Cytarabine is a drug used at Great Ormond Street Hospital (GOSH) to treat certain types of cancer and leukaemia.
How is cytarabine given?
Cytarabine is usually given in one of three ways:
- By a slow injection or infusion into a vein (intravenously or IV) through a cannula, central venous catheter, implantable port or PICC line.
- By injection under the skin (subcutaneously or ‘SC’). Injections under the skin can often be quite distressing for your child. There are ways of coping with injections. Please speak to one of the nurses or play specialists.
- By injection through a needle which is inserted into one of the spaces between the bones in the lower back. This is known as a lumbar puncture. When drugs are given in this way, they are said to be given intrathecally.
Children may be able receive some of their cytarabine intravenous bolus injections at home, given by the community nursing team. We can do this because:
- allergic reactions to cytarabine are uncommon
- cytarabine does not irritate the veins
- it is widely used in cancer treatments
- we are giving low doses
What are the side effects of cytarabine?
The side effects listed below are more common when higher doses of cytarabine are given to your child as an inpatient. If your child is receiving lower doses of cytarabine as an outpatient the side effects are likely to be less frequent and less severe.
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.
These tend to occur six to 12 hours after the drug is given. Your child may have headaches and tiredness, aching joints and muscles, a high temperature and chills. Paracetamol may be given only if your child is not neutropenic to relieve these symptoms.
However, if your child is having cytarabine at home and has a raised temperature of 38.0°C or above, you should contact your shared care hospital. They should NOT be given paracetamol. If your child complains of hot or cold flushes during the administration of cytarabine they will need a medical review at your shared care hospital.
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.
This may occur when high doses of the drug are given. Eyedrops will be given to prevent this.
Mouth sores and ulcers
You will be given advice about appropriate mouthcare including a leaflet. If your child complains of having a sore mouth, please tell your doctor or nurse.
If your child has a sore mouth, they will often also have a sore gut. This can cause stomach pain and bloating as well as diarrhoea. Please tell your doctor or nurse if your child has symptoms which are not controlled or persist. It is important that your child drinks lots of fluids.
Please tell your doctor or nurse if your child develops a rash. They will advise you on the appropriate treatment to use.
Lethargy, sleepiness, dizziness and loss of balance
This is very rare and only occurs in high doses. If you notice these effects it is important to report them to your doctor immediately.
Your child may lose some or all of his or her hair or it may become thinner. This is temporary and the hair will grow back once the treatment is finished.
Cytarabine and interactions with other medicines
Some medicines can react with cytarabine, 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.
Taking cytarabine syringes home
Cytarabine is a relatively stable product and short term fluctuations in temperature up to 40°C should not affect the given expiry date. When taking cytarabine syringes home, minimise the effects of temperature fluctuations by:
- Keeping the syringes out of direct sunlight.
- Do not leave syringes in a parked car where the temperature may rise significantly for an extended period.
- Do not put the syringes near to hot air blowers in cars.
- Placing syringes in an insulated container for long journeys (please discuss this with nursing staff).
Storage of cytarabine at home
Store the cytarabine inside a plastic container in the bag supplied by the pharmacy cytotoxic unit at GOSH in a normal domestic fridge as soon as you return home. Keep the box out of the reach of children and away from any food. It must not be frozen. Please remove from the fridge 30 minutes before use to minimise discomfort while it is being given.
If the cytarabine syringes are out of the fridge for more than six hours, contact GOSH for advice.
Spillage is unlikely as each cytarabine dose is packaged in a sealed bag. However, if a spillage does occur follow the advice below:
- If contact occurs with your skin, you must wash the area immediately, using plenty of water. If the skin is sore you should contact your GP (family doctor) for advice.
- If contact occurs with your eyes, wash immediately with plenty of water for at least 10 minutes. If after this your eyes are sore you should go to your nearest accident and emergency (A&E) department.
- If you spill any cytotoxic medicines on the work surface or floor, wearing gloves, cover the spillage with kitchen paper. Wipe the area with water then clean with household cleaner and water. Used kitchen paper and other items used to clean up the spillage should be double bagged and disposed of with the household waste.
- If any cytotoxic medicine is spilt on clothing, the spill should be blotted dry with kitchen paper. Clothing should be removed immediately and washed separately from other items. Used kitchen paper should be disposed of as above.
If any type of spillage occurs you should contact GOSH for advice immediately.
Please read this information sheet from GOSH alongside the patient information leaflet (PIL) provided by the manufacturer. If you do not have a copy of the manufacturer’s patient information leaflet please talk to your pharmacist. A few products do not have a marketing authorisation (licence) as a medicine and therefore there is no PIL.
For children in particular, there may be conflicts of information between the manufacturer’s patient information leaflet (PIL) and guidance provided by GOSH and other healthcare providers. For example, some manufacturers may recommend, in the patient information leaflet, that a medicine is not given to children aged under 12 years. In most cases, this is because the manufacturer will recruit adults to clinical trials in the first instance and therefore the initial marketing authorisation (licence) only covers adults and older children.
For new medicines, the manufacturer then has to recruit children and newborns into trials (unless the medicine is not going to be used in children and newborns) and subsequently amend the PIL with the approved information. Older medicines may have been used effectively for many years in children without problems but the manufacturer has not been required to collect data and amend the licence. This does not mean that it is unsafe for children and young people to be prescribed such a medicine ‘off-licence/off-label’. However, if you are concerned about any conflicts of information, please discuss with your doctor, nurse or pharmacist.