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Overview: Clofarabine is used to treat acute lymphoblastic leukemia (ALL). Common side effects include nausea and vomiting, diarrhea, headache, and tiredness. Serious side effects may include blood disorders, infections, and bleeding. Clofarabine is given as an injection (IV) by a health care provider. 

Uses

What is clofarabine used for?

Clofarabine is commonly used to treat certain people with acute lymphoblastic leukemia (ALL). ALL is a type of blood cancer that causes the bone marrow to make too many white blood cells that are abnormal.

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

How does clofarabine work (mechanism of action)?

Clofarabine is chemotherapy. It may work by affecting the ability of cancer cells to make and repair their DNA. This helps stop the cancer cells from growing and multiplying, which can slow or stop the spread of cancer.

How is clofarabine supplied (dosage forms)?

Brands and other names

  • Clolar

Dosage forms and strengths

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

How should I store clofarabine?

Clofarabine 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 clofarabine?

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

  • Nausea and vomiting
  • Diarrhea
  • Blood disorders (see below)
  • Rash, itching, or spots on the skin
  • Headache
  • Infections (see below)
  • Fever and chills
  • Fast heartbeat
  • Stomach pain
  • Tiredness
  • Loss of appetite
  • Pain in the arms or legs
  • Low blood pressure
  • Nosebleeds

There may be other side effects of clofarabine 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 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 clofarabine?

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

Severe Allergic Reactions. Clofarabine 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, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Blood Disorders. Clofarabine can cause blood disorders, such as low hemoglobin levels (anemia), low platelet levels (thrombocytopenia), and low neutrophil levels (neutropenia). It may also cause a dangerous type of neutropenia where you also have fever, called febrile neutropenia. It is important to keep all appointments for blood tests to make sure clofarabine 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

Severe Bleeding. Clofarabine can increase your risk of severe bleeding that can lead to death. Some people with serious bleeding may need a blood transfusion or surgery. Call your health care provider right away if you have any of the following signs of severe bleeding while using clofarabine.

  • Pink, red, or brown urine (pee)
  • Vomit with blood that looks like coffee grounds
  • Red or black stools (which look like tar)
  • Coughing up blood or blood clots

Infections. Clofarabine 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.

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

Tumor Lysis Syndrome. Clofarabine 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 clofarabine and keep all appointments for blood tests so that your health care provider can see how your body is responding to clofarabine. Tell your health care provider right away if you have any of the following signs of tumor lysis syndrome while using clofarabine.

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

Capillary Leak Syndrome (CLS) and Systemic Inflammatory Response Syndrome (SIRS). Clofarabine may cause capillary leak syndrome (CLS), where proteins and fluid leak out of your blood vessels into your body tissues. CLS can be serious or life-threatening. It may also cause systemic inflammatory response syndrome (SIRS), which can cause life-threatening damage to your organs. Tell your health care provider right away if you have any of the following symptoms of CLS or SIRS.

  • Fever
  • Fast heartbeat
  • Low blood pressure
  • Dizziness, feeling lightheaded, or fainting upon standing
  • Fluid retention
  • Weight gain
  • Fast breathing or shortness of breath

Liver Damage. Liver damage, also called hepatotoxicity, can happen when using clofarabine. Call your health care provider right away if you have any of the following symptoms of liver damage.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine (pee)
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Kidney Damage. Kidney damage can happen when using clofarabine. Call your health care provider right away if you have any of the following symptoms of kidney damage.

  • Reduced need to pee
  • Swelling in your feet, ankles, or legs
  • Weakness or unusual tiredness
  • Difficulty catching your breath or chest pain/pressure
  • Confusion
  • Nausea
  • Seizures

Inflammation of the Intestines. Clofarabine can cause inflammation of the intestines, also known as colitis. Some people using clofarabine have also had an overgrowth of germs called Clostridioides difficile, or C. diff. Call your health care provider right away if you have any of the following symptoms.

  • Watery diarrhea
  • Diarrhea that does not go away
  • Blood in your stool (poop)
  • Severe stomach cramps
  • Fever that starts after you start or finish the medicine

Severe Skin Reactions. Clofarabine 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 red or purple skin that looks burned and peels off
  • Flat red rash or blisters on your skin, mouth, nose, and genitals
  • Red, painful, watery eyes
  • Flu-like symptoms including fever, chills, and muscle aches

Warnings & Precautions

Who should not use clofarabine?

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

  • Clofarabine
  • Clolar
  • Any of the ingredients in the specific product dispensed

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

What should I know about clofarabine before using it?

Clofarabine is usually given by a health care provider in a hospital or clinic. It is given as an infusion into a vein (IV).

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

Clofarabine may make it hard for you to get pregnant or get your partner pregnant. If you have concerns, talk to your health care provider.

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

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 determine if clofarabine 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.

  • Liver problems
  • Kidney problems
  • An infection or have had any serious infections in the past
  • Have received a stem cell transplant

Other Medicines and Supplements. Clofarabine may interact with other medicines and supplements. Before using clofarabine, 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. Clofarabine may cause harm to a fetus. Your health care provider will likely make sure you are not pregnant before starting clofarabine. If you can get pregnant, you should use effective birth control while using clofarabine and for at least six months after your last dose. If you are able to get a partner pregnant, you should use effective birth control while using clofarabine and for at least three months 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 clofarabine passes into breast milk. Do not breastfeed while using clofarabine and for at least two weeks after your last dose. Tell your health care provider if you are breastfeeding or plan to breastfeed.

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

Interactions

Does clofarabine interact with foods or drinks?

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

It is unknown if drinking alcohol will affect clofarabine, but heavy drinking can slow your immune response and make it harder for your body to fight cancer. Both clofarabine and alcohol can also increase your risk of bleeding. It is best to limit the amount of alcohol you drink.

Does clofarabine 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 any medicine or supplement that can cause kidney problems or liver problems, such as some pain relievers or antibiotics. Ask your pharmacist or another health care provider if you are not sure if your medicines may cause kidney or liver problems.

This may not be a complete list of medicines that can interact with clofarabine. 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 clofarabine?

If you or someone else has used too much clofarabine, 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 clofarabine?

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