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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Related Studies

Ontology: Cytarabine (C0010711)

Definition (NCI) An antimetabolite analogue of cytidine with a modified sugar moiety (arabinose instead of ribose). Cytarabine is converted to the triphosphate form within the cell and then competes with cytidine for incorporation into DNA. Because the arabinose sugar sterically hinders the rotation of the molecule within DNA, DNA replication ceases, specifically during the S phase of the cell cycle. This agent also inhibits DNA polymerase, resulting in a decrease in DNA replication and repair. (NCI04)
Definition (NCI_NCI-GLOSS) A drug used to treat certain types of leukemia and prevent the spread of leukemia to the meninges (three thin layers of tissue that cover and protect the brain and spinal cord). It is also being studied in the treatment of other types of cancer. Cytarabine blocks tumor growth by stopping DNA synthesis. It is a type of antimetabolite.
Definition (MSH) A pyrimidine nucleoside analog that is used mainly in the treatment of leukemia, especially acute non-lymphoblastic leukemia. Cytarabine is an antimetabolite antineoplastic agent that inhibits the synthesis of DNA. Its actions are specific for the S phase of the cell cycle. It also has antiviral and immunosuppressant properties. (From Martindale, The Extra Pharmacopoeia, 30th ed, p472)
Definition (CSP) class of pyrimidine nucleoside analogs used mainly in the treatment of leukemia, especially acute non-lymphoblastic leukemia; antimetabolite antineoplastic agents that inhibit the synthesis of DNA with actions specific for the S phase of the cell cycle; also have antiviral and immunosuppressant properties.
Definition (PDQ) An antimetabolite analogue of cytidine with a modified sugar moiety (arabinose instead of ribose). Cytosine arabinoside is converted to the triphosphate form within the cell and then competes with cytidine for incorporation into DNA. Because the arabinose sugar sterically hinders the rotation of the molecule within DNA, DNA replication ceases, specifically during the S phase of the cell cycle. This agent also inhibits DNA polymerase, resulting in a decrease in DNA replication and repair. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39015&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39015&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C408" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Nucleic Acid, Nucleoside, or Nucleotide (T114)
MSH D003561
SnomedCT 387511003, 89265009
LNC LP70367-5
English Arabinofuranosylcytosine, Arabinoside, Cytosine, Arabinosylcytosine, Aracytidine, Cytarabine, Cytosine Arabinoside, 2(1H)-Pyrimidinone, 4-amino-1-beta-D-arabinofuranosyl-, cytarabine, 4-Amino-1-beta-D-arabinofuranosyl-2(1H)-pyrimidinone, 1-Beta-D-arabinofuranosylcytosine, Cytarabinum, Beta-Cytosine Arabinoside, cytosine arabinoside (medication), cytosine arabinoside, cytarabine (medication), CYTARABINE, Cytarabine [Chemical/Ingredient], 1-.beta.-D-Arabinofuranosyl-4-amino-2(1H)pyrimidinone, .beta.-Cytosine arabinoside, 1.beta.-D-Arabinofuranosylcytosine, Cytosine-.beta.-arabinoside, 1-.beta.-D-Arabinofuranosylcytosine, 2(1H)-Pyrimidinone, 4-amino-1.beta.-D-arabinofuranosyl-, Cytosine arabinoside, 1-beta-D-Arabinofuranosylcytosine, Cytarabine (product), Cytarabine (substance), arabinofuranosylcytosine, arabinosylcytosine
Swedish Cytarabin
Czech cytarabin, cytosinarabinosid
Finnish Sytarabiini
Russian TSITARABIN, TSITOZAR, ARA-TS, ARABINOZILTSITOZIN, TSITOZINA ARABINOZID, ARABINOFURANOZILTSITOZIN, АРАБИНОЗИЛЦИТОЗИН, АРАБИНОФУРАНОЗИЛЦИТОЗИН, АРА-Ц, ЦИТАРАБИН, ЦИТОЗАР, ЦИТОЗИНА АРАБИНОЗИД
Japanese サイトサールU, シトシンアラビノシド, アラビノフラノシルシトシン, サイトサール, スポンゴシチジン, キロサイド, シタラビン, アイレチン, アラビノシルシトシン
Italian Aracitidina, Arabinosilcitosina, Arabinofuranosilcitosina, Citosina arabinoside, Citarabina
Polish Arabinozyd cytozyny, Ara-C, Cytarabina
Spanish 1-beta-D-arabinofuranosilcitosina, arabinosilcitosina, arabinósido de citosina, citarabina (producto), citarabina (sustancia), citarabina, Arabinofuranosilcitosina, Arabinosido de Citosina, Arabinosilcitosina, Citarabina
French Cytarabine, Cytosine arabinoside
German Arabinofuranosylcytosin, Arabinosylcytosin, Cytarabin, Cytosinarabinosid, Zytosinarabinosid
Portuguese Arabinofuranosilcitosina, Arabinosilcitosina, Citarabina, Citosina Arabinosídeo