Parenteral Manual

Cytarabine

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): 
CYTOSAR, ARA-C, cytosine arabinoside
Classification: 
Antineoplastic, antimetabolite - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
June 2015
Indications: 
  • Induction of remission and maintenance therapy in acute leukemia
  • Non-Hodgkin's lymphoma
  • Meningeal leukemia

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: 
  • For intrathecal use, reconstitute 100 mg vial with 5 mL of preservative FREE NS for a final concentration of 20 mg/mL (do not use supplied diluent)  Stable 8 hrs after reconstitution.
  • Aqueous solution (from manufacturer) 100 mg/mL - used for infusions and subcutaneous injections/infusions
  • Vial, and further  diluted solution are stable for 7 days at room temperature  (RT)
  • When reconstituted with bacteriostatic water, syringes stable 48 hrs RT & 96 hrs fridge
  • Discard any solution which is slightly hazy
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl, dextrose-saline solutions

- Additive/Above Cassette Compatible: hydrocortisone, methotrexate

- Y-site Compatible: dexamethasone, metoclopramide, mitoxantrone, morphine, ondansetron, KCl (up to 100 mmol/L), ranitidine, sodium bicarbonate, vincristine, amino acids and dextrose

- Incompatible: allopurinol, amphotericin B, fluorouracil, gentamicin, heparin, insulin, penicillin

Administration: 

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

SC YES
IM NO
IV Direct

YES, specially trained nurse
Infusion time: 15 minutes

IV Intermittent Infusion

Yes

Doses < 200 mg/m2 may be given undiluted via syringe pump

Usual dilution: dilute in 50-250 mL

Infusion time: at least 30 minutes

IV Continuous Infusion YES, dilute to a concentration suitable to deliver 15-30 mL/hour
Intrathecal YES, physician or specially trained nurse only
Dosage: 

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

Intravenous

  • Low Dose: 150 - 175 mg/m2/day by continuous infusion x 3-7 days
  • High Dose: 1 -3 g/m2/dose, q12h x 4-10 doses (children with BSA < 0.6 m2 should be dosed on a mg/kg basis)*

Subcutaneous

  • 10-75 mg/m2 subcutaneously daily to q12h x 4-7 days, repeat q 2 weeks

Intrathecal

  • 5 - 75 mg/m2 ; Age dependant
  • Maximum: 70 mg

 - Numerous dosage schedules exist; refer to specific protocol

Potential hazards of parenteral administration: 

     -CYTOImmediate (within a few minutes to hours):

  • Increased uric acid levels (hyperuricemia) - Tumour Lysis Syndrome (with first course of therapy in patients with large tumor burden)
  • Fever/rash (hypersensitivity reaction)
  • Flu-like syndrome (malaise, fatigue, bone pain, fever, rash)
  • Nausea, vomiting, diarrhea, abdominal pain - may be severe with doses >3 g/m2
  • Conjunctivitis (usually with doses >1 g/m2 or continuous infusions) - prevent with dexamethasone 0.1% or prednisolone 1 % eye drops
  • Arachnoiditis (with intrathecal administration) fever, back pain, vomiting
  • Cerebellar toxicity (with high doses), ataxia
  • Cerebral dysfunction (with high doses) - somnolence, confusion, cognitive impairment, psychosis, seizures
  • Sudden respiratory distress (rare with high doses)

Delayed (within a few days or weeks):

  • Alopecia
  • Myelosuppression, nadir 7-9 days
  • Mucositis, colitis
  • Neurotoxicity with high doses (encephalopathy)
  • Hepatotoxicity

 - NON-VESICANT

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

Notes: 
  • Caution in patients with impaired liver function, may require dosage reduction or discontinuation.
  • Drug interaction with flucytosine (cytarabine may decrease effectiveness of flucytosine)
  • *To convert dosage from mg/m2 to mg/kg, divide by 30 (i.e: 1 m2 = 30 kg)
  • No dosage adjustment required in renal failure

The information contained on this website is provided for informational purposes only, as a guide to assist physicians, nurses and other healthcare providers in deciding on the appropriate care required for a particular patient. At all times, physicians, nurses and other healthcare providers must exercise their independent clinical judgment, based on their knowledge, training and experience, taking into account the specific facts and circumstances of each patient, when deciding on the appropriate course of investigation and/or treatment to recommend in a particular clinical situation.

CHEO has made every effort to ensure that the information contained on this website is as current and accurate as possible. However, changes can occur due to ongoing research and the constant influx of new information. Where possible, hospitals and healthcare practitioners should verify the information before acting on it.

Reliance on any information in this website is at the user's own risk. CHEO is not responsible or liable for any harm, loss or other consequences from the use or misuse of the information on this website.