Fludarabine is a chemotherapy medicine used to treat certain types of leukaemia such as acute myeloid leukaemia (AML) and acute lymphoblastic leukaemia (ALL). It is also used to prepare some children for bone marrow transplant.
How is fludarabine given?
It is given as an infusion into a vein (intravenously) through a cannula, central venous catheter, implantable port or PICC.
What are the side effects of fludarabine?
Nausea and vomiting
Anti-sickness drugs can be given to reduce or prevent these symptoms. Please tell your doctor or nurse if your child’s sickness is not controlled or persists.
Bone marrow suppression
There will be a temporary reduction in how well your child’s bone marrow works. This means he or she may become anaemic, bruise or bleed more easily than usual, and have a higher risk of infection. Your child’s blood counts will be checked regularly to see how the bone marrow is working. Please tell your doctor if your child seems unusually tired, has bruising or bleeding, or any signs of infection, especially a high temperature.
Mouth sores and ulcers
Your child may get painful or bleeding gums, ulcers or a sore mouth. You will be given advice about appropriate mouth care including a copy of the mouth care leaflet. If your child complains of having a sore mouth, please tell your doctor or nurse.
Your child may lose some or all of his or her hair, including eyebrows and eyelashes. This is temporary and the hair will grow back once the treatment has finished.
Fever and chills
Your child may develop a fever and chills shortly after fludarabine is given. This effect is temporary and paracetamol may be given to relieve these symptoms.
If your child complains of blurred vision or painful eyes, please inform your doctor or nurse.
Your child is at risk of developing a a type of chest infection called Pneumocystis Jiroveci pneumonia. You may hear the doctors and nurses referring to this as `PCP’ as it was previously called Pneumocystis Carinii pneumonia. This infection is due to an organism (bug) that is probably present in most people’s lungs. Children who are receiving long term drugs which interfere with the body’s ability to cope with infections may be more at risk from this type of pneumonia. The symptoms of this infection are a raised temperature, rapid breathing and a dry cough. Your child should take co-trimoxazole (Septrin®) for the duration of fludarabine treatment and for three months after treatment has finished. If your child has had a bone marrow transplant, treatment with co-trimoxazole will be stopped for the duration of the transplant and re-started as your child’s blood counts improve.
Numbness, tingling, aches and pains
This can happen because of the effect of fludarabine on your child’s nervous system. Your child may complain of aches and pains in their legs. If you notice your child has difficulty walking, please tell the doctor. These side effects are temporary and usually wear off a few months after treatment has finished. In some younger children, their eyelids may droop a little whilst on fludarabine. This again is due to the effect on the nervous system.
This can be caused by an increase in fluid in the body. If you notice any swelling or puffiness around your child’s limbs, especially the ankles, please tell your doctor or nurse.
Fludarabine and interactions with other medicines
Some medicines can react with fludarabine, altering how well it works. Always check with your doctor or pharmacist before giving your child any other medicine, including medicines on prescription from your family doctor (GP), medicines bought from a pharmacy (chemist) or any herbal or complementary medicines.
Last reviewed by Great Ormond Street Hospital: April 2013
Ref: 2013F0736 April 2013
Compiled by the Pharmacy department in collaboration with the Child and Family Information Group.
Please read this information in conjunction with any patient information leaflet provided by the manufacturer. However, please note that this information explains about the use of medicines in children and young people so may differ from the manufacturer’s information.
Each person reacts differently to medicines so your child will not necessarily suffer every side effect mentioned. This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals. If you have any questions, please ask your doctor. No liability can be taken as a result of using this information.