Fludarabine (Fludara)

Fludarabine is mainly used to treat chronic lymphocytic leukaemia (CLL). It is also used to treat low grade non Hodgkin’s lymphoma (NHL), hairy cell leukaemia, and a type of lymphoma that affects the skin called mycosis fungoides. Fludarabine is one of a group of chemotherapy drugs known as anti metabolites. These stop cells making and repairing DNA. Cancer cells need to make and repair DNA in order to grow and multiply. Its brand name is Fludara.

You usually have fludarabine as a drip (infusion) into a vein over at least 30 minutes. Or you may have it as a slow injection through a small tube (cannula). It also comes as a 10mg pink tablet, which you take every day for a short time. It is important that you store tablets in a safe place away from children. Take any unused tablets back to the pharmacy. You should only get your prescription for these tablets from your cancer specialist, not from your GP.

It is very important that you take tablets according to the instructions your doctor or pharmacist gives you. For example, whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.

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.

More than 10 in every 100 people have one or more of the side effects listed below.

A temporary drop in the number of blood cells made by the bone marrow, causing

• 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, sore throat, pain passing urine or feel cold and shivery. 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)

Some of these side effects can be life threatening, particularly infections. You should contact your treatment centre straight away if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Tiredness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• A raised temperature in up to 6 out of 10 people (60%)
• 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
• Feeling or being sick is usually mild – it is more common with fludarabine tablets than when fludarabine is given into the bloodstream
• This drug may have a harmful effect on a baby that is developing in your womb. It is not advisable to become pregnant or father a child if you are having this drug, so talk about contraception with your doctor or nurse before having the treatment

Some people have diarrhoea. But this 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.

Fewer than 1 in 100 people have these.

• Women may stop having periods (amenorrhoea) but this may only be temporary
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if this is important to you
• Nerve changes causing numbness and tingling in fingers and toes
• Effects on the brain and spinal cord causing eyesight problems, drowsiness, agitation, fits (seizures) or confusion – tell your doctor if you have any of these effects
• A cough or difficulty breathing
• A sore mouth
• A skin rash
• High uric acid levels 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

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

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. 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.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.