WARNING

Cladribine is a medication primarily used to treat hairy cell leukemia, but it’s also investigated for use in multiple sclerosis. Like any medication, it carries potential risks and side effects. Some common risks associated with Cladribine include:

• Immune Suppression: Cladribine affects the immune system, potentially increasing the risk of infections.
• Bone Marrow Suppression: It can lower blood cell counts (white blood cells, red blood cells, and platelets), which may lead to increased susceptibility to infections, anemia, or bleeding.
• Autoimmune Disorders: There is a risk of developing autoimmune disorders due to alterations in immune function.
• Other Side Effects: These may include nausea, vomiting, diarrhea, fever, fatigue, headache, and skin rash.
• Long-term Risks: Since Cladribine affects the immune system, there could be long-term implications, including an increased risk of certain cancers.

It’s crucial for patients taking Cladribine to be closely monitored by healthcare providers to manage these risks and ensure timely intervention if complications arise.

Why is this medication prescribed?

Cladribine tablets are prescribed primarily for the treatment of relapsing forms of multiple sclerosis (MS). MS is a chronic autoimmune disease that affects the central nervous system, causing inflammation, damage to the myelin sheath (protective covering of nerve fibers), and potentially leading to disability over time. Cladribine helps reduce the frequency of relapses and slows the progression of disability in people with MS.

How should this medicine be used?

When Cladribine is prescribed as a tablet, it is important to follow your healthcare provider’s instructions carefully. Here is a general guideline on how Cladribine tablets should be used:

• Dosage: The dosage of Cladribine tablets depends on the condition being treated, your medical history, and other factors determined by your healthcare provider. Follow the prescribed dosage exactly as instructed.
• Administration: Cladribine tablets are typically taken orally by mouth with water. Swallow the tablets whole; do not crush, chew, or break them before swallowing.
• Treatment Schedule: Cladribine treatment is usually given in cycles. The specific schedule can vary, but typically it involves taking the tablets once daily for several days, followed by a period of rest before starting the next cycle. The exact duration and number of cycles will be determined by your healthcare provider.
• Monitoring: During treatment with Cladribine tablets, your healthcare provider will monitor your blood counts and overall health regularly to assess the medication’s effectiveness and manage any potential side effects.
• Adherence to Prescription: It is important to take Cladribine tablets exactly as prescribed. If you have any questions or concerns about the dosage or schedule, talk to your healthcare provider or pharmacist for clarification.
• Other Instructions: Follow any additional instructions provided by your healthcare provider, such as dietary guidelines or precautions related to sun exposure.
• Missed Dose: If you miss a dose of Cladribine, take it as soon as you remember, unless it is almost time for your next dose. Do not double the dose to make up for a missed one. If you are unsure about what to do, contact your healthcare provider for advice.
• Duration of Treatment: Complete the full course of treatment as prescribed by your healthcare provider, even if you start to feel better. Stopping the medication prematurely could result in the condition not being fully treated.

Always keep Cladribine tablets stored properly according to the instructions provided, and do not share your medication with others. If you experience any unexpected side effects or have concerns during treatment, promptly inform your healthcare provider for further guidance.

Other uses for this medicine

• Non-Hodgkin Lymphoma: It has been used in the treatment of certain types of non-Hodgkin lymphoma, particularly those that are resistant to other therapies.
• Waldenström’s Macroglobulinemia: Cladribine has been explored as a treatment option for this rare type of lymphoma.
• Autoimmune Disorders: There is ongoing research into the use of Cladribine for various autoimmune disorders, although this is still considered experimental.

What special precautions should I follow?

Special Precautions for Cladribine:

• Immune System Monitoring: Since Cladribine suppresses the immune system, patients should be monitored closely for signs of infection. It’s important to report any symptoms of infection (such as fever, chills, sore throat, cough, or unusual tiredness) to a healthcare provider promptly.
• Blood Counts: Regular monitoring of blood cell counts (white blood cells, red blood cells, and platelets) is essential to detect any potential bone marrow suppression early.
• Vaccinations: Live vaccines should generally be avoided during and shortly after treatment with Cladribine due to the risk of infection. Discuss vaccination schedules with your healthcare provider.
• Pregnancy and Breastfeeding: Cladribine can cause harm to a developing fetus, so it should not be used during pregnancy unless clearly necessary. It is also not recommended during breastfeeding.
• Kidney and Liver Function: Cladribine may affect kidney and liver function, so these should be monitored regularly during treatment.
• Other Medications: Inform your healthcare provider about all medications (including over-the-counter drugs, vitamins, and supplements) you are taking, as some may interact with Cladribine.
• Sun Exposure: Avoid prolonged sun exposure and use sunscreen when outdoors, as Cladribine may increase sensitivity to sunlight.
• Patient Education: Patients should receive thorough education about the risks and benefits of Cladribine, including potential side effects and the need for regular monitoring.

