- 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.
- Aqueous solution (from manufacturer) 100 mg/mL - used for infusions and subcutaneous injections/infusions
- Discard any solution which is slightly hazy
- Prepared syringes and diluted solutions stable for 24 hours room temperature or 72 hours refrigerated
- 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
(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 |
| 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 |
(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
-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
- 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