Nelarabine parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Infusion containing nelarabine.
Drugs List
Therapeutic Indications
Uses
Third line treatment for T-cell acute lymphoblastic leukaemia
Third line treatment for T-cell lymphoblastic lymphoma
Dosage
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 networks protocols and Trust chemotherapy protocols should be consulted.
Administration
For intravenous infusion only.
Contraindications
Concurrent intrathecal chemotherapy
Craniospinal irradiation
History of intrathecal chemotherapy
Breastfeeding
Pregnancy
Precautions and Warnings
Children under 4 years
Elderly
Predisposition to hyperuricaemia
Restricted sodium intake
Dehydration
Hepatic impairment
Renal impairment
Administration of live vaccines is not recommended
Sodium content of formulation may be significant
Advise ability to drive/operate machinery may be affected by side effects
Consider premedication with hypouricaemic agent
Maintain adequate hydration of patient prior / during treatment
Consult local policy on the safe use of anti-cancer drugs
Staff: Not to be handled by pregnant staff
Treatment to be administered under the supervision of a specialist
Monitor closely patient with pre-existing renal impairment
Monitor for signs of neurological toxicity
Monitor full blood count regularly
Monitor patients for signs of tumour lysis syndrome
Increased risk of CNS toxicity in the elderly
Potentially mutagenic and carcinogenic
Discontinue if grade 2 neurological toxicity occurs
Consider delaying subsequent treatment for all non-neurological toxicities
May cause impaired fertility
Male & female: Contraception required during & for 3 months after treatment
Pregnancy and Lactation
Pregnancy
Nelarabine is contraindicated during pregnancy.
The manufacturer suggests that nelarabine should not be used in pregnancy unless clearly necessary.
At the time of writing, there is no published experience in humans. The molecular weight and lack of protein binding indicates nelarabine will cross the placenta and the properties of nelarabine suggest there is a significant embryonal foetal risk.
Animal studies have shown increased incidences of foetal malformations.
The effect of concurrent therapies must also be considered.
Lactation
Nelarabine is contraindicated during breastfeeding.
The manufacturer suggests that breastfeeding should be discontinued during treatment with nelarabine.
At the time of writing, it is unknown if nelarabine or its metabolites are excreted in human breast milk. A risk to neonates cannot be excluded.
The effect of concurrent therapies must also be considered.
Side Effects
Abdominal pain
Amnesia
Anaemia
Anorexia
Arthralgia
Ascending neuropathy
Asthenia
Ataxia
Back pain
Bacteraemia
Blurred vision
Coma
Confusion
Constipation
Cough
Craniospinal demyelination
Creatine phosphokinase increased
Diarrhoea
Dizziness
Dysgeusia
Dyspnoea
Extremity pain
Fatigue
Febrile neutropenia
Fungal infection
Gait abnormality
Grand mal seizure
Headache
Hyperbilirubinaemia
Hypocalcaemia
Hypoesthesia
Hypoglycaemia
Hypokalaemia
Hypomagnesaemia
Hypotension
Increase in aminotransferase level
Increase in serum transaminases
Infections
Leucopenia
Loss of balance
Muscle weakness
Myalgia
Nausea
Neutropenia
Numbness
Oedema
Opportunistic infections
Pain
Paraesthesia
Paralysis
Peripheral neuropathy
Peripheral oedema
Pleural effusion
Pneumonia
Progressive multifocal leukoencephalopathy (PML)
Pyrexia
Rhabdomyolysis
Seizures
Sepsis
Serum creatinine increased
Somnolence
Status epilepticus
Stomatitis
Thrombocytopenia
Tremor
Tumour lysis syndrome
Vomiting
Wheezing
Overdosage
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 (https://www.toxbase.org/)
Further Information
Last Full Review Date: June 2019
Reference Sources
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 05 June 2019.
Paediatric Formulary Committee. BNF for Children (online) London: BMJ Group, Pharmaceutical Press, and RCPCH Publications. Accessed on 05 June 2019.
Summary of Product Characteristics: Atriance solution for infusion. Novartis. Revised April 2018.
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