This page tells you about the chemotherapy drug fludarabine and its possible side effects. There is information about
Fludarabine is a chemotherapy drug and has the brand name Fludara.
Fludarabine is mainly used to treat chronic lymphocytic leukaemia (CLL). It may also be used in trials for low grade non Hodgkin lymphoma (NHL), hairy cell leukaemia, and a type of lymphoma that affects the skin called mycosis fungoides.
You may have fludarabine
You can have fludarabine liquid through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. You may have it as a drip (infusion) over at least 30 minutes. Or you may have it as a slow injection into the cannula or into a central line, a portacath or a PICC line. These are long, plastic tubes that give the drug directly into a large vein in your chest. The tube stays in place as long as you need it. You usually have the treatment once a day for 5 consecutive days each month.
Fludarabine also comes as tablets called Fludara oral. You take the tablets once a day for 5 consecutive days each month. Swallow them whole with plenty of water. Don't chew or break them. You can take them on an empty stomach or with food. Take the tablets according to the instructions your doctor or pharmacist gives you. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.
How long treatment lasts
You usually keep having fludarabine treatment until there is little or no sign of the abnormal leukaemia or lymphoma cells in your blood. This may be between 6 months and 2 years. You will have regular blood tests and your doctor will adjust the dose depending on how well the treatment is working. They may lower the dose or stop the treatment if it causes bad side effects.
The side effects associated with fludarabine are listed below. You can use the links (underlined) to find out more about each side effect. Where there is no link please see our chemotherapy side effects section, or click on search at the top of the page. The side effects may be different if you are having fludarabine alongside other cancer treatment drugs.
More than 10 in every 100 people have one or more of the side effects listed below.
- An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C. You will have regular blood tests to check your blood cell levels. You may be asked to take antibiotics to try to prevent infection while you are having fludarabine treatment
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion. Fludarabine can make the red cells in donated blood attack your own red blood cells. To prevent this, it is important that you always have irradiated blood if you need a transfusion. Before you have a transfusion, always tell your nurse or doctor that you have been taking fludarabine
- Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)
- Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
- A raised temperature occurs in up to 6 out of 10 people (60%)
- Feeling or being sick is usually mild – it is more common with fludarabine tablets than when fludarabine is given into the bloodstream
- Diarrhoea is more common with fludarabine tablets than with injections or when you have it through a drip. Drink plenty of fluids and if the diarrhoea becomes severe or continues, tell your doctor or nurse
Between 1 and 10 in every 100 people have one or more of these effects.
- Dizziness – do not drive or operate machinery if you have this
- Nerve changes causing numbness and tingling in fingers and toes
- Effects on the brain and spinal cord causing eyesight changes, drowsiness, agitation, fits (seizures) or confusion – tell your doctor or nurse straight away if you have any of these effects
- A cough or difficulty breathing
- A sore mouth
- A skin rash
- Loss of appetite leading to weight loss
- Fluid build up causing swollen hands, legs and feet
- An increased risk of blood disorders such as acute myeloid leukaemia or myelodysplastic syndrome
Fewer than 1 in 100 people have these.
- Women may stop having periods (amenorrhoea) but this may only be temporary
- Liver changes that are very mild and unlikely to cause symptoms – they will almost certainly go back to normal when treatment is finished. You will have regular blood tests to check how well your liver is working
- Loss of fertility – you may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
- Fludarabine may cause changes in your immune system that permanently affect the production of blood cells – these include autoimmune haemolytic anaemia, thrombocytopenia and thrombocytopenic purpura
- Changes in lung tissue may cause a cough or breathlessness – let your doctor or nurse know if you have this
- High uric acid levels may occur in your blood due to cancer cells being broken down by the body – you will have regular blood tests and will be asked to drink plenty of fluids to flush out the uric acid. Your doctors may also give you a drug called allopurinol
- Bleeding from the stomach or bowel – let your doctor or nurse know straight away if you have sudden, sharp tummy (abdominal) pain, vomiting, or blood in your poo (faeces)
- If you have skin cancer, or have had it in the past, it may worsen or come back during or after fludarabine treatment. This is usually easy to treat. Tell your doctor or nurse if you notice any skin changes
The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on
- How many times you've had the drug before
- Your general health
- The amount of the drug you have (the dose)
- Other drugs you are having
Coping with side effects
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
Pregnancy and contraception
This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Do not breastfeed during this treatment because the drug may come through in the breast milk.
You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.
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