Fludarither contains Fludarabine, a purine nucleotide analog used primarily as a chemotherapeutic agent. It is effective in treating certain hematological malignancies by inhibiting DNA synthesis and causing apoptosis in rapidly dividing cells.

Uses

1. Chronic Lymphocytic Leukemia (CLL): Used as a first-line or second-line treatment.
2. Non-Hodgkin’s Lymphoma: Specifically for indolent (slow-growing) forms.
3. Acute Myeloid Leukemia (AML): In some regimens for refractory or relapsed cases.
4. Bone Marrow Conditioning: Used in pre-transplant regimens.

Fludarabine is phosphorylated within cells to its active triphosphate form, inhibiting DNA polymerase, ribonucleotide reductase, and DNA primase, leading to inhibition of DNA synthesis and cell death.

Onset of Action

• The pharmacologic effect typically begins within 24 to 48 hours after administration.

Duration of Action

• The therapeutic effects can last for several days to weeks after discontinuation, depending on the regimen and patient response.

Dosage

Chronic Lymphocytic Leukemia (CLL):

• 25 mg/m² intravenously daily for 5 consecutive days in a 28-day cycle.

Dosage adjustments are required for renal impairment.

Common Side Effects

• Bone marrow suppression (neutropenia, thrombocytopenia, anemia)
• Fever and infections
• Nausea and vomiting
• Fatigue
• Neurological effects (rare but serious)

Precautions

• Monitor blood counts regularly due to myelosuppression risks.
• Avoid live vaccines during and after treatment.
• Caution in patients with renal impairment.

Drug Interactions

• Pentostatin: Co-administration increases pulmonary toxicity risk.
• Cytarabine: Enhanced cytotoxic effects, but requires careful monitoring.
• Live vaccines: Risk of severe infections.

Storage

• Store between 2°C to 8°C. Avoid freezing. Keep away from direct light.