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fludarabine

( flu-DA-ra-been )
Other Name(s): Fludara®
Appearance: Clear solution mixed into larger bags of fluids. Also available as tablets.

Medication Information Sheet
fludarabine (flu-DA-ra-been)
This document provides general information about your medication. It does not replace the advice of your health care professional. Always discuss your therapy with your health care professional and refer to the package insert for more details.

Other Name: Generic brand(s) available, Fludara®

 

Appearance:
Clear solution

mixed into larger bags of fluids.

Also available as tablets.

 

What is this medication for?

For treating certain types of lymphoma or leukemia

What should I do before I have this medication?
  • Tell  your doctor if you have/had significant medical condition(s), especially if you have or had kidney or liver problems, low red blood cell count, if you need a blood transfusion, have had viral infections such as hepatitis or shingles, or have any allergies.
  • People with cancer have a higher risk of getting other cancers or developing blood clots. Some cancer medications may increase these risks, especially if used for a long period of time. Discuss any concerns about this medication with your health care team.
How will this medication affect sex, pregnancy and breastfeeding?
  • The use of this medication in men or women may cause harm to the unborn baby if pregnancy occurs. Let your health care team know if you or your partner is pregnant, becomes pregnant during treatment, or if you are breastfeeding
  • If there is any chance that you or your partner may become pregnant, you and your partner together must: 
  • ► Use 2 effective forms of birth control at the same time while taking this drug. Keep using birth control for at least 6 months after your last dose unless your health care team told you differently. Talk to your health care team to figure out the best method(s) for you and/or your partner.
  • Do not breastfeed while using this drug.

 

 

  • Effects on Fertility: Likely
  • Effects on Fertility: Likely
How is this medication given?

Injection:

  • This medication is given by injection into a vein.

Tablets:

  • Take it exactly as directed by your doctor. Make sure you understand the instructions.
  • If your blood counts are low, your doctor or nurse may tell you to take fewer tablets (a lower dose) until your blood cells return to normal. Do not take it more often or for a longer time than your doctor ordered.
  • Do not remove fludarabine tablets from the blister pack until they are ready for use.
  • Swallow whole with a glass of water with or without food.
  • Do not crush or chew.
  • If you miss a dose, speak to your health care team as soon as possible. Do not take a double dose.
What else do I need to know while on this medication?
  • This medication can interact with other medications and can result in the treatment not working as well or cause severe side effects.

  • Make sure your health care team knows about all your medications (prescription, over-the-counter, herbals and supplements). Check with your health care team before starting or stopping any of them.

  • For mild aches and pain:

    • You may take acetaminophen (Tylenol®) tablets. Ask your health care team about the right dose for you. 
    • Ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or aspirin (acetylsalicylic acid, ASA), including low dose aspirin for heart conditions, may increase your chance of bleeding.
    • Talk to your health care team before you start or stop these medications.
    • If you feel unwell, take your temperature before taking any of these medications. They may hide a fever. 
    • Talk to your health care team or go to the closest emergency room right away if you have a fever.  See the Fever pamphlet for more information.
  • Drinking alcohol and smoking during your treatment may increase some side effects and make your medication less effective. Speak to your health care team about smoking and drinking alcohol while on treatment.

 

 

How should I safely store this medication?

For tablets:

  • Keep this medication in the original packaging at room temperature in a dry place, away from heat and light. Keep out of sight and reach of children and pets.
  • Do not throw out any unused medications at home. Bring them to your pharmacy to be thrown away safely.

What are the side effects of this medication?

Common side effects usually occur in more than 1 out of every 10 patients. Other side effects are less common, but may be severe. You may not have all of the side effects below. You may have side effects that are not listed.

Side effects and what to doWhen to contact doctor?
More Common Side Effects

Unusual bleeding or bruising

You may have black stools, cough up blood, blood in your urine, purple or red dots on your skin or bleeding that will not stop. 

Fever, chills, infection (including reactivating infections, for example shingles, hepatitis)

  • For hepatitis, look for unusual tiredness and yellowing of the whites of your eyes or skin.
  • For shingles, look for pain, burning, numbness and tingling followed by a blistering rash, often in a belt-like pattern on one side of the body.

You have a fever if your temperature taken in your mouth (oral temperature) is:

  • 38.3°C (100.9°F) or higher at any time OR
  • 38.0°C (or 100.4°F) or higher for at least one hour.

While you are getting chemotherapy treatments:

  • Keep a digital thermometer at home and take your temperature if you feel hot or unwell (for example, chills).
  • Avoid taking medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen) as they may hide a fever.
  • Do not eat or drink anything hot or cold right before taking your temperature.
  • Wash your hands often.
  • Check with your doctor before getting any vaccines, surgeries, medical procedures or visiting your dentist.


If you have a fever, talk to your health care team or go to the closest emergency room. 
See our Neutropenia (Low white blood cell count) pamphlet for more information.

Get emergency medical help right away

Anemia (low red blood cells)

  • You may feel more tired or weak than normal and have pale skin.
  • This may occur in days to weeks after you start or receive your medication.
  • Rest often and eat well.
  • Light exercise, such as walking may help.
  • You may need medication or a blood transfusion.
  • If it is very bad, your doctor may ask you to stop the medication that is causing the low red blood cells.
Contact your health care team if no improvement or if severe

Low appetite

  • You may not feel like eating or you may lose weight.
  • Try to eat foods that you like and eat small meals throughout the day. 
  • You may need to take meal supplements to help keep your weight up.
  • Talk to your health care team if you have a low appetite.
  • See our Loss of appetite pamphlet for more information.
Contact your health care team if no improvement or if severe

Cough; feeling short of breath

You may have cough and feel short of breath without any signs of infection, such as a sore throat or a stuffed nose.

