WARNING

Cladribine injection, is a medication used primarily in the treatment of hairy cell leukemia. Like all medications, it carries potential risks and side effects. Here are some key risks associated with cladribine injection:

• Bone marrow suppression: Cladribine can suppress the bone marrow’s ability to produce blood cells (red cells, white cells, and platelets), leading to an increased risk of infections, anemia, and bleeding.
• Immunosuppression: Due to its effects on the immune system, cladribine can increase susceptibility to infections. Patients may be at higher risk for viral, bacterial, and fungal infections.
• Neurological effects: Some patients may experience neurological side effects such as headaches, dizziness, or confusion. Severe cases can include seizures or coma.
• Gastrointestinal effects: Nausea, vomiting, diarrhea, and abdominal pain are common gastrointestinal side effects associated with cladribine.
• Skin reactions: Rash and itching can occur in some patients.
• Liver toxicity: Cladribine can affect liver function, leading to elevated liver enzymes or, rarely, liver failure.
• Kidney toxicity: There may be an increased risk of kidney damage with cladribine use, leading to changes in urine output or kidney function tests.
• Autoimmune disorders: Rarely, cladribine has been associated with the development of autoimmune disorders such as autoimmune hemolytic anemia or autoimmune thrombocytopenia.
• Secondary malignancies: Long-term use of cladribine has been associated with an increased risk of developing other types of cancers.
• Pregnancy risks: Cladribine can cause harm to a developing fetus, so it is contraindicated during pregnancy.

It’s essential for patients receiving cladribine injection to be closely monitored by healthcare providers for these potential risks and side effects. The decision to use cladribine should always be carefully weighed against its potential benefits, and patients should discuss any concerns with their healthcare team.

Why is this medication prescribed?

Cladribine injection, is primarily prescribed for the treatment of hairy cell leukemia (HCL), a rare type of cancer that affects the blood and bone marrow. HCL is characterized by abnormal B cells that accumulate in the bone marrow, leading to decreased production of normal blood cells (red cells, white cells, and platelets). Cladribine works by interfering with the DNA synthesis of these abnormal cells, leading to their destruction and reduction in bone marrow infiltration.

How should this medicine be used?

Cladribine Injection Should Be Used:

• Administration: Cladribine is typically administered as an intravenous infusion (injection into a vein) over a period of 2 hours. The exact dosing schedule and duration of treatment may vary depending on the patient’s condition and response to therapy.
• Treatment Schedule: The treatment is usually given daily for 7 consecutive days. This 7-day cycle may be repeated every 4 weeks for up to 6 cycles, depending on the response and tolerance of the patient.
• Monitoring: During treatment with cladribine, patients will require regular monitoring of blood counts (to assess bone marrow function), liver function tests, and kidney function tests to detect and manage any potential side effects.
• Precautions: Due to its potential to suppress the immune system, patients receiving cladribine should avoid contact with individuals who have infections, and vaccinations with live vaccines should be avoided during treatment and for at least 6 months after treatment ends.
• Pregnancy and Contraception: Cladribine can harm an unborn baby, so it is important for both men and women receiving this medication to use effective contraception during treatment and for at least 6 months after the last dose. It is contraindicated during pregnancy.
• Side Effects Management: Common side effects include bone marrow suppression (leading to increased susceptibility to infections, anemia, and bleeding), nausea, vomiting, diarrhea, fatigue, and fever. These side effects are typically managed symptomatically or with supportive care.
• Special Populations: Cladribine should be used with caution in patients with impaired kidney or liver function, as dosage adjustments may be necessary.
• Follow-Up: After completing treatment, patients will require regular follow-up visits to monitor for disease recurrence and to manage any long-term side effects.

It’s crucial for patients to follow their healthcare provider’s instructions carefully and to communicate any concerns or side effects experienced during treatment with cladribine.

Other uses for this medicine

• Waldenström macroglobulinemia: This rare type of lymphoma that affects the bone marrow and blood may also be treated with cladribine in some cases.
• Cutaneous T-cell lymphoma: Cladribine has been used in the treatment of certain types of skin lymphomas.
• Other hematologic malignancies: In some cases, cladribine may be used in the treatment of other types of blood cancers, though its efficacy and safety profiles vary.

What special precautions should I follow?

Special Precautions for Cladribine Injection:

• Infections: Due to its immunosuppressive effects, patients receiving cladribine are at increased risk of infections. Precautions should be taken to avoid exposure to infectious agents, and patients should promptly report any signs of infection to their healthcare provider.
• Monitoring: Regular monitoring of blood counts, liver function, and kidney function is essential during treatment with cladribine to detect and manage potential side effects promptly.
• Vaccinations: Live vaccines should be avoided during treatment with cladribine and for at least 6 months after treatment ends due to the risk of infection.
• Pregnancy and breastfeeding: Cladribine can cause harm to a developing fetus, so it should not be used during pregnancy. Effective contraception should be used during treatment and for at least 6 months after the last dose. It is also not recommended during breastfeeding.
• Kidney and liver function: Cladribine should be used with caution in patients with impaired kidney or liver function, as dosage adjustments may be necessary.
• Previous treatments: Patients who have received prior chemotherapy or immunosuppressive therapies may have an increased risk of bone marrow suppression and infections when treated with cladribine.
• Allergic reactions: Individuals with a history of allergic reactions to cladribine or related medications should avoid its use.
• Other medical conditions: Inform your healthcare provider about any other medical conditions you have, such as diabetes, heart disease, or neurological disorders, as these may influence the decision to prescribe cladribine or require special monitoring.

