Generic Name

Fludarabine Phosphate

---

Classification

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

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.