II. Indications

III. Mechanism

  1. Pyrimidine Antimetabolite Chemotherapy
  2. Cytarabine is an analog of cytidine
    1. Originally discovered in Cryptotethia crypta (sponge species) in the 1950s
    2. Modified sugar component with arabinose in place of ribose
    3. Intracellular conversion of Cytarabine to the active triphosphate (araCTP)
  3. AraCTP is incorporated into DNA
    1. Results in abnormal DNA rotation that terminates DNA Replication prematurely
  4. AraCTP also inhibits DNA Polymerase, further blocking replication and repair

IV. Medications

  1. Cytarabine IV Solution
    1. Available in 20 mg/ml and 100 mg/ml vials
  2. Intrathecal depot Cytarabine Liposomal (for Meningeal Leukemia)
    1. Available in 50 mg/5 ml suspension vials for intrathecal injection
    2. Minimal systemic effects
    3. Risk of Chemical Arachnoiditis (see adverse effects below)
      1. Coadminister with Dexamethasone (see below)

V. Dosing

  1. See other references for disease specific dosing protocols

VI. Adverse Effects

  1. Myelosuppression
  2. Alopecia
  3. Gastrointestinal
    1. Hepatotoxicity
    2. Pancreatitis
    3. Nausea and Vomiting
    4. Diarrhea
  4. Cytarabine Syndrome
    1. Fever
    2. Malaise
    3. Conjunctivitis
    4. Bone pain and myalgias
    5. Chest Pain (variably present)
    6. Maculopapular rash
  5. Neurologic
    1. Neurotoxicity
    2. Peripheral Neuropathy
    3. Chemical Arachnoiditis (with intrathecal depot Cytarabine Liposomal)
      1. Presents with Fever, Headache, Nausea and Vomiting
      2. Coadminister Cytarabine Dexamethasone 4 mg orally or IV twice daily for 5 days
      3. Mortality risk in untreated patients

VII. Safety

  1. Avoid in Pregnancy (any trimester)
    1. Use reliable Contraception
  2. Avoid in Lactation
  3. Monitoring
    1. Complete Blood Count
    2. Liver Function Tests
    3. Renal Function Tests

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