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Cytarabine into spinal fluid

Cytarabine is a chemotherapy drug. Doctors may use a type of cytarabine called DepoCyte. Or they may use generic cytarabine.

It is a treatment for some types of lymphoma (cancer of the lymph glands).

How it works

This drug is a type of chemotherapy drug called an anti metabolite.

Anti metabolites are similar to normal body molecules but they are slightly different in structure. They kill cancer cells by stopping them making and repairing DNA that they need to grow and multiply.

How you have it

Cytarabine is a clear liquid. An experienced cancer doctor injects it into the fluid around the spinal cord during a lumbar puncture. This treatment is also called intrathecal cytarabine.

If you have DepoCyte your doctor prescribes steroid tablets called dexamethasone for you to take. The steroid reduces the side effects. You need to take them after a meal, or with milk, as they can irritate your stomach.

Intrathecal injection

You have an intrathecal injection of cytarabine the same way you have a lumbar puncture. You lie on your side. Your doctor gives you a small injection to numb an area in your back. They then inject the cytarabine between 2 of your spinal bones into the spinal fluid. It takes from 1 to 5 minutes. Afterwards you need to lie flat for an hour.

Diagram showing how you have a lumbar puncture

Taking tablets

You must take tablets according to the instructions your doctor or pharmacist gives you.

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.

Never stop taking a cancer drug without talking to your specialist first.

When you have it

If you have DepoCyte treatment you usually have it every 2 weeks for 5 doses. After that you have treatment once a month for 4 months.

If you have generic cytarabine you may have the treatment from twice a week to once a month. The number of treatments may vary. Your doctor will tell you how often you need treatment.

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.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • drop in blood cells causing shortness of breath, an increase of bruising and bleeding
  • loss of appetite
  • high levels of uric acid in the blood causing inflamed and sore joints (gout)
  • feeling sleepy, unable to stay awake, unaware of surroundings (a low level of conciousness)
  • difficulty speaking
  • abnormal eye movements
  • eye problems such as sore bleeding eyes, sensitivity to light, watery or burning eyes and inflammation
  • changes to how your liver works
  • skin changes such as reddening, rash, blisters and hives that aren't permanent
  • inflammation of the blood vessels
  • hair loss
  • changes to how well the kidneys work
  • unable to pass urine
  • high temperature (fever)
  • small blood clots where the injection is causing inflammation
  • feeling or being sick
  • diarrhoea
  • tummy (abdomen) pain
  • sore mouth and or ulcers
  • sore back passage (anus) and or ulcers

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • whole body infection (sepsis) causing fever, being sick, confusion, dizziness and chills
  • brown or black spots on the skin (lentigo)
  • headache
  • numbness, weakness or pain in lower arms or legs
  • loss of ability to move (paralysis of) legs and lower body
  • inflammation of the sac surrounding the heart
  • lung infection (pneumonia)
  • shortness of breath
  • sore throat, inflammation and or ulcers of the food pipe (oesophagus)
  • cysts in the bowel, severe inflammation of the bowel causing damage symptoms include bloating, blood in the poo, diarrhoea, being sick and loss of appetite
  • infection of the tissue lining the abdomen (peritonitis)
  • ulcers on the skin
  • itching
  • pain, burning, reddening and blistering of the palms of the hands and soles of the feet
  • muscle and joint pain
  • inflammation at the site of injection

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 drinks

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.

Loss of 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.

Contraception and pregnancy

This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

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.

Immunisation

Having 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