Always discuss with your healthcare provider about the specific risks, benefits, and precautions related to cladribine injection based on your individual medical history and condition.

What special dietary instructions should I follow?

There are no specific dietary restrictions associated with cladribine injection. However, it’s essential to maintain a healthy and balanced diet to support your overall health and immune function during treatment. Eating a variety of fruits, vegetables, lean proteins, and whole grains can help provide essential nutrients and support your body’s ability to tolerate treatment.

What should I do if I forget a dose?

If you miss a dose of cladribine injection, contact your healthcare provider or clinic immediately for instructions. Depending on the dosing schedule, they may advise you to receive the missed dose as soon as possible or adjust the treatment schedule accordingly. It’s essential not to double the dose to make up for a missed one unless specifically instructed by your healthcare provider.

What side effects can this medication cause?

Cladribine injection, like any medication, can cause a range of side effects. The severity and frequency of these side effects can vary among individuals. Here are some potential side effects associated with cladribine injection:

• Bone marrow suppression: This is one of the most significant side effects. Cladribine affects the bone marrow’s ability to produce blood cells, leading to:
  • Increased risk of infections (due to low white blood cell count)
  • Fatigue, weakness (due to low red blood cell count/anemia)
  • Easy bruising or bleeding (due to low platelet count)
• Gastrointestinal effects: Common gastrointestinal side effects may include:
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal pain or discomfort
• Immunosuppression: Cladribine suppresses the immune system, which can lead to an increased susceptibility to infections. Patients may experience infections ranging from mild to severe.
• Liver toxicity: Elevated liver enzymes (aspartate aminotransferase (AST), alanine aminotransferase (ALT)) may occur, indicating liver inflammation or damage.
• Kidney toxicity: Cladribine can affect kidney function, causing changes in urine output or kidney function tests.
• Neurological effects: Some patients may experience neurological side effects such as:
  • Headaches
  • Dizziness
  • Confusion
  • Seizures (rare)
• Skin reactions: Rash and itching are possible.
• Fever: Low-grade fever may occur, especially during infusion.
• Respiratory effects: Rarely, respiratory symptoms such as shortness of breath or cough may occur.
• Allergic reactions: Severe allergic reactions (anaphylaxis) are rare but possible. Symptoms may include swelling of the face, lips, tongue, or throat; difficulty breathing; and severe itching or rash.
• Other: Other less common side effects may include muscle pain, joint pain, and changes in taste.

It’s essential for patients receiving cladribine injection to be monitored closely by healthcare providers for these potential side effects. Prompt reporting of any new symptoms or side effects is crucial for timely management and adjustment of treatment as necessary.

What should I know about storage and disposal of this medication?

Storage and Disposal of Cladribine Injection:

• Storage: Cladribine injection should be stored at controlled room temperature, ideally between 20°C to 25°C (68°F to 77°F). It should be protected from light.
• Handling: Healthcare providers typically handle the storage and disposal of cladribine injection. They should follow appropriate guidelines for handling cytotoxic drugs, which includes wearing gloves and other protective equipment during preparation and administration.
• Disposal: Any unused portion of cladribine injection should be disposed of properly according to local regulations for hazardous waste disposal. This is typically managed by healthcare facilities or pharmacies that handle chemotherapy drugs.

In case of emergency/overdose

• Emergency: If you experience severe allergic reactions (anaphylaxis) or other serious side effects immediately after receiving cladribine injection, seek emergency medical attention by calling your local emergency services or going to the nearest emergency room.
• Overdose: In case of an overdose, which could potentially lead to severe bone marrow suppression and increased risk of infections, contact your healthcare provider or go to the nearest emergency room immediately. Overdose management would likely involve supportive care and monitoring of blood counts and organ function.

What other information should I know?

• Monitoring: Regular monitoring of blood counts, liver function tests, and kidney function tests is essential during treatment with cladribine to detect and manage any potential side effects promptly.
• Infections: Due to the immunosuppressive effects of cladribine, take precautions to avoid infections. Report any signs of infection (fever, chills, sore throat, etc.) to your healthcare provider promptly.
• Vaccinations: Avoid receiving live vaccines during treatment with cladribine and for at least 6 months after treatment ends due to the risk of infection.
• Pregnancy/Breastfeeding: Cladribine can harm an unborn baby, so it should not be used during pregnancy. Effective contraception should be used during treatment and for at least 6 months after the last dose. It is also not recommended during breastfeeding.
• Special Populations: Cladribine should be used with caution in patients with impaired kidney or liver function, and dosage adjustments may be necessary.
• Follow-Up: After completing treatment with cladribine, regular follow-up visits are necessary to monitor for disease recurrence and manage any long-term side effects.

Always discuss any concerns or questions about cladribine injection with your healthcare provider. They can provide personalized advice based on your medical history and current condition.