Home Drug Guide Clofarabine

Drug Guide

Generic Name

Clofarabine

Brand Names Clolar

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Nucleoside analog (Purine nucleoside antimetabolite)

FDA Approved Indications

Treatment of relapsed or refractory acute lymphoblastic leukemia (ALL) in patients age 1 year and older

Mechanism of Action

Clofarabine is incorporated into DNA and RNA and inhibits DNA synthesis, leading to apoptosis of leukemia cells. It inhibits ribonucleotide reductase and DNA polymerase, disrupting DNA replication and repair.

Dosage and Administration

Adult: Typically 20 mg/m² IV on days 1-5 of each 28-day cycle, but doses may vary based on clinical protocol.

Pediatric: Dosing based on body surface area, generally 20 mg/m² IV on days 1-5 of each 28-day cycle.

Geriatric: Adjust doses based on renal function and tolerability.

Renal Impairment: Reduced doses may be necessary; renal function should be evaluated prior to therapy.

Hepatic Impairment: No specific guidelines; use caution and monitor closely.

Pharmacokinetics

Absorption: Administered intravenously; bioavailability is not applicable.

Distribution: Widely distributed in body tissues; volume of distribution varies.

Metabolism: Primarily metabolized in the liver; exact pathways not fully elucidated.

Excretion: Excreted predominantly in urine as metabolites.

Half Life: Approximately 8-21 hours, depending on renal function.

Contraindications

Hypersensitivity to clofarabine or any component of the formulation.

Precautions

Use with caution in patients with compromised renal or hepatic function, active infections, or hematologic conditions. Monitor for myelosuppression, infections, and hepatic toxicity.

Adverse Reactions - Common

Myelosuppression (neutropenia, anemia, thrombocytopenia) (Common)
Nausea, vomiting (Common)
Mucositis (Common)
Elevated liver enzymes (Common)

Adverse Reactions - Serious

Severe infections (Serious)
Hepatic failure (Serious)
Renal toxicity (Serious)
Hemorrhage (Serious)

Drug-Drug Interactions

Other myelosuppressive agents (e.g., fludarabine, cytarabine)
Immunosuppressants

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood counts, renal and hepatic function, signs of infection.

Diagnoses:

Risk for infection
Risk for bleeding
Imbalanced nutrition: less than body requirements

Implementation: Administer IV as scheduled, monitor for adverse effects, provide supportive care.

Evaluation: Ensure blood counts recover post-treatment, monitor for adverse reactions.

Patient/Family Teaching

Report signs of infection, bleeding, or unusual fatigue.
Follow infection control precautions.
Maintain good hydration and nutrition.
Inform about potential side effects and when to seek medical attention.

Special Considerations

Black Box Warnings:

Potential for severe myelosuppression leading to infections, bleeding, and anemia.
Risk of hepatotoxicity and hepatic failure.

Genetic Factors: N/A

Lab Test Interference: May cause false elevation of serum bilirubin due to hepatic effects.

Overdose Management

Signs/Symptoms: Severe myelosuppression, bleeding, infections, hepatic toxicity.

Treatment: Supportive care, monitor blood counts, provide blood products if needed, and supportive measures in intensive care setting.

Storage and Handling

Storage: Store at 2-8°C in a refrigerator.

Stability: Stability for up to 24 hours at room temperature after reconstitution depending on the product label.