Uses of Tarabin: - Blood cancer Acute myeloid leukaemia, acute lymphocytic leukaemia (ALL), lymphomas, Leukaemic meningitis Hypersensitivity; pregnancy and lactation.

Cytotoxic Chemotherapy

Cytarabine inhibits deoxyribonucleic acid (DNA) synthesis specifically at the S-phase of the cell cycle. It also has an antiviral and immunosuppressant activity.

How to use Cytarabine: Your doctor or nurse will give you this medicine. Kindly do not self administer. Administration: IV Administration Rapid IV, infusion over 1-3 hr, or SC intrathecal Has been administered by IM & continuous SC infusion IT: Patient should lie flat for 1 hour after lumbar puncture Liposomal: To reduce incidence of arachnoiditis, administer dexamethasone concurrently IV Preparation Reconstitute vials in BWI containing benzyl alcohol 0.945% as follows (CAUTION: Do not use benzyl alcohol for intrathecal inj) 100 mg vial: add 5 mL diluent to 20 mg/mL 500 mg vial: add 10 mL diluent to 50 mg/mL 1 g vial: add 10 mL diluent to 100 mg/mL 2 g vial: add 20 mL diluent to 100 mg/mL Adult Dose: Acute Nonlymphocytic Leukemia IV administration for remission induction 100-200 mg/sq.meter/day for 5-10 days; begin second course in 2-4 weeks after initial therapy if necessary OR 100 mg/sq.meter for 7 days OR 100 mg/sq.meter/dose q12hr for 7 days Intrathecal (IT) administration for remission induction 5-75 mg/sq.meter q2-7Days until CNS findings normalize IV administration for remission maintenance 70-200 mg/sq.meter/day for 2-5 days at monthly intervals IM administration for remission maintenance 1-1.5 mg/kg single dose for maintenance at 1- 4 week intervals Meningeal Leukemia IT administration 30 mg/sq.meter intrathecal (IT) q4Days until CSF findings normal plus one additional dose Refractory Leukemia IV administration 3 g/sq.meter IV (infusion over 1-3 hours) q12hr x 4-12 doses Repeat q2-3Weeks

May reduce efficacy of gentamicin, digoxin and flucytosine. Potentially Fatal: Potentiates bone marrow depression with radiotherapy and other myelotoxic drugs.

Hypersensitivity; pregnancy and lactation.

Common - Rash - Skin ulcer - Nausea - Vomiting - Hair loss - Abdominal pain - Anal ulcers - Anemia (low number of red blood cells) - Decreased white blood cell count - Fever - Infection - Abnormal liver function - Low blood platelets - Mouth ulcer - Pneumonia - Sepsis - Mouth sore - Stomatitis (Inflammation of the mouth) 1-10% Anorexia,Nausea,Vomiting,Diarrhea,Oral/anal inflammation,Thrombophlebitis,Bleeding,Myelosuppression,Rash,Fever,Hepatic dysfunction Frequency Not Defined Headache,Neuropathy,Chest pain,Pericarditis,Pneumonia,Anemia,Bleeding,Leukopenia,Thrombocytopenia,Kidney disease,Infectious disease,Sepsis,"Cytarabine syndrome": fever, myalgia, bone pain, rash, conjunctivitis, malaise,Skin ulcers,Cellulitis,Urinary retention,Neuritis,Jaundice,Anaphylaxis Potentially Fatal: Convulsions. Cerebellar dysfunction, respiratory distress syndrome, GI perforation, bone marrow suppression.

Pregnancy Category D. There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

Precaution: Hepatic and renal dysfunction, severe infections, preexisting drug-induced bone marrow suppression. Monitor WBC, platelet counts and blood uric acid frequently. Assess renal and hepatic function periodically. Lactation: not known if excreted in breast milk, avoid

Symptoms: Irreversible CNS toxicity and death. Severe arachnoiditis including encephalopathy. Management: Therapy cessation followed by treatment of ensuing bone marrow depression including whole blood or platelet transfusion and antibiotics. Maintain vital functions.

IV/SC: Store between 15-25°C. Intrathecal: Store between 2-8°C. Avoid freezing.

Cytotoxic Chemotherapy

Cytarabine acts by interfering with DNA synthesis specifically at the S-phase of the cell cycle. It is a potent myelosuppressant and requires careful haematological monitoring during its use. It also has antiviral property.

Pregnancy Category: D Lactation: not known if excreted in breast milk, avoid