Drug reference

Clofarabine

Antineoplastic purine nucleoside analogue · Anticancer

START

52 mg/m² IV over 2 h daily ×5 days per cycle

TYPICAL MAX

52 mg/m²/day ×5 days (≈50% reduction if CrCl 30–60)

STOP IF

Capillary leak/SIRS, severe hepatotoxicity, or AKI

WATCH

CBC, LFTs, renal function, fluid status, tumour lysis labs

CDSCO approvedSchedule HATC L01BB06

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 6min · infusion start
PEAK: 2h · end infusion
t½: 5h · t½
DURATION: 2w · cycle interval

EXCRETION

Renal ~49–60% unchanged

route + CYP

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Can cause fetal harm — avoid; effective contraception required.

FDA category + note

Top interactionssee all 12 →

AdalimumabSevereDatabaseDDInter
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Mechanism

Intracellularly phosphorylated to clofarabine triphosphate, which inhibits DNA polymerase and ribonucleotide reductase and disrupts mitochondrial membrane integrity — terminating DNA synthesis and inducing apoptosis in leukaemic blasts.

Indications

Relapsed/refractory paediatric acute lymphoblastic leukaemia (after ≥2 prior regimens)

Dosing

Adult: ALL (1–21 y): 52 mg/m² IV over 2 h once daily for 5 consecutive days, repeated every 2–6 weeks per recovery.
Pediatric: As above (primary population, 1–21 years).
Renal adjustment: Reduce dose ~50% if CrCl 30–60; avoid/limited data if <30.
Hepatic adjustment: Caution; hold for hepatic toxicity (transaminase/bilirubin rise).
Geriatric: Limited data (paediatric drug).
Max dose: 52 mg/m²/day for 5 days per cycle

Pharmacokinetics

Onset

Cytoreduction over the 5-day cycle

Peak effect

End of infusion

Duration

Cycle every 2–6 weeks (recovery-dependent)

Half-life

~5 h (terminal)

Bioavailability

IV 100%

Protein binding

~47%

Metabolism

Minimal hepatic; intracellular phosphorylation

Excretion

Renal (~49–60% unchanged)

Contraindications

Severe hypersensitivity
Caution: significant renal/hepatic impairment, pre-existing cardiac disease

Side effects

Common

Nausea/vomitingDiarrhoeaFebrile neutropeniaRashHeadacheTachycardia

Serious

Severe myelosuppression
Capillary leak syndrome / SIRS
Hepatotoxicity (VOD/SOS)
Acute kidney injury
Tumour lysis syndrome
Cardiac dysfunction

Pregnancy & lactation

Pregnancy

Can cause fetal harm — avoid; effective contraception required.

Lactation

Contraindicated during therapy.