Parenteral Manual

Cladribine (NON-FORMULARY)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
2-CdA, LEUSTATIN
Classification: 
Antineoplastic, Antimetabolite - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
June 2015
Indications: 
  • Relapsed or refractory leukemias, lymphomas
  • Refractory Langerhans Cell histiocytosis (investigational)

THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.

Reconstitution and Stability: 
  • Supplied as a 1 mg/mL, 10 mL vial
  • Refrigerate (2-8°C)
  • Precipitate may form but it can be resolubilized by allowing the drug to warm to room temperature and shaking vigorously
  • Infusions are stable 24 hours at room temperature in NS
  • For Cassettes: Seven (7) day infusions must be diluted with bacteriostatic NS and the solution should be filtered with a 0.22 micron filter before filling cassette
Compatibility: 
  • Solutions Compatible: saline solutions
  • Additive/Above Cassette Compatible: no information
  • Y-site Compatible: dexamethasone, diphenhydramine (Benadryl), ondansetron, potassium chloride, ranitidine, sodium bicarbonate

INCOMPATIBLE: dextrose solutions

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

NO

IV Intermittent Infusion YES
Infusion time: usually over 2 hours
IV Continuous Infusion YES
Usual dilution: dilute daily dose in 500 mL NS, infuse over 24 hours
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • Pediatric: 6.2-9 mg/m2/day x 5 days
  • Dosage in Myelosuppression: 
    - Usually none required; may require delay until count recovery
    - Check protocol for specifics

** Dosage may differ according to protocol

Dosage adjustment in renal/hepatic impairement

  • No information
Potential hazards of parenteral administration: 
  • Injection site redness, swelling, pain, thrombosis, phlebitis, cellulitis
  • Rash
  • Nausea (mild)
  • Fever, headache, fatigue
  • Non-vesicant
  • Bone marrow suppression, nadir 7-14 days after therapy, recovery by 21-28 days

**Treatment for unusual side effects are available through the study chair identified on the front page of the protocol and/or pharmacy

Notes: 
  • Ensure adequate hydration during treatment
  • If white count is high give allopurinol, hydration, and bicarbonate prior to first course
  • Cumulative and prolonged thrombocytopenia can occur after multiple cycles
  • Very high doses >0.26 mg/kg (8 mg/m2) x 10-14 days have been associated with CNS and renal toxicity in adults

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