Contact your health care team if no improvement or if severe

Diarrhea

May happen days to weeks after you get your treatment.

If you have diarrhea :

  • Take anti-diarrhea medication if your health care team prescribed it.
  • Avoid foods or drinks with artificial sweetener (e.g. chewing gum, “diet” drinks), coffee and alcohol.
  • Eat many small meals and snacks instead of 2 or 3 large meals.
  • Drink at least 6 to 8 cups of liquids each day. Talk to your health care team if you can’t drink 6-8 cups of liquids each day when you have diarrhea. You may need special liquids with salt and sugar, called Oral Rehydration Therapy.

​See the Diarrhea pamphlet for more information.

Contact your health care team if no improvement or if severe

Mild swelling in arms and legs; puffiness

To help prevent swelling :

  • Eat a low-salt diet.
  • Avoid tight fitting clothing.

If you have swelling in your legs, keep your feet up when sitting.

Contact your health care team if no improvement or if severe

Fatigue (tiredness)

  • Be active and aim to get 30 minutes of moderate exercise (you are able to talk comfortably while exercising) on most days. Check with your health care team before starting any new exercise.
  • Pace yourself, do not rush. Put off less important activities. Rest when you need to.
  • Eat well and stay hydrated by drinking at least 6 to 8 glasses of water or other liquids every day (unless your doctor told you to drink more or less).
  • Avoid driving or using machinery if you are feeling tired

See our Fatigue pamphlet for more information. 

Contact your health care team if no improvement or if severe

Mouth sores

You may have round, painful, white or gray sores inside your mouth. They can occur on the tongue, lips, gums, or inside your cheeks. In more severe cases they may make it hard swallow, eat or to brush your teeth. They usually last 1 to 2 weeks.

To help prevent mouth sores: 

  • Take care of your mouth by gently brushing and flossing regularly.
  • Rinse your mouth often. Do not use mouthwashes with alcohol.
  • Instead, try a homemade mouthwash:
  • Mix 1 teaspoonful of baking soda and 1 teaspoonful of salt in 4 cups (1L) of water.

If you have mouth sores:

  • Check with your health care team as soon as you notice mouth or lip sores or if it hurts to swallow.
  • Avoid hot, spicy, acidic, hard or crunchy foods.. Your doctor may prescribe a mouthwash to relieve mouth sores and prevent infection.

See the Mouth Care pamphlet for more information.

Contact your health care team as soon as possible (office hours)

Nausea and vomiting (generally mild)

May occur in hours to days after your treatment. 

If you have nausea or vomiting:

  • Take anti-nausea medication(s) as prescribed to you by your doctor. 
  • Drink clear liquids and have small meals. Get fresh air and rest.
  • Do not eat spicy, fried foods or foods with a strong smell.
  • Limit caffeine (e.g. coffee, tea) and alcohol.
  • Contact your health care team if the prescribed anti-nausea medications are not helping to control your nausea and vomiting.

 Also see Nausea & Vomiting pamphlet for more information.

Contact your health care team if no improvement or if severe

Tingling, numb fingers and toes

  • May slowly get better after your treatment ends.
  • Contact your health care team if you have trouble doing up buttons, writing, picking up small objects, have pain or trouble moving.
Contact your health care team if no improvement or if severe
 
Side effects and what to doWhen to contact doctor?
Less Common Side Effects, but may be Severe

Abnormal levels of pancreas tests (lipase, amylase)

Your doctor may monitor these regularly.

Contact your health care team if no improvement or if severe

Abnormal liver lab tests

  • You may have yellowish skin or eyes, unusually dark pee or pain on the right side of your belly. Talk to your health care team if this happens.
  • Your doctor may monitor your liver regularly with a blood test.
Contact your health care team if no improvement or if severe

Heart problems 

You may have an irregular heartbeat, shortness of breath, chest pain, fainting spells or swelling in your legs, ankles and belly.

Get emergency medical help right away

Effects on your brain

You may have a severe headache, pass out (faint), or have seizures, confusion or hallucinations (seeing or hearing things that aren’t there).

Get emergency medical help right away

Rapid breakdown of red blood cells

Your skin and eyes may look yellow and your pee can become red-brown.

Get emergency medical help right away

Irritation of the bladder wall

You may have blood in your pee, feel the need to pee urgently, have pain in your belly/lower belly area or pain when peeing.

Get emergency medical help right away

Eye problems 

  • You may have dry eyes, redness, irritation, pain, tearing, sensitivity to light or blurred vision.
  • Avoid wearing contact lenses.
  • You may try artificial tears or ointment. 
Contact your health care team as soon as possible (office hours)

Lung problems

You may have a cough, breathing problems, chest pain or cough up blood.

Get emergency medical help right away

Rash; dry, itchy skin

Rash may be severe in some rare cases and cause your skin to blister or peel. If this happens, get emergency medical help right away.

Contact your health care team as soon as possible (office hours)

Kidney problems

  • You may have lower back pain, swelling, pee less than usual and have unusual weight gain.
  • Your doctor may monitor for proteins in your pee. You may have blood in your pee.
  • This may be sign of a serious kidney or bladder infection.
Get emergency medical help right away

Rapid killing of cancer cells when you start treatment

  • If mild, this may cause gout and joint pains. In some more severe cases, it may cause fevers, kidney problems, confusion and be life-threatening.
  • Your doctor may prescribe medication to prevent these effects.
  • Drink plenty of liquids (6 to 8 cups per day, unless you have been told otherwise) and pee frequently.
Get emergency medical help right away

For more links on how to manage your symptoms go to https://www.cancercareontario.ca/en/symptom-management.

The information set out in the medication information sheets, regimen information sheets, and symptom management information (for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.