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Purine analogue / immunosuppressant

Cladribine

Brand names: Litak, Mavenclad

Adult dose

Dose: MS (Mavenclad): 3.5mg/kg over 2 yrs in 4 short courses. Oncology: refer to specialist BNF/SmPC

Route: PO/SC/IV

Frequency: per protocol

Clinical pearls

Highly active relapsing MS
Screen for TB, hepatitis B/C, HIV, malignancy; check pregnancy

Contraindications

Pregnancy/breastfeeding
HIV
Active malignancy
Active chronic infection
Moderate-severe renal/hepatic impairment

Side effects

Lymphopenia (profound, prolonged)
Increased infection risk
Reactivation of latent infection (TB, HBV, HCV, HSV)
Malignancy risk
Hepatotoxicity

Interactions

Live vaccines
Other immunosuppressants

Monitoring

FBC + lymphocyte count
LFTs
Pregnancy testing

Reference: BNF; NICE TA616; https://bnf.nice.org.uk/drugs/cladribine/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Pathways