevent infection.
  • Avoid live vaccines during therapy.

Special Considerations

Black Box Warnings:

  • Severe myelosuppression, which can be life-threatening.
  • Potential for secondary malignancies.

Genetic Factors: N/A

Lab Test Interference: May cause pancytopenia, affecting blood counts.

Overdose Management

Signs/Symptoms: Severe myelosuppression, neurotoxicity, seizures.

Treatment: Supportive care, monitor vital signs, blood counts, and provide supportive therapies.

Storage and Handling

Storage: Store at room temperature, away from moisture and light.

Stability: Stable under recommended conditions for the shelf life specified on the 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.