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.