Fludarabine Phosphate

Indications & Dose:

Treatment of chronic lymphyocytic leukaemia .

DOSEAND ADMINISTRATION

Intravenous infusion over 30 minutes in a usual dose of 25 mg per m2 body-surface for five consecutive days. Courses may be repeated every 28 days. Haematological function should be monitored regularly; the dosage may need to be reduced or further courses delayed, if blood counts indicate severe or persistent myelosuppressio. Doses should be reduced by up to 50% in patients with mild to modernate renal impairment (creating clearance between 30 and 70 mL per minute); the drug should not be given in more severe renal impairment.

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Drugs
Gentamicin, Severe ototoxicity 

Warnings:

Adverse Effects:

Bone marrow suppression from fludarabine is doselimiting, manifesting as leucopenia, thrombocytopenia, and anaemia, the nadir of the white cell and platelet counts usually occurs after about 2 to 3 weeks. Myclosuppression can be severe and cumulative. Other adverse effects include cough dysponea, pneumonia, gastro-intestinal disturbances, stomatitis, oedema, angina pectoris, the tumour lysis syndrome, dysuria and renal dysfunction, and neurological disturbances including peripheral neuropathy, agitation, confusion, hallucinations, and coma. High doses have been associated with progressive encephalopathy and blindness. Increased pulmonary toxicity has been reported in patients given concomitant therapy with fludarabine and pentostatin. Administration with cytarabine may reduce the metabolic activation of fludarabine. Dosage should be reduced in renal impairment and fludarabine should not be given if creatinine clearance is less than 30 mL per minute

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