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Overview: Fludarabine is used to treat certain people who have chronic lymphocytic leukemia. Common side effects include a fever, chills, nausea, vomiting, and tiredness or weakness. Serious side effects may include blood disorders and infections. Fludarabine is given as an injection by a health care provider.

Uses

What is fludarabine used for?

Fludarabine is commonly used to treat certain kinds of B-cell chronic lymphocytic leukemia (CLL), which is a type of blood cancer.

Fludarabine may also be used for other conditions as determined by your health care provider.

How does fludarabine work (mechanism of action)?

Fludarabine is chemotherapy. It works by preventing the DNA in cancer cells from working. This stops the cancer cells from growing and multiplying, which can help slow or stop the spread of cancer.

How is fludarabine supplied (dosage forms)?

Brands and other names

  • Fludara
  • Oforta

Dosage forms and strengths

Fludarabine is available in an injectable form that is given by a health care provider.

How should I store fludarabine?

Fludarabine is usually given by a health care provider in a hospital or clinic. You will not store it at home.

Side Effects

What are the most common side effects of fludarabine?

The most common side effects of fludarabine are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Blood disorders (see below)
  • Fever and chills
  • Tiredness and weakness
  • Infections (see below)
  • Cough
  • Nausea and vomiting
  • Diarrhea
  • Mouth sores
  • Loss of appetite

There may be other side effects of fludarabine that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada or by calling 866-234-2345.

What are the serious side effects of fludarabine?

While less common, the most serious side effects of fludarabine are described below, along with what to do if they happen.

Severe Allergic Reactions. Fludarabine may cause allergic reactions, which can be serious. Get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching or skin rash
  • Bumps on the skin called hives that can be red, pink, white, or brown, depending on your skin tone
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Blood Disorders. Fludarabine can cause blood disorders, including low red blood cell levels (anemia), low platelet levels (thrombocytopenia), and low neutrophil levels (neutropenia). It may also cause your red blood cells to be destroyed (hemolytic anemia). It is important to go to all appointments for bloodwork to make sure fludarabine is safe for you. Get help right away if you have any of the following symptoms of blood disorders.

  • Fever
  • Shortness of breath
  • Pale or yellowish skin
  • Easy bruising or bleeding
  • Frequent infection
  • Unusual weakness or tiredness
  • Dizziness, lightheadedness, or feeling like you are about to pass out
  • Headache
  • Fast or abnormal heartbeat

Infections. Fludarabine can increase your risk of infections, including serious infections. Call your health care provider right away if you have an infection or any of the following symptoms.

  • Burning or stinging when you pee
  • Coughing, especially coughing up blood
  • Fever, sweats, chills, or muscle aches
  • Shortness of breath
  • Diarrhea or stomach pain
  • Weight loss

Tumor Lysis Syndrome. Fludarabine can cause a fast breakdown of cancer cells. This can lead to a condition called tumor lysis syndrome, which can be serious. It is important to drink plenty of water while receiving fludarabine and to keep all appointments for bloodwork so your health care provider can see how your body is responding to fludarabine. Tell your health care provider right away if you have any of the following signs of tumor lysis syndrome while using fludarabine.

  • Nausea and vomiting
  • Weakness
  • Swelling or fluid retention
  • Shortness of breath
  • Muscle cramps
  • Seizures

Breathing Problems. Fludarabine may cause breathing problems. Call your health care provider or get help right away if you have new or worsening shortness of breath, coughing, or trouble breathing.

Cancer. Fludarabine can cause a new cancer to develop or cause a previously treated cancer to recur. Tell your health care provider about any new symptoms that you may get.

Severe Skin Reactions. Fludarabine can cause severe skin reactions, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), that can lead to death if not treated. If you get a rash, call your health care provider right away. Get emergency help if you have any of the following symptoms of SJS or TEN.

  • Painful skin that looks burned and peels off
  • Flat rash or blisters on your skin, mouth, nose, and genitals
  • Red, painful, watery eyes
  • Flu-like symptoms including fever, chills, and muscle aches

Nervous System Problems. Fludarabine may rarely cause problems with your central nervous system (CNS). Tell your health care provider right away if you have symptoms such as confusion, agitation, vision changes, or seizures. Also tell your health care provider if you have pain, burning, tingling, numbness, or weakness in your arms, hands, legs, or feet.

Warnings & Precautions

Who should not use fludarabine?

Allergies to Ingredients. People who are allergic to any of the following should not use fludarabine.

  • Fludarabine
  • Fludara
  • Oforta
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific fludarabine products they stock.

What should I know about fludarabine before using it?

Fludarabine is usually given by a health care provider in a hospital or clinic.

It is important to attend all appointments for bloodwork with your health care provider. They will use these tests to monitor your body's response to fludarabine and make sure it is safe for you to continue using the medicine.

Fludarabine may cause tiredness, weakness, vision changes, or confusion. Do not drive or do other activities that require alertness or coordination until you know how fludarabine affects you.

What should I tell my health care provider before using fludarabine?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if fludarabine is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

Vaccines. Talk with your health care provider about any vaccines that you may need. You should not receive certain vaccines right before or while using fludarabine. Tell your health care provider about any vaccines you have recently received or have scheduled.

Other Medicines and Supplements. Fludarabine may interact with other medicines and supplements. Before using fludarabine, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. Fludarabine may harm an unborn baby. If you can get pregnant, you should use effective birth control while using fludarabine. If you are able to get a partner pregnant, you should use effective birth control while using fludarabine and afterward. Your health care provider can let you know how long to continue using birth control after your last dose. Tell your health care provider right away if you are pregnant, think you might be pregnant, or plan to become pregnant.

Breastfeeding. It is not known if fludarabine passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will let you know if you should stop breastfeeding or stop fludarabine.

Interactions

Does fludarabine interact with foods or drinks?

There are no known interactions between fludarabine and foods or drinks.

It is unknown if drinking alcohol will affect fludarabine, but heavy drinking can slow your immune response and make it harder for your body to fight cancer or infection.

Does fludarabine interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using pentostatin (Nipent), which is a chemotherapy medicine used for certain cancers.

This may not be a complete list of medicines that can interact with fludarabine. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much fludarabine?

If you or someone else has used too much fludarabine, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of fludarabine?

Fludarabine is usually given by a health care provider in a hospital or clinic. Your health care provider will make sure you are receiving fludarabine as scheduled. If you miss an appointment to get your fludarabine dose, call to make another appointment as soon as possible.