Coronavirus and cancer

We know it’s a worrying time for people with cancer, we have information to help. If you have symptoms of cancer contact your doctor.

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Cytarabine (Ara C, cytosine arabinoside)

Cytarabine is a type of chemotherapy drug and is also known by its brand name, Ara C.

It is a treatment for:

  • acute leukaemias (cancers of the blood)
  • some lymphomas (cancers of the lymph glands)

How it works

Cytarabine is a type of chemotherapy drug.  It kills cancer cells by stopping them from making and repairing DNA that they need to grow and multiply.

How you have it

How you have cytarabine depends on what type of cancer you have. You can have it as an injection:

  • into your bloodstream (intravenously)
  • just under the skin (subcutaneously)
  • into your spinal fluid (intrathecal injection)

Drugs into your bloodstream

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Injection under your skin

You usually have injections under the skin (subcutaneous injection) into the stomach or thigh. You might have stinging or a dull ache for a short time after this type of injection. The skin in the area may go red and itchy for a while.

Chemotherapy into the spinal fluid (intrathecal chemotherapy)

You might have chemotherapy injected into the fluid around the spinal cord (cerebrospinal fluid or CSF). This is called intrathecal chemotherapy. 

Your doctor gives you the drug during a procedure called lumbar puncture. The drug mixes with the cerebrospinal fluid and circulates through the brain.

When you have it

You usually have cytarabine as a course of several cycles of treatment. A cycle of treatment means that you have this drug and then have a rest to allow your body to recover. You usually have it with other drugs in your cycle.

Each cycle varies depending on what type of cancer you have. Your doctor or nurse will tell you more about this. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

Each of these effects happens in more than 10 in 100 people (10%). You might have one or more of them. They include:

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nosebleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia).

Sore mouth

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Diarrhoea 

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Inflammation and ulcers of the opening at the end of the bowel (anus)

Talk to the team looking after you about this. They might be able to give you medicines or creams to help with this.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Skin rash

You might notice skin changes, such as dryness, itching and rashes similar to acne on your face, neck and trunk. 

Tell your doctor if you have any rashes or itching. Don't go swimming if you have a rash because the chlorine in the water can make it worse.

If your skin gets dry or itchy, using unperfumed moisturising cream may help. Check with your doctor or nurse before using any creams or lotions. Wear a high factor sun block if you’re going out in the sun.

High temperature 

Talk to the team mooking after you or telephone your advice line.

Breathlessness and cough

Tell your doctor or nurse if you’re breathless or have a cough. This could be due to an infection, such as pneumonia. Or it could be caused by changes to the lung tissue, making it less flexible.

Contact your advice line if you are worried. You may need a course of antibiotics.

Cytarabine syndrome

Cytarabine syndrome sometimes happens about 6 to 12 hours after having this drug. 

It is a combination of symptoms including a high temperature, aching muscles, bone pain, occasionally chest pain, a rash, sore eyes, and extreme weakness.Steroids can help to prevent or treat this syndrome.

Biopsy and blood test results

This drug can cause abnormal results. Your doctor or nurse might need to take more biopsies or blood tests. Talk to your team about this. 

Possible additional common side effects if you have high dose cytarabine treatment

Feeling very sleepy

You might feel very tired or find you are falling asleep during the day.Do not drive or operate machinery. Let your doctor know straight away.

Fluid in the lungs (pulmonary oedema)

The fluid stops your lungs expanding fully. So you have to take shallower breaths and make more effort to breathe.Talk to the team looking after you if you are breathless. 

Inflammation of the lungs due to infection or injury

You might have symptoms that include fast and shallow breathing, tiredness, drowsiness, confusion, feeling like you will faint and shortness of breath. This is called acute respiratory distress syndrome (ARDS). It causes lack of oxygen to your organs such as the lungs, heart and brain. 

Contact your team or advice line straight away

Difficulty with movement and speech

You might have problems with your speech.You might be unsteady when you stand and find it diffcult to walk. You might have no muscle control causing coordination problems.

Tiredness and weakness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Eye changes 

You might have eye problems including blurred vision, sore, red, itchy, dry eyes (conjunctivitis) or an infection. Tell your doctor or nurse if you have this. They can give you eye drops or other medication to help. 

Occasional side effects

Each of these effects happens in between 1 and 10 in 100 people (1% to 10%). You might have one or more of them. They include:

  • inflammation of the bowel (colitis)
  • peeling of the skin

Other side effects

There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:

  • soreness and swelling of the injection site
  • allergic reaction which might lead to swelling underneath the skin in areas such as the hands, feet, lips, tongue, around the eyes or gentials (angioedema)
  • lowered appetite
  • inflammation of the nerves, headaches or dizziness
  • inflammation of the conjunctiva in the eye (conjunctivitis)
  • heart problems such as changes in heart rate, build up of fluid around the heart (pericardial effusion) or chest pain
  • pain in the mouth or throat (oropharyngeal pain)
  • inflammation of the pancreas (pancreatitis)
  • inflammation of ulceration of the foodpipe (oesophagus)
  • yellowing of the eyes or whites of the eyes (jaundice)
  • redness, soreness and peeling of hands and soles of feet (palmar plantar syndrome)
  • kidney changes such as urinating often but not fully emptying your bladder (urinary retention)

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help