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Overview: Nelarabine is used to treat certain types of leukemias and lymphomas. Common side effects include nausea and vomiting, tiredness, headache, and diarrhea or constipation. Serious side effects may include blood disorders and severe sleepiness, weakness, or numbness or tingling in your hands or feet, which could be signs of nerve damage. Nelarabine is given as an injection by a health care provider.

Uses

What is nelarabine used for?

Nelarabine is commonly used to treat certain kinds of acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma, which are types of blood cancer. 

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

How does nelarabine work (mechanism of action)?

Nelarabine is a type of chemotherapy that works by preventing the DNA in certain 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 nelarabine supplied (dosage forms)?

Brands and other names

  • Arranon

Dosage forms and strengths

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

How should I store nelarabine?

Nelarabine 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 nelarabine?

The most common side effects of nelarabine are listed below. These side effects may vary based on your age. Tell your health care provider if you have any of these side effects that bother you.

  • Blood disorders (see below)
  • Nausea and vomiting
  • Diarrhea or constipation
  • Sleepiness or tiredness
  • Fever
  • Cough
  • Shortness of breath
  • Dizziness
  • Headache
  • Tingling, burning, prickling, loss of sensation, or numbness in part of the body, which may be a sign of nervous system problems (see below)

There may be other side effects of nelarabine 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.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of nelarabine?

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

Severe Allergic Reactions. Nelarabine 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

Nervous System Problems. Nelarabine can affect your nervous system, and these effects can sometimes be severe. Nerves are the fibers that carry sensations from your body to the brain. Damage to these nerves, called peripheral neuropathy, can happen with nelarabine. Nelarabine can also make you feel very weak or sleepy. Call your health care provider right away if you have the following symptoms.

  • Headache
  • Dizziness
  • Sleepiness
  • Confusion
  • Pain, burning, tingling, numbness, or weakness in your arms, hands, legs, or feet
  • Seizures
  • Weakness, unsteadiness, or frequent tripping
  • Tremor
  • Trouble using your hands, such as buttoning your clothes

Blood Disorders. Nelarabine can cause blood disorders, such as low red blood cell 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 nelarabine 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

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

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

Warnings & Precautions

Who should not use nelarabine?

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

  • Arranon
  • Nelarabine
  • Any of the ingredients in the specific product dispensed

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

What should I know about nelarabine before using it?

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

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 nelarabine and make sure it is safe for you to continue using the medicine. 

Nelarabine can make you sleepy while receiving the medicine and for several days after treatment. Do not drive or do other activities that require alertness or coordination until you know how nelarabine affects you and you do not feel sleepy.

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

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 nelarabine 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.

  • Nervous system problems
  • Kidney problems
  • Liver problems
  • An infection or symptoms of an infection, such as a fever

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

Other Medicines and Supplements. Nelarabine may interact with other medicines and supplements. Before using nelarabine, 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. Nelarabine may cause harm to a fetus. You should not be pregnant before starting nelarabine. If you can get pregnant, you should use effective birth control while using nelarabine. If you are able to get a partner pregnant (even if you have had a vasectomy), you should use condoms during sex while using nelarabine and for at least three months after your last dose. Tell your health care provider right away if you are pregnant or plan to become pregnant.

Breastfeeding. It is not known if nelarabine passes into breast milk. Do not breastfeed while using nelarabine. Tell your health care provider if you are breastfeeding or plan to breastfeed.

Interactions

Does nelarabine interact with foods or drinks?

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

It is unknown if drinking alcohol will affect nelarabine, but heavy drinking can slow your immune response and make it harder for your body to fight cancer. The risk of sleepiness, dizziness, or other side effects may also increase if you drink alcohol while using nelarabine.

Does nelarabine 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 taking pentostatin (Nipent), which is a chemotherapy medicine used for certain cancers.

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

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

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