Cytarabine: Usage, Side Effects And Risks

Cytarabine is a colorless and clear solution. It is a chemotherapy drug used to treat cancer. It is often used in combination with other cancer drugs.

This medicine is often used to treat the following conditions:

  • Different types of leukemia (acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML))
  • Different types of lymphomas (non-Hodgkin lymphomas)

Things To Consider Before Using Cytarabine

Do not use Cytarabine in the following situations:

  • If you are hypersensitive to cytarabine or any of the other ingredients of the drug,
  • If you have a decrease in the production of blood cells in your bone marrow (bone marrow suppression)
  • If you have severe decrease in kidney and/or liver functions,
  • If you have severe infections,
  • If you have gastrointestinal ulcers (stomach-intestinal sores) or have recently had surgery,
  • If you have anemia (anemia/erythrocytopenia), leukopenia (white blood cells deficiency) and/or thrombocytopenia (platelet-coagulation cells deficiency),
  • If you are taking brivudine, sorivudine or its analogues for the treatment of chickenpox or shingles (herpes zoster) or have taken it within the last 4 weeks,
  • If you are breast-feeding

Use Cytarabine with caution in the following conditions and talk to your doctor or pharmacist before using it.

If you are using phenytoin to prevent epileptic seizures, you should be checked regularly as phenytoin plasma levels may be elevated.

Concomitant use of phenytoin and cytarabine may increase the effects of phenytoin.

Cytarabine should only be administered in an inpatient hospital by physicians experienced in cancer treatment and should be used with caution in specific centers with appropriate facilities where effects can be regularly monitored during and after administration.

Cytarabine inhibits the production of blood cells in the bone marrow (bone marrow suppression).

After discontinuation of this drug, prospective decreases in the number of blood cells may occur.

Even after the end of treatment, the number of blood cells should be monitored regularly and, if necessary, a bone marrow test should be performed after treatment.

Caution should be exercised during the treatment of patients with a history of drug-induced bone marrow suppression.

Cytarabine may cause an increase in the level of uric acid in the blood due to the destruction of cancer cells.

Therefore, the amount of uric acid in the blood should be monitored.

Your doctor will tell you to check the uric acid levels in your blood when you need to take medication.

Conditions with mildly reduced liver and kidney function require special attention.

Decreased kidney and liver function are predisposing factors for increased central nervous system toxicity (poisoning) of Cytarabine.

Since cytarabine is predominantly degraded in the liver, it can have a potent effect on liver damage.

An increase in efficacy also results in decreased kidney function.

In renal and/or hepatic impairment, the dose should be reduced accordingly while monitoring blood levels.

Liver and kidney function and uric acid levels should be monitored regularly.

It should be used with caution and after a rigorous risk-benefit analysis in patients with pre-existing reduced liver function (especially at high doses).

Adequate fluid consumption should be ensured.

Anaphylactic reactions (immediate hypersensitivity response) may occur during treatment with cytarabine, especially immediately after intravenous administration.

High-dose Cytarabine therapy should be given to patients over 60 years of age only after a rigorous risk-benefit analysis.

Cytarabine can damage genetic material.

Therefore, men should avoid having children during treatment and for six months after treatment ends.

In addition, because of the possibility of irreversible infertility as a result of treatment, it is recommended that male patients receive information on sperm preservation prior to treatment.

Genetic counseling is recommended for female patients who want to have children after treatment.

Severe gastrointestinal side effects require antiemetic (a group of drugs used to treat nausea) or other supportive measures.

High-dose therapy requires regular monitoring of the central nervous system and lung function by a specialist.

Eyes should be rinsed regularly during high-dose therapy to avoid discomfort associated with eye-related disease.

Vaccination with live vaccines should not be administered during cytarabine therapy.

Cytarabine treatment carries a risk of severe infection and discomfort associated with bleeding.

Central nervous system disorders, gastrointestinal disorders, liver diseases, skin reactions and eye disorders may occur during high-dose therapy.

Contact with eyes, skin and mucous membranes should be avoided.

Using cytarabine at the same time as other medicines can lead to acute pancreatitis (inflammation of the pancreas).

Cases of severe neurological adverse events ranging from headache to stroke, coma and stroke-like conditions have been observed mainly in children and adolescents receiving intrathecal (into the spinal fluid) methotrexate in combination with intravenous cytarabine.

Cytarabine can harm the unborn child and change genetic material.

If these warnings apply to you, even at any time in the past, please consult your doctor.


Consult your doctor or pharmacist before using this medication.

