Drug reference

fludarabine phosphate

purine analogue, antimetabolite, adenosine analogue · anticancer

purine analogue, antimetabolite, adenosine analogueanticancer

CDSCO approved

EXCRETION

—

not curated

INTERACTIONS

1 major

SEVERE in our sources

PREGNANCY

—

not curated

Top interactions

PentostatinSevereTextbookG&G 14e

Mechanism

Fludarabine phosphate is a nucleotide that is rapidly dephosphorylated in plasma, releasing the nucleoside which is then readily taken up by cells.

Indications

chronic lymphocytic leukemia (CLL) (standard treatment)Chronic lymphocytic leukemia (CLL)Follicular B-cell lymphomas refractory to standard therapyImmunosuppressive agent in nonmyeloablative allogeneic bone marrow transplantation

Dosing

Adult: Administered daily for 5 days, repeated every 4 weeks. Dosage should be reduced in patients with renal impairment in proportion to the reduction in CLCr.

Pharmacokinetics

Onset

Median time to reach maximal concentrations in plasma after oral administration is 1.5 h.

Half-life

10 h (in plasma)

Bioavailability

55% to 60% (oral)

Metabolism

Rapidly converted to fludarabine in the plasma.

Excretion

Primarily by renal excretion.

Side effects

Common

Myelosuppression (50% of patients)LymphopeniaThrombocytopeniaNauseaVomitingChillsFeverMalaiseAnorexiaPeripheral neuropathyWeakness

Serious

Opportunistic infections (due to depletion of CD4+ T cells)
Tumor lysis syndrome (rare, primarily in previously untreated CLL patients)
Altered mental status
Seizures
Optic neuritis
Coma (at higher doses and in older patients)
Autoimmune events (acute hemolytic anemia, pure red cell aplasia, prolonged cytopenias)
Myelodysplasia (late complication)
Acute leukemias (late complication)
Pneumonitis