cladribine

cladribine

Leustatin

Indications

Action

Pharmacokinetics

Time/action profile (noted as effect on peripheral counts)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• fatigue (most frequent)
• headache (most frequent)
• dizziness
• insomnia
• malaise
• weakness

Ear, Eye, Nose, Throat

• epistaxis

Respiratory

• abnormal breath sounds (most frequent)
• cough (most frequent)
• dyspnea

Cardiovascular

• edema
• tachycardia

Gastrointestinal

• anorexia (most frequent)
• diarrhea (most frequent)
• nausea (most frequent)
• vomiting (most frequent)
• abdominal pain
• constipation

Dermatologic

• rash (most frequent)
• erythema
• petechiae
• pruritis
• sweating

Hematologic

• neutropenia
• anemia (most frequent)
• thrombocytopenia (most frequent)

Local

• injection site reactions
• phlebitis
• thrombosis

Musculoskeletal

• arthralgia
• myalgia

Miscellaneous

• chills
• fever (most frequent)
• infection (most frequent)
• trunk pain

Interactions

Drug-Drug interaction

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Monitor for bone marrow depression. Assess for fever, chills, sore throat, and signs of infection. Monitor platelet count throughout therapy. Assess for bleeding (bleeding gums, bruising, petechiae; test stool, urine, and emesis for blood). Avoid administering IM injections and taking rectal temperatures. Apply pressure to venipuncture site for 10 min. Anemia may occur. Monitor for increased fatigue and dyspnea.
• Monitor IV site for phlebitis.
• Monitor intake and output. Development of uric acid nephropathy in patients with leukemia and lymphoma may be prevented with adequate oral hydration and allopurinol, if needed.
• Lab Test Considerations: Monitor CD4 T-lymphocyte count and CD8 T-lymphocyte count before initiation of therapy and periodically during and after therapy. Cladribine causes prolonged depression of CD4 and CD8 lymphocyte subset counts, with recovery taking at least 6–12 mo.
  • Monitor hemoglobin, hematocrit, leukocyte, and platelet counts before and periodically throughout therapy, especially during the first 4–8 wk after treatment. During the first 2 wk after therapy, platelet counts, absolute neutrophil count (ANC), and hemoglobin decrease. Transfusions of platelets and red blood cells may be required. Platelet count, ANC, and hemoglobin usually return to normal levels by day 12, week 5, and week 8, respectively.
  • Monitor renal and hepatic function before and periodically during therapy. May cause nephrotoxicity, resulting in elevated serum creatinine, anuria, and acidosis.
  • Monitor serum uric acid concentrations before and periodically during therapy, especially in patients with high tumor burden. May cause elevated serum and uric acid concentrations. May require alkalinization of the urine.
May cause irreversible neurologic toxicity, resulting in motor weakness progressing to paraparesis or quadriparesis with high doses. If symptoms occur, discontinue cladribine. There is no known antidote.

Potential Nursing Diagnoses

Implementation

• high alert: Fatalities have occurred with chemotherapeutic agents. Before administering, clarify all ambiguous orders; double-check single, daily, and course-of-therapy dose limits; have second practitioner independently double-check original order, calculations, and infusion pump settings.
• Prepare solution in a biologic cabinet. Wear gloves, gown, and mask while handling IV medication. Discard IV equipment in specially designated containers (see ).

• Intravenous Administration

• pH: 5.5–8.0.
• Continuous Infusion: Diluent: Add the daily dose to 500 mL of 0.9% NaCl for injection. Solution is stable for 24 hr at room temperature or 8 days if refrigerated.
  • May also be prepared as a 7-day solution with bacteriostatic 0.9% NaCl for infusion via Pharmacia Deltec medication cassettes.
• Rate: Administer as a continuous infusion over 24 hr.
• Y-Site Compatibility: aminophylline, bumetanide, buprenorphine, butorphanol, calcium gluconate, carboplatin, chlorpromazine, cisplatin, cyclophosphamide, cytarabine, dexamethasone, diphenhydramine, dobutamine, dopamine, doxorubicin hydrochloride, droperidol, enalaprilat, etoposide, famotidine, furosemide, granisetron, haloperidol, heparin, hydrocortisone, hydromorphone, idarubicin, leucovorin, lorazepam, mannitol, meperidine, mesna, methylprednisolone, metoclopramide, mitoxantrone, morphine, nalbuphine, ondansetron, paclitaxel, potassium chloride, prochlorperazine, promethazine, ranitidine, sodium bicarbonate, teniposide, vincristine
• Additive Incompatiblity: D5W. Do not admix with other medications or solutions.

Patient/Family Teaching

• Instruct patient to notify health care professional promptly in the event of fever; sore throat; signs of infection; bleeding gums; bruising; petechiae; blood in urine, stool, or emesis; unusual swelling; joint pain; shortness of breath; or confusion. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor and to be especially careful to avoid falls. Patients should also be cautioned not to drink alcoholic beverages or to take products containing aspirin or NSAIDs because these may precipitate GI hemorrhage.
• Advise patient to use nonhormonal contraceptive measures during and for at least 4 mo after completion of therapy and to avoid breastfeeding.
• Instruct patient not to receive any vaccinations without advice of health care professional.

Evaluation/Desired Outcomes

• Improvement in hematologic status in patients with leukemia.