Cytarabine should not be used during pregnancy.

Cytarabine may have mutagenic effects, meaning this drug may cause genetic changes (mutations).

Cytarabine can adversely affect sperm and egg production, increasing the likelihood of birth defects.

Childbearing should be avoided during treatment with cytarabine and for at least 6 months after treatment.

All sexually active male and female patients should use an appropriate method of contraception during treatment with Cytarabine and for up to 6 months after treatment.

If it is planned to have children after the end of treatment, genetic counseling is strongly recommended.

The use of cytarabine has caused structural defects in the fetal organ or tissue in some animal species.

Cytarabine may be administered to women who are pregnant or of childbearing potential after careful consideration of the potential risks and benefits.

If you realize that you are pregnant during your treatment, consult your doctor or pharmacist immediately.


Consult your doctor or pharmacist before using this medication.

Cytarabine should not be used during breastfeeding.

Breastfeeding should be discontinued before starting treatment with cytarabine.

Concomitant Use With Other Drugs

  • If Cytarabine is used concurrently with some anti-viral (drugs used against direct viruses) drugs that are sorvidine, brivudine or their derivatives, the side effects of Cytarabine may increase significantly.
  • You should be especially careful if you are using any medication (phenytoin) for epileptic attacks (episodic seizures). Concomitant use of phenytonin with Cytarabine may increase the effects of phenytoin. Your doctor will regularly check the phenytoin levels in your plasma.
  • An increase in the bone marrow-suppressing effect of Cytarabine may be seen if you have been treated or are being treated with compounds that cause cell damage at the same time, or if you have received or are receiving radiotherapy (radiation therapy).
  • If you have been treated with L-asparaginase (a medicine used to treat blood cancer),
  • Cytarabine may cause acute pancreatitis (inflammation of the pancreas).
  • When used together with various cytotoxic agents (cancer drugs), infections should be expected.
  • 5-fluorocytosine should not be used together with Cytarabine, as the effect of 5-fluorocytosine (a drug used to treat fungal infections) may be inhibited by Cytarabine.
  • Patients receiving digoxin (a drug used in the treatment of heart failure) should be followed up, as digoxin levels in the blood may decrease and reduce the effect of digoxin. Since this will not occur with digitoxin, digoxin should be replaced with digitoxin in patients receiving cytarabine therapy.
  • Laboratory tests revealed that Cytarabine reduced the susceptibility of some bacteria (K. pneumoniae) to the antibiotic gentamicin. If gentamicin does not work, your doctor will change your antibiotic if necessary.

If you are currently using or have recently used any prescription or non-prescription drugs, please inform your doctor or pharmacist about them.

How Is Cytarabine Used?

Cytarabine should only be administered by physicians experienced in the treatment of cancer.

Your medicine will be administered to you by the health personnel, do not take it by yourself.

This treatment will be started in the hospital.

Cytarabine is often given with other medicines according to a specific treatment protocol designed for your disease.

Your doctor will determine the amount of medicine you need to use in accordance with your disease.

Application route and method:

For intravenous (intravenous), spinal fluid (intrathecal) or subcutaneous administration.

You will receive cytarabine by infusion into a vein (intravenous), by injection into the spinal fluid, or by injection, usually under the skin (subcutaneous), into fatty tissue.

Information for Physicians: For information on dosage, refer to prescribing information or treatment protocols in the specialist literature.

Different age groups:

  • Use in children: Your doctor will determine the dose of the drug to be administered in children.
  • Use in the elderly: There is no data showing the need for dose changes in the elderly. However, as elderly patients are more sensitive to the harmful effects of the drug, there may be drug-induced changes in blood values.

If you experience significant side effects, tell your doctor immediately.

Your doctor will ensure that you get the correct dose for your disease.

In case of overdose, increased side effects may occur.

Your doctor will then stop treatment and, if necessary, treat any side effects symptoms and initiate supportive measures.

If you have used more than you should use from Cytarabine, talk to a doctor or pharmacist.

Consult your doctor for detailed information about the effects that may occur when treatment with Cytarabine is terminated.

Side Effects of Cytarabine

Like all medicines, side effects may occur in people who are sensitive to the ingredients of Cytarabine.

Side effects caused by Cytarabine depend on the dose, route of administration and duration of treatment.

Regional tolerance is generally good. In some cases, inflammation (inflammation) may occur at the injection site.

If any of the following occur, stop using Cytarabine and tell your doctor immediately or go to the nearest hospital emergency department:

  • Immediate hypersensitivity reaction (anaphylactic reactions) characterized by difficulty breathing, swelling of the lips, itching or rash
  • Allergic reactions (hives, rash, shock due to allergic reaction)

These are all very serious side effects.

