Drug reference

Nelarabine

Antimetabolite · Antineoplastic

AntimetaboliteAntineoplastic

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Avoid due to toxicity observed in animal studies. Effective contraception is advised during and for at least 3 months after treatment in men and women.

FDA category + note

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Mechanism

Nelarabine is an antimetabolite that acts as a purine analog. It is a cell cycle-specific agent, primarily exerting its cytotoxic effects during the S-phase of the cell cycle by interfering with DNA synthesis.

Indications

T-cell acute lymphoblastic leukaemia in patients who have relapsed or who are refractory after receiving at least two previous regimensT-cell lymphoblastic lymphoma in patients who have relapsed or who are refractory after receiving at least two previous regimenspediatric ALLAcute T-cell leukemia (relapsed/refractory)T-cell lymphoblastic lymphoma (relapsed/refractory)

Dosing

Adult: Consult local protocol
Pediatric: Given a lower dose for 5 days, repeated every 21 days.
Renal adjustment: The drug should be used with close clinical monitoring in patients with renal impairment (CLCr <50 mL/min).

Pharmacokinetics

Half-life

3 h (plasma t1/2 of Ara-G)

Excretion

Drug and its metabolite Ara-G are primarily eliminated by metabolism to guanine, and a smaller fraction by renal excretion of Ara-G.

Contraindications

Previous or concurrent craniospinal irradiation (increased risk of neurotoxicity)
Previous or concurrent intrathecal chemotherapy (increased risk of neurotoxicity)

Side effects

Common

Abdominal painAnaemiaAppetite decreasedArthralgiaAstheniaConfusionConstipationCoughDiarrhoeaDizzinessDrowsinessDyspnoeaElectrolyte imbalanceFeverGait abnormalHeadacheHyperbilirubinaemiaHypotensionIncreased risk of infectionLeucopeniaMemory lossMovement disordersMuscle weaknessMyalgiaNauseaNeutropeniaOedemaPainPeripheral neuropathyRespiratory disordersSeizuresSensation abnormalSepsisStomatitisTaste alteredThrombocytopeniaTremorTumour lysis syndromeVision blurredVomitingMyelosuppressionLiver function test abnormalities

Serious

Rhabdomyolysis
Progressive multifocal leukoencephalopathy (PML)
Neurotoxicity (requiring treatment discontinuation if it occurs)
Seizures
Delirium
Somnolence
Peripheral neuropathy
Guillain-Barré syndrome (neurological adverse effects may not be reversible)

Pregnancy & lactation

Pregnancy

Avoid due to toxicity observed in animal studies. Effective contraception is advised during and for at least 3 months after treatment in men and women.