These precautions are crucial to ensure the safe and effective use of Cladribine in treating various conditions, minimizing risks, and maximizing therapeutic benefits.

What special dietary instructions should I follow?

There are no specific dietary restrictions associated with Cladribine. However, maintaining a healthy diet and staying well-hydrated can support overall health and may help manage potential side effects.

What should I do if I forget a dose?

If you miss a dose of Cladribine, take it as soon as you remember. However, if it is almost time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not take double doses to make up for a missed dose.

What side effects can this medication cause?

Cladribine, like any medication, can cause a range of side effects. These can vary in severity from mild to potentially serious. Common side effects of Cladribine include:

• Immune System Effects: Cladribine suppresses the immune system, which can increase the risk of infections. Common infections may include respiratory infections (such as bronchitis or pneumonia), urinary tract infections, and skin infections.
• Bone Marrow Suppression: Cladribine can lower blood cell counts, leading to an increased risk of anemia (low red blood cells), neutropenia (low white blood cells), and thrombocytopenia (low platelets). This can result in symptoms like fatigue, weakness, easy bruising or bleeding, and increased susceptibility to infections.
• Gastrointestinal Issues: Nausea, vomiting, diarrhea, and abdominal pain are common gastrointestinal side effects of Cladribine.
• Skin Reactions: Rash, itching, and dry skin can occur with Cladribine treatment.
• Headache: Some patients may experience headaches as a side effect.
• Fatigue: Cladribine can cause fatigue or tiredness.
• Fever: Low-grade fevers may occur, especially during the infusion period.
• Liver and Kidney Function: Cladribine may affect liver and kidney function tests, though serious complications in these organs are rare.
• Autoimmune Disorders: There is a potential risk of developing autoimmune disorders as a result of Cladribine treatment.
• Other: Less common side effects include muscle pain, joint pain, respiratory symptoms like cough, and changes in taste.

It’s important for patients receiving Cladribine to be monitored closely by their healthcare providers for these side effects. If any side effects occur, it’s crucial to report them promptly to ensure appropriate management and adjustment of treatment if necessary.

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

Storage of Cladribine:

• Temperature: Cladribine should be stored at room temperature, typically between 20°C to 25°C (68°F to 77°F).
• Protect from Light: Keep Cladribine tablets in their original container and protect them from light.
• Keep Out of Reach of Children: Store Cladribine in a secure place out of the reach of children and pets.
• Do Not Freeze: Do not freeze Cladribine.
• Storage Duration: Follow any specific storage instructions provided with the medication, and check the expiration date on the packaging. Do not use Cladribine if it has expired.

Disposal of Cladribine:

• Follow Local Guidelines: Dispose of unused or expired Cladribine tablets according to local regulations and guidelines. Do not flush them down the toilet or pour them down the drain unless instructed to do so.
• Take-back Programs: Some pharmacies or local government offices may have medication take-back programs where you can safely dispose of unused medications.

In case of emergency/overdose

• Seek Immediate Medical Attention: If you suspect an overdose or experience severe side effects, such as difficulty breathing, severe dizziness, or loss of consciousness, call emergency services (911 in the US) or your local poison control center immediately.
• Emergency Information: Have information readily available about the medication you are taking, including the name (Cladribine), dosage, and any other pertinent details, to provide to healthcare providers in case of emergency.

What other information should I know?

• Monitoring: Regular monitoring of blood counts and overall health is essential during Cladribine treatment. Follow-up appointments with your healthcare provider are crucial to assess treatment effectiveness and manage potential side effects.
• Pregnancy and Breastfeeding: Cladribine can harm an unborn baby, so it should not be used during pregnancy unless clearly necessary. It is also not recommended during breastfeeding.
• Interactions: Inform your healthcare provider about all medications you are taking, including over-the-counter drugs, vitamins, and supplements, as they may interact with Cladribine.
• Patient Education: Understand the risks and benefits of Cladribine treatment. Ask your healthcare provider for detailed information about the medication, including potential side effects and what to do if they occur.

By following these guidelines for storage, disposal, emergencies/overdose, and other pertinent information, you can ensure the safe and effective use of Cladribine as prescribed by your healthcare provider.