Cytarabine

Cytarabine is a prescription medication used for the treatment of acute nonlymphocytic leukemia, meningeal leukemia, refractory leukemia, and lymphomatous meningitis.

• Cytarabine is available under the following different brand names: Cytosar U, DepoCyt

Adult and pediatric dosage

Injectable solution

• 10mg/mL
• 20mg/mL
• 100mg/mL

Intrathecal injection, liposomal (DepoCyt)

• 50mg/5mL

Powder for injection

• 100mg/vial
• 500mg/vial
• 1g/vial
• 2g/vial

Acute Nonlymphocytic Leukemia

Adult dosage

IV administration for remission induction

• 100-200 mg/sq.meter/day for 5-10 days; begin the second course in 2-4 weeks after initial therapy if necessary OR  
• 100 mg/sq.meter for 7 days OR
• 100 mg/sq.meter/dose every 12 hours for 7 days

IT administration for remission induction

• 5-75 mg/sq.meter every 2-7 days until CNS findings normalize

IV administration for remission maintenance

• 70-200 mg/sq.meter/day for 2-5 days at monthly intervals

IM administration for remission maintenance

• 1-1.5 mg/kg single dose for maintenance at 1- 4 week intervals

Meningeal Leukemia

Adult dosage

IT administration

• 30 mg/sq.meter intrathecal (IT) every 4 days until CSF findings normal plus one additional dose

Refractory Leukemia

Adult dosage

IV administration

• 3 g/sq.meter IV (infusion over 1-3 hours) every 12 hours x 4-12 doses  
• Repeat every 2-3 weeks

Lymphomatous Meningitis (DepoCyt)

Adult dosage

• IT liposomal administration
• IT by intraventricular or lumbar puncture
• Induction: 50 mg every 14 days weeks 1 and 3 (2 doses total)
• Consolidation: 50 mg every 14 days (weeks 5, 7, 9) and an additional dose on week 13
• Maintenance: 50 mg every 28 days for 4 doses (weeks 17, 21, 25, and 29)

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Cytarabine include:

• nausea and vomiting (may be severe),
• loss of appetite,
• diarrhea,
• constipation,
• headache,
• dizziness,
• injection site reactions (pain, swelling, and redness),
• drowsiness,
• weakness,
• memory problems,
• back pain,
• pain in the arms or legs, or
• trouble sleeping (insomnia).

Serious side effects of Cytarabine include:

• severe drowsiness, confusion, unusual thoughts or behavior;
• fever, chills, body aches, feeling very ill;
• stomach pain, bloating, nausea, vomiting, bloody or tarry stools;
• loss of movement in any part of the body;
• liver problems--loss of appetite, right-sided upper stomach pain, dark urine, jaundice (yellowing of the skin or eyes);
• low platelets or red blood cells--pale skin, easy bruising, unusual bleeding, tiredness, feeling light-headed, cold hands and feet;
• lung problems--pain while breathing, shortness of breath while lying down, cough with foamy mucus; or
• signs of eye infection--swelling, redness, severe discomfort, crusting, or drainage.

Rare side effects of Cytarabine include:

• none 

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Cytarabine has severe interactions with no other drugs.
• Cytarabine has serious interactions with the following drugs:
  • adenovirus types 4 and 7 live, oral
  • axicabtagene ciloleucel
  • brexucabtagene autoleucel
  • cedazuridine
  • ciltacabtagene autoleucel
  • idecabtagene vicleucel
  • influenza virus vaccine quadrivalent, adjuvanted
  • influenza virus vaccine trivalent, adjuvanted
  • lisocabtagene maraleucel
  • palifermin
  • ropeginterferon alfa 2b
  • tisagenlecleucel
  • tofacitinib
• Cytarabine has moderate interactions with the following drugs:
  • acalabrutinib
  • belatacept
  • cholera vaccine
  • dengue vaccine
  • denosumab
  • dichlorphenamide
  • digoxin
  • fingolimod
  • hydroxyurea
  • influenza A (H5N1) vaccine
  • influenza virus vaccine (H5N1), adjuvanted
  • meningococcal group B vaccine
  • ofatumumab SC
  • olaparib
  • siponimod
  • sipuleucel-T
  • tobramycin inhaled
  • trastuzumab
  • trastuzumab deruxtecan
• Cytarabine has minor interactions with the following drugs:
  • gentamicin
  • maitake
  • taurine
  • vitamin A
  • vitamin E

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• Hypersensitivity
• Liposomal cytarabine: active meningeal infection

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Cytarabine?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Cytarabine?”

Cautions

• Potent bone marrow suppression
• Severe and at times fatal CNS, GI, and pulmonary toxicity
• Cardiomyopathy with subsequent death was reported following experimental high dose therapy with cytarabine in combination with cyclophosphamide when used for bone marrow transplant preparation
• Do not use benzyl alcohol-containing solutions in IT or neonates
• Avoid pregnancy
• Liposomal IT administration
• CSF flow assessment should be considered before treatment is started Blockage to CSF flow may increase the risk of neurotoxicity due to increased serum concentrations
• To reduce the incidence of arachnoiditis, administer dexamethasone concurrently
• Hydrocephalus has also been reported, possibly precipitated by arachnoiditis
• Infectious meningitis may be associated with IT drug administration
• Following IT administration, CNS toxicity, including persistent extreme somnolence, hemiplegia, visual disturbances including blindness which may be total and permanent, deafness, cranial nerve palsies, and visual disturbances including blindness which may be total and permanent, have been reported
• Symptoms and signs of peripheral neuropathy (e.g., pain, numbness, paresthesia, weakness, impaired bowel and bladder control) were observed; in some cases, these signs and symptoms have been reported as Cauda Equina Syndrome

Pregnancy and Lactation

• Use in LIFE-THREATENING emergencies when no safer drug is available. Positive evidence of human fetal risk
• Lactation
  • Not known if excreted in breast milk, avoid