This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo

Cytarabine parenteral

Updated 2 Feb 2023 | Antimetabolites


Infusions containing cytarabine

Drugs List

  • cytarabine 100mg/1ml injection solution
  • cytarabine 100mg/5ml injection solution
  • cytarabine 1g/10ml injection solution
  • cytarabine 2g/20ml injection solution
  • cytarabine 500mg/25ml injection solution
  • cytarabine 500mg/5ml injection solution
  • Therapeutic Indications


    Monotherapy or adjunct in diffuse histiocytic lymphomas

    Acute myeloid leukaemia Acute non-lymphoblastic leukaemias Acute lymphoblastic leukaemias Acute lymphocytic leukaemia Erythroleukaemia Blast crises of chronic myeloid leukaemia Diffuse histiocytic lymphomas (non-Hodgkin's lymphomas of high malignancy) Meningeal leukaemia and meningeal neoplasms


    Due to the complexity and specialist nature of dosage regimens for the treatment of malignant disease, specific dosing information on this agent is not included.
    Doses may vary significantly if this agent is used as monotherapy or different combinations.
    When using this agent, specialist literature, national guidelines, cancer network protocols and Trust chemotherapy protocols should be consulted.

    Patients with Renal Impairment

    Some manufacturers recommend dose reductions in patients with renal impairment.

    The renal drug handbook recommends no dose reductions in low dose regimes and gives the following dose reductions in high dose regimes:
    Glomerular filtration rate greater than 60 ml/minute: Dose as normal
    Glomerular filtration rate 45 to 60 ml/minute: 60% of dose.
    Glomerular filtration rate 30 to 45 ml/minute: 50% of dose.
    Glomerular filtration rate less than 30 ml/minute: Avoid.

    Some manufacturers recommend considering the time of administration in relation to dialysis, as cytarabine can be dialysed.


    By intravenous infusion or injection, or subcutaneous injection.

    Some brands of the 20 mg/ml presentation are also suitable for intrathecal use (refer to individual manufacturers information).

    Higher doses may be better tolerated when given by rapid injection rather than slow infusion because of the rapid clearance of cytarabine. However, rapid injection may be more emetogenic.



    Precautions and Warnings

    Children under 18 years
    History of intrathecal chemotherapy
    History of radiotherapy
    Patients over 60 years
    Hepatic impairment
    Renal impairment

    Administration of live vaccines is not recommended
    Reduce dose in patients with hepatic impairment
    Advise ability to drive/operate machinery may be affected by side effects
    Maintain adequate hydration of patient prior / during treatment
    Not all available brands are licensed for all routes of administration
    Treatment to be prescribed under the supervision of a specialist
    Consult local policy on the safe use of anti-cancer drugs
    Resuscitation facilities must be immediately available
    Staff: Not to be handled by pregnant staff
    Monitor closely patient with pre-existing hepatic impairment
    Monitor for signs of bone marrow depression
    Monitor haematological parameters daily throughout therapy
    Monitor hepatic function regularly
    Monitor patients for signs of tumour lysis syndrome
    Monitor patients for symptoms of neuropathy
    Monitor renal function regularly
    Monitor uric acid levels
    Perform bone marrow examinations frequently after blasts have disappeared
    Advise patient to report abdominal pain or tenderness, fever or diarrhoea
    Advise patient to report any new or worsening respiratory symptoms
    Advise patient to report unexplained fever, sore throat, bruising, bleeding
    Consider dose/ schedule adjustment if neuropathy occurs
    Risk of cardiomyopathy increases with high cumulative dosage
    Suspend or modify therapy if platelet count less than 50,000 per cubic mm
    Suspend or modify therapy if polymorphonuclear count < 1000 per cubic mm
    May cause impaired fertility
    Male & female: Contraception required during & for 6 months after treatment
    Advise patients of possible adverse reactions

    Myelosuppression, anaemia and thrombocytopenia occur in almost all patients given daily infusions or injections. Myelosuppression is biphasic with nadirs at days 7 to 9 and days 15 to 24 with evidence of bone marrow improvement expected after a mean of 28 days.

    Rarely neurological effects such as severe spinal cord toxicity leading to necrotising encephalopathy, quadriplegia, paralysis and blindness have occurred. These have occurred predominantly with intrathecal administration but isolated cases have been reported with high intravenous doses during combination regimens.

    Pregnancy and Lactation


    Cytarabine is contraindicated during pregnancy.

    At the time of writing there is limited data on the use of cytarabine in pregnancy, cases of intrauterine death and foetal abnormalities have been reported. Animal studies have shown teratogenicity.

    The effect of concurrent therapies must also be considered.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Cytarabine is contraindicated during breastfeeding.

    It is not known whether cytarabine is excreted in human breast milk, a risk to neonates cannot be excluded. Some sources suggest withholding breastfeeding for 24 to 48 hours will minimise the risks.

    The effect of concurrent therapies must also be considered.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Abdominal pain
    Adult respiratory distress syndrome
    Anal ulceration
    Bone marrow depression
    Bone pain
    Bowel necrosis
    Budd-Chiari syndrome
    Bullous reactions
    Burning sensation in hands and feet
    Cellulitis (injection site)
    Cerebellar dysfunction
    Cerebral dysfunction
    Chest pain
    CNS toxicity
    Corneal toxicity
    Cytarabine reaction syndrome
    Gastro-intestinal haemorrhage
    Gastro-intestinal perforation
    Gastro-intestinal toxicity
    Gastro-intestinal ulceration
    Hepatic abscess
    Hepatic impairment
    Increased lacrimation
    Injection site reactions
    Joint pain
    Maculopapular rash
    Mouth ulcers
    Necrotising encephalopathy
    Necrotising enterocolitis
    Pancreatitis has been observed with the induction of cytarabine
    Peripheral neuropathy
    Personality change
    Pneumatosis cystoides intestinalis
    Pulmonary oedema
    Pulmonary toxicity
    Reduction in reticulocytes
    Refractive changes
    Renal impairment
    Skin and mucosal bleeding
    Skin ulcer
    Sore throat
    Thrombophlebitis (injection site)
    Tumour lysis syndrome
    Urinary retention
    Visual disturbances


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: September 2015

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Joint Formulary Committee. British National Formulary(online) London: BMJ Group and Pharmaceutical Press. Accessed on 9 September 2015.

    Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

    Paediatric Formulary Committee. BNF for Children (online) London: BMJ Group, Pharmaceutical Press, and RCPCH Publications. Accessed on 9 September 2015.

    The Renal Drug Handbook. Fourth Edition (2014) ed. Ashley, C and Dunleavy, A, Radcliffe Publishing Ltd, London.

    Summary of Product Characteristics: Cytarabine 100mg/ml. Accord healthcare. Revised September 2014.
    Summary of Product Characteristics: Cytarabine 20mg/ml. Pfizer Ltd. Revised July 2014.
    Summary of Product Characteristics: Cytarabine 100mg/ml. Pfizer Ltd. Revised July 2014.
    Summary of Product Characteristics: Cytarabine 20mg/ml. Hospira UK Ltd. Revised June 2015.
    Summary of Product Characteristics: Cytarabine 100mg/ml. Hospira UK Ltd. Revised June 2015.

    Access the full UK drug database with a FREE Medscape UK Account
    It takes just a few minutes, and you’ll get unlimited access to information on over 11,000 UK drugs.
    Register for Free

    Already a member? Log in

    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

    FDB Logo

    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.