Fludarabine (Fludara)

Fludarabine is a chemotherapy drug that is mainly used in the treatment of chronic lymphocytic leukaemia. It may be helpful to read the general chemotherapy information section together with this section, as it will give more advice on chemotherapy side effects.

What Fludarabine looks like?

It is a colourless fluid when dissolved from a powder.

How is it given?

Fludarabine can be given as an injection or infusion (intravenous) into a peripheral cannula or via a central line.

Side effects

The side effects mentioned below may not affect everyone, as each patient’s reaction to chemotherapy is different. It will also depend on how many chemotherapy drugs you are receiving. If you experience any effects that you think are related to your chemotherapy, please discuss them with your oncology doctor or chemotherapy nurse.

Infection

You will be more prone to infection as Fludarabine affects your white cell production from the bone marrow. This effect usually occurs about 7 days after your chemotherapy. Your white cells however do gradually recover and are usually within normal ranges for your next chemotherapy course.
You should contact your doctor or the Oncology Unit straight away if you if you have a sore throat,cough, pain passing urine, redness and swelling at e.g. at a catheter site. Or have a temperature of 38 degrees° C or greater.

Anaemia

You may feel lethargic and breathless due to a reduction in your red cells caused by Fludarabine. Inform your doctor if you are feeling these effects.

Bruising

Fludarabine can also affect the production of platelets, which can cause bleeding or bruising. Inform your doctor if you notice any unexplained bleeding or bruising.

Sore mouth

You may develop a sore mouth or ulcers due to your chemotherapy. You will be prescribed some mouthwashes. Inform your doctor or nurse if your mouth becomes sore or you develop ulcers. You may also experience some taste changes, which will resolve when you finish your treatment.

Diarrhoea

You may experience some diarrhoea. It is important to inform your doctor or nurse if you are having a lot of bowel motions in a day.

Fatigue

You may feel very tired. This can last for a few months after your treatment. Inform your doctor or nurse of how you are feeling.

Loss of appetite

You may find that your appetite decreases while you are receiving chemotherapy. You should maintain a healthy diet and ask to speak to your dietician if you have any worries.

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Less common side effects

Nausea and vomiting

Fludarabine can make you feel sick nausea   or to to be sick vomit  . When this occurs can vary. Your doctor some medications to prevent this anti-emetics  . If you continue to feel sick it is important to inform your doctor.

Hair loss

You may lose all your hair or it may just thin out. This usually happens after your first course of chemotherapy. This is temporary and your hair will grow back.

Neurological effects

Fludarabine can cause headaches, seizures or some changes to your vision. If any of these symptoms occur inform your doctor.

Changes to your lungs

You may experience some changes to your breathing. Inform your doctor if you experience any shortness of breath or cough.

Liver changes

Fludarabine can cause some changes to your liver. You will have regular blood tests to monitor your liver function.

Bladder irritation

Fludarabine can cause some irritation to your bladder. It is important to maintain a high fluid intake. If you notice any blood in your urine it is important to inform your doctor.

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Other information

Fertility

It is important to discuss this with your doctor as Fludarabine may affect your fertility.

Contraception

It is important to use a reliable form of contraception while you are on treatment and for at least two years after your treatment has completed. It is not advised to get pregnant while on treatment as the drugs may affect the foetus.

Other medications

It is important to inform your doctor of any medications that you are taking, including over the counter medications or herbal drugs as they can interfere with some chemotherapy drugs.

Care of chemotherapy tablets

  • If you miss a dose, inform your doctor.
  • If you vomit immediately after taking a tablet, inform your nurse or doctor. You may need to repeat the dose.
  • Keep them in a cool dry place away from sunlight and out of reach of children.
  • Return any unused tablets to the pharmacy.

References

  • The Chemotherapy Source Book (2nd edition). M. Perry, Lippincott, Williams and Wilkins, 1997
  • British National Formulary (53rd edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, March 2007
  • The Cytotoxics Handbook (3rd edition). M. Allwood, A. Stanley and P. Wright, Radcliffe Medical Press, Oxford and New York, 1997

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