If you have one of these, you have a serious allergy to Cytarabine.

In such cases, you may need emergency medical attention or hospitalization.

All of these very serious side effects are very rare

Very common side effects:

  • Blood poisoning (sepsis), lung inflammation (pneumonia), infection caused by the passage of microbes into the blood
  • Bone marrow failure, dose-dependent changes in the amount of blood cells (e.g. decrease in white or red blood cells or in the amount of blood coagulant cells, abnormal blood cells)
  • Rash
  • Conjunctivitis (a kind of eye inflammation) (in high-dose treatment)
  • Decreased liver function and hyperbilirubinemia (increased levels of the bile pigment bilirubin in the blood) have been observed in 25% to 50% of patients receiving high-dose therapy.

Common side effects:

  • Loss of appetite, increased uric acid levels in the blood
  • Hypocalcemia (lack of calcium in the blood) may also occur.
  • Abdominal pain, difficulty in swallowing, inflammation or sores in mouth or anus, severe diarrhea, nausea and vomiting (especially after rapid intravenous injection)
  • Skin reactions (redness, ulceration, rash, hives), inflammation of blood vessels, mottled skin color, itching
  • Following high doses, exfoliative dermatitis (inflammation with blistering and splitting of the skin) and hair loss may occur.
  • Cerebral disorders (involuntary movements of the eyes, speech disorders, movement disorders, confusion and personality changes), disorders in thinking and movement processes, stupor, consciousness disorders with increased excitatory thresholds, coma, tremor, convulsions and loss of appetite.
  • Conjunctivitis (a type of eye inflammation), inflammation of the cornea, sensitivity to light, burning eyes, and visual disturbances are dose-dependent and have been reported in 25% to 80% of patients receiving high-dose therapy. These effects can be prevented or alleviated by frequent rinsing of the eyes or the conservative use of eye drops.
  • Urinary disorders, kidney failure
  • Elevations in plasma creatinine (a metabolic product) have been observed in 5 to 20% of patients receiving high-dose cytarabine therapy, but a causal relationship to cytarabine has not been established.
  • Precautions should be taken to prevent kidney dysfunction due to uric acid in major cell degeneration.
  • Throat inflammation, allergic edema (water accumulation), sex hormones, impaired production of sperm and egg cells, pain in the chest, ascites (water accumulation in the abdominal cavity), weakened immune system, sepsis (blood poisoning), thrombophlebitis (inflammation and closure of the vessels) and bleeding. Fever occurs in 20-50% of patients receiving high-dose therapy.

Uncommon side effects:

  • Inflammation or wounds in the esophagus, stomach pain, severe changes in the stomach and intestinal mucous membrane, damage and perforation of the intestinal wall (necrosis), intestinal obstruction, peritonitis (inflammation of the peritonitis)
  • Brown/black pigment spots on the skin (lentigo)
  • Ulcerations on the skin (sores), itching, burning pain on the palms and soles
  • Dysfunction or destruction of peripheral nerves (peripheral neuropathy)
  • Muscle and/or joint pain has been observed after high dose Cytarabine therapy.
  • Difficulty in breathing, shortness of breath, sore throat, pulmonary edema (fluid accumulation in the lung which is treatable in most cases), pneumonia, diffuse interstitial pneumonia
  • Acute inflammation of the heart sac
  • Intrathecal (injection into the spinal fluid) administration of Cytarabine may cause nausea, vomiting and fever.

Very rare side effects:

  • Inflammation of the pancreas
  • Inflammation in sweat glands
  • Pathological changes in the cerebral white matter, paralysis of the extremities (paraplegia and quadriplegia), as well as spinal cord injury, blindness have been reported individually after administration of cytarabine into the spinal fluid.
  • The onset of rhabdomyolysis (muscle wasting) is defined.
  • Liver enlargement. There are individual reports of occlusion of the veins exiting the liver (Budd-Chiari syndrome).
  • Cardiac muscle damage, temporary heart rhythm disturbances
  • Allergic reactions (Hives, allergic shock)
  • Syndrome of inappropriate antidiuretic hormone secretion (low blood sodium level due to overproduction of a hormone that causes fluid retention in the body and resulting weakness, fatigue or confusion) has been observed in individual cases in patients receiving high-dose therapy with cytarabine.

The side effects listed above do not appear in everyone and if these side effects are seen, the doctor should be contacted without waiting.

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