Fludarabine Phosphate (Generic Name) 

Other Names: Fludara®

 
About This Drug

Fludarabine phosphate is used to treat cancer. This drug is given in the vein (IV).

 
Possible Side Effects (More Common) 

  • Bone marrow depression. This is a decrease in the number of white blood cells, red blood cells, and platelets. Bone marrow depression usually occurs 13 to 15 days after the drug is given and may be prolonged. This may raise your risk of infection, make you tired and weak (fatigue), and raise your risk of bleeding.
  • Nausea and throwing up (vomiting)
  • Loose bowel movements (diarrhea) that may last for several days
  • Raised, red rash
  • Decreased appetite (decreased hunger)
  • Flu-like symptoms: fever, headache, muscle and joint aches, and fatigue (low energy, feeling weak)
  • Trouble catching your breath
  • Trouble breathing when lying flat
  • Coughing
  • Muscle weakness
  • Changes in vision, such as blurred or double vision or a decrease in vision

Possible Side Effects (Less Common) 

  • Hair loss. Hair loss is often complete scalp hair loss and can involve loss of eyebrows, eyelashes, and pubic hair. You may notice hair thinning five to seven days after getting this drug. Usually hair loss is temporary; your hair should grow back when treatment is done.
  • Soreness of the mouth and throat. You may have red areas, white patches, or sores that hurt.
  • Ankle swelling
  • Chest pain
  • Feeling drowsy or sleepy
  • Decreased hearing or ringing in the ears. This effect is rare.
  • Effects on the nerves are called peripheral neuropathy. You may feel numbness, tingling, or pain in your hands and feet. It may be hard for you to button your clothes, open jars, or walk as usual. The effect on the nerves may get worse with more doses of the drug. These effects get better in some people after the drug is stopped but it may not get better in all people.
  • High blood sugar

Allergic Reactions

Serious allergic reactions including anaphylaxis are rare.  While you are getting this drug in your IV, tell your nurse right away if you have any of these symptoms of an allergic reaction:

  • trouble catching your breath
  • feeling like your tongue or throat are swelling
  • feeling your heart beat quickly  or in a not normal way (palpitations)
  • feeling dizzy or lightheaded
  • flushing, itching, rash, and/or hives

Treating Side Effects

  • Avoid contact with people who are sick or have infections. You have a higher risk of lung illness, such as pneumonia, and other illness and infection that are contagious.
  • Mouth care is very important. Your mouth care should consist of gently brushing with a very soft tooth brush and rinsing your mouth with a mixture of 1/2teaspoon of salt in 8 ounces of water or 1/2 teaspoon of sodium bicarbonate (baking soda) in 8 ounces of water. This should be done at least after every meal and at bedtime.
  • Avoid mouthwash that contains alcohol. Also avoid alcohol and smoking because they can bother your mouth and throat.
  • Ask your doctor or nurse about medicine to help stop or lessen nausea, throwing up, and loose bowel movements (diarrhea).
  • Drink 6-8 cups of fluids each day unless your doctor has told you to limit your fluid intake due to some other health problem. A cup is 8 ounces of fluid. If you throw up or have loose bowel movements, you should drink more fluids so that you do not become dehydrated (lack water in the body from losing too much fluid).
  • If you get a rash do not put anything on it unless your doctor or nurse says you may. Keep the area around the rash clean and dry. Ask your doctor for medicine if the rash bothers you.
  • Be careful when cooking, walking, and handling sharp objects and hot liquids.

Food and Drug Interactions

There are no known interactions of fludarabine phosphate with food. This drug may interact with other medication. Tell your doctor and pharmacist about all the medication and dietary supplements (vitamins, minerals, herbs and others) that you are taking at this time. The safety and effectiveness of dietary supplements and alternative diets are often unknown. Using these might affect your cancer or interfere with your treatment. Until more is known, you should not use dietary supplements or alternative diets without your cancer doctor's help.

 
When to Call the Doctor

Call your doctor or nurse right away if you have any of these symptoms:

  • Fever of 100.5 F (38 C) or higher
  • Chills
  • Trouble catching your breath
  • Rash or itching
  • Feeling dizzy or lightheaded
  • Feeling that your heart is beating in a fast or not normal way (palpitations)
  • Easy bleeding or bruising
  • Nausea that stops you from eating or drinking
  • Throwing up more than three times in one day
  • Chest pain
  • Swelling of legs, ankles, or feet
  • Trouble passing urine or pain when passing urine
  • Urination that is frequent, with small amounts of urine
  • Urgent need to urinate
  • Coughing

Call your doctor or nurse as soon as possible if you have any of these symptoms:

  • Pain in your mouth or throat that makes it hard to eat or drink
  • Loose bowel movements (diarrhea) more than 4 times a day or diarrhea with weakness or feeling lightheaded
  • Nausea that is not relieved by prescribed medicines
  • Pain in arms or legs that is not relieved by prescribed medicines
  • Headache that is not relieved by prescribed medicines
  • Numbness, tingling, or decreased sensation in fingers and toes
  • Muscle weakness
  • Changes in vision, such as blurred or double vision
  • Changes in hearing
  • Inability to empty all urine in the bladder
  • Lasting loss of appetite or weight loss of five pounds or more in one week
  • Extreme tiredness/weakness that interferes with normal activities
  • Rash that is not relieved by prescribed medicines

Sexual Problems and Reproduction Concerns

  • Infertility warning: Sexual problems and reproduction concerns may happen. In both men and women, this drug may affect your ability to have children. This cannot be determined before your treatment. Talk with your doctor or nurse if you plan to have children.  Ask for information on sperm or egg banking.
    • In men, this drug may interfere with your ability to make sperm, but it should not change your ability to have sexual relations.
    • In women, menstrual bleeding may become irregular or stop while you are getting this drug. Do not assume that you cannot become pregnant if you do not have a menstrual period.
    • Women may go through signs of menopause (change of life) like vaginal dryness or itching. Vaginal lubricants can be used to lessen vaginal dryness, itching, and pain during sexual relations. 
    • Genetic counseling is available for you to talk about the effects of this drug therapy on future pregnancies. Also, a genetic counselor can look at the possible risk of problems in the unborn baby due to this medicine if an exposure happens during pregnancy.
  • Pregnancy warning: This drug may have harmful effects on the unborn child, so effective methods of birth control should be used during your cancer treatment. Ask your doctor or nurse about effective methods of birth control.
  • Breast feeding warning: It is not known if this drug passes into breast milk.  For this reason, women should talk to their doctor about the risks and benefits of breast feeding during treatment with this drug because this drug may enter the breast milk and badly harm a breast feeding baby.

Revised August 2014

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