Infrequently, serious nervous system problems have occurred with the use of this medication. The risk may be increased if you have previously received chemotherapy injection into a certain part of the spine (intrathecal) or radiation treatment to the head/spine area. Tell your doctor right away if you notice any symptoms of nervous system problems including: extreme sleepiness, confusion, numbness/tingling in hands/feet, loss of coordination, muscle weakness, or unsteadiness while walking. Seek immediate medical attention if any of the following symptoms occur: inability to move (paralysis), seizure. These symptoms may not go away completely even when treatment with nelarabine is stopped. Consult your doctor for details.
Read the Patient Information Leaflet provided by your pharmacist before you start using nelarabine and each time you get a refill. If you have any questions, consult your doctor or pharmacist.
This medication is given by slow injection into a vein, usually by a health care professional. Each treatment period is called a cycle. In adults, it is usually given on days 1, 3, and 5 of each treatment cycle or as directed by your doctor. In children, it is usually given daily for 5 days in a row during each treatment cycle or as directed by the doctor.
The dosage is based on your medical condition, age, body size, and response to treatment. Your doctor will check your blood counts to make sure you can receive your next cycle. Keep all medical and laboratory appointments.
See also Warning section.
Headache, nausea, vomiting, loss of appetite, constipation, diarrhea, cough, shortness of breath, dizziness, drowsiness, and tiredness may occur. In some cases, your doctor may prescribe medication to prevent or relieve nausea and vomiting. Eating several small meals, not eating before treatment, or limiting activity may help lessen some of these effects. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
Many people using this medication have serious side effects. However, your doctor has prescribed this drug because he or she has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.
Tell your doctor right away if you have any serious side effects, including: easy bruising/bleeding, swelling ankles/feet.
This medication can lower the body's ability to fight an infection. Tell your doctor promptly if you develop any signs of an infection such as fever, chills, or persistent sore throat.
Nelarabine sometimes causes side effects due to the rapid destruction of cancer cells (tumor lysis syndrome). To lower your risk, drink plenty of fluids unless your doctor directs you otherwise. Also, your doctor may prescribe an additional medication. Tell your doctor right away if you have symptoms such as: low back/side pain (flank pain), pink/bloody urine, change in the amount of urine, painful urination, muscle spasms/weakness.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any of the following symptoms of a serious allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
In the US -
Before using nelarabine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood/bleeding disorders (e.g., anemia, low blood cell counts), kidney problems, liver disease, numbness/tingling in hands/feet (peripheral neuropathy), seizure.
Do not have immunizations/vaccinations without the consent of your doctor, and avoid contact with people who have recently received oral polio vaccine or flu vaccine inhaled through the nose. Wash your hands well to prevent the spread of infections.
Avoid contact with people who have illnesses that may spread to others (e.g., flu, chickenpox).
To lower your risk of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.
Before having surgery, tell your doctor or dentist that you are using this medication.
This drug may make you dizzy or drowsy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages and other drugs that may cause drowsiness. (See also Drug Interactions.)
Caution is advised when using this drug in older adults because they may be more sensitive to the effects of the drug, especially nervous system problems (e.g., numbness/tingling in hands/feet).
This drug is not recommended for use during pregnancy. It may harm the unborn baby. Consult your doctor for details and to discuss the use of reliable forms of birth control while using this medication. If you become pregnant or think you may be pregnant, contact your doctor right away.
It is not known whether this drug passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Some products that may interact with this drug include: other anti-cancer drugs (especially pentostatin).
Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as: certain antihistamines (e.g., diphenhydramine), anti-seizure drugs (e.g., carbamazepine), medicine for sleep or anxiety (e.g., alprazolam, diazepam, zolpidem), muscle relaxants, narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., chlorpromazine, risperidone, trazodone). Check the labels on all your medicines (e.g., cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.
If overdose is suspected, contact a poison control center or emergency room right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
Laboratory and/or medical tests (e.g., complete blood count) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.
For the best possible benefit, it is important to receive each scheduled dose of this medication as directed. If you miss a dose, contact your doctor to establish a new dosing schedule. Do not double the dose to catch up.
Not applicable. This medication is given in a clinic and will not be stored at home.
MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).
Information last revised March 2014. Copyright(c) 2014 First Databank, Inc.
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