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Chemotherapy and other systemic treatment regimens may change due to COVID-19. Find out more at Systemic Treatment Regimens During COVID-19.


( nel AR a been )
Other Name(s): Atriance® (Novartis)
Appearance: clear, colourless solution

Medication Information Sheet
nelarabine (nel AR a 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: Atriance®

clear, colourless solution

What is this medication for?
  • For treating T-cell acute lymphoblastic leukemia or T-cell lymphoblastic lymphoma.

What should I do before I have this medication?
  • Tell your doctor and pharmacist if you have/had significant medical condition(s), especially if you have / had liver, kidney, muscle or nervous system problems, have been treated with other forms of chemotherapy (especially if injected around your spinal cord) or radiation, or if you have any allergies.
  • People who have cancer or leukemia are at a higher risk of developing other cancers/leukemias (usually some years later). Some cancer medications may increase these risks, especially if used  for a prolonged period of time. You should discuss any concerns about this drug with your doctor.
How will this medication affect sex, pregnancy and breastfeeding?
  • nelarabine can harm the unborn baby and should not be used by pregnant women.
  • If there is ANY chance that you or your partner may become pregnant, you and your partner together must: 

    Use 2 highly effective forms of birth control at the same time while receiving this drug: Keep using birth control until at least 6 months after the last dose (general recommendation). Discuss with your healthcare team.

  • Tell your doctor right away if you or your partner becomes pregnant.
  • Do not breastfeed while using this drug.
  • Effects on Fertility: Unknown
  • Effects on Fertility: Unknown
How is this medication given?
  • This drug is given by injection into a vein.

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.
What are the side effects of this medication?

The following side effects are common (usually in more than 10% of patients, or the 10 most common) or less common, but may be severe or life-threatening. You may not have all of the side effects listed, while others not on this list may also occur. Discuss with your doctor if you have any unusual or bothersome symptoms.

Side effects and what to do When 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

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 (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 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


  • Rest often; take naps if needed. Move slowly when getting up.
  • Eat well-balanced meals and drink plenty of fluids. Light exercise may help.
  • If you are feeling tired, avoid driving or operating machinery
Contact your health care team if no improvement or if severe

Nausea and vomiting

  • May occur in hours to days after the dose is given/ after treatment starts.
  • Take anti-nausea drug(s) exactly as directed by your doctor. It is easier to prevent nausea than to treat it.
  • Contact your doctor if nausea lasts more than 48 hours or vomiting for more than 24 hours.
  • Drink clear fluids and avoid large meals. Get fresh air and rest.
  • Limit spicy, fried foods or foods with a strong smell.
  • Also see Nausea & Vomiting pamphlet.*
Contact your health care team if no improvement or if severe
Cough; Feeling short of breath Contact your health care team if no improvement or if severe

Drowsiness, dizziness and/or confusion

  • If you are drowsy, avoid driving or operating machinery.   
  • May go away as your body adjusts to the drug. 
  • If you feel confused, contact your doctor right away
Contact your health care team if no improvement or if severe


  • May occur days to weeks after the drug is given / after treatment starts.
  • Take anti-diarrhea drug(s) if given to you by your doctor.
  • Drink plenty of clear fluids. Limit hot, spicy, fried foods, foods/drinks with caffeine (coffee, tea or cola), orange or prune juice. Try a low-fiber BRAT diet (Bananas, white Rice, Apple sauce, Toast made with white bread).
  • Also see Diarrhea pamphlet.*



Contact your health care team if no improvement or if severe


  • Eat a balanced diet with fibres such whole grains, fruit and raw vegetables.
  • Drink plenty of fluids. Try light exercise regularly.
  • Speak to your doctor if no bowel movement for 3 or more days.
  • Also see Constipation Pamphlet.*
Contact your health care team if no improvement or if severe

Tingling, numb fingers and toes (may be severe)

  • Contact your doctor or nurse if you have trouble doing up buttons, writing, picking up small objects, have pain or trouble with movement.
  • May slowly return to normal after treatment ends.
Contact your health care team if no improvement or if severe

Mild swelling in arms and legs; puffiness

  • Keep your feet up when sitting. Eat a low-salt diet.
  • Avoid tight fitting clothing.
Contact your health care team if no improvement or if severe

Headache; mild joint, muscle pain or cramps 

  • Take painkiller(s) as directed, if given to you by your doctor.
  • Otherwise, take acetaminophen (Tylenol®) tablets as needed for mild aches and pains. Ask your doctor or pharmacist about the right dose for you.
  • Rest often, but may try light exercise.



Contact your health care team if no improvement or if severe

Side effects and what to do When to contact doctor?
Less Common Side Effects, but may be Severe

Liver problems (tender right side of belly, yellowish skin or eyes, dark urine)

Get emergency medical help right away

Eye problems
(dry eyes, redness, irritation, pain, tearing, sensitivity to light, blurred vision or other unusual changes with your sight)

  • Avoid wearing contact lenses while taking this drug
  • For dry eyes, may try artificial tears or ointment. Contact your doctor if this becomes bothersome.
Contact your health care team as soon as possible (office hours)

Effects on the brain (confusion, difficulty with thinking, speaking, movement or balance, blurred and/or loss of vision, weakness on one side of the body)

Effects on the nerves in your head/face, leading to weakness or changes in senses such as hearing

Get emergency medical help right away

Inflammation of the spinal cord (weakness of the legs and arms, back pain, changes in or loss of sensation, problems with urinating or having bowel movements)

Get emergency medical help right away

Breakdown of muscle cells, may lead to kidney problems
(severe muscle pain or weakness, dark urine)

Get emergency medical help right away
Seizures Get emergency medical help right away

For more links on how to manage your symptoms go to

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.