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Purine analogue / immunosuppressant

Cladribine

Brand names: Litak, Mavenclad

Cladribine is a purine nucleoside analogue cytotoxic agent used in hairy cell leukaemia and certain other lymphoid malignancies, and (as a separate oral preparation) in relapsing multiple sclerosis.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

As a deoxyadenosine analogue it is phosphorylated intracellularly and accumulates particularly in lymphocytes, disrupting DNA synthesis and repair and causing selective lymphocyte depletion and apoptosis.

Prescribing in practice

  • Profound and prolonged myelosuppression and lymphopenia occur, with a consequent risk of serious and opportunistic infection requiring close haematological monitoring.
  • It is markedly immunosuppressive; consider infection prophylaxis and avoid live vaccines during and after treatment.
  • Verify the correct product and route, as haematology (parenteral) and multiple sclerosis (oral) preparations and regimens differ.

Monitoring

Monitor full blood count, including lymphocyte subsets, and watch closely for febrile neutropenia and opportunistic infection.

Counselling the patient

  • Report fever or any sign of infection without delay, as your white cell count may be very low.
  • Effective contraception is advised during and for a period after treatment.
  • Avoid live vaccines and discuss any planned immunisations with your team.

Evidence & guidelines

Cladribine produces durable complete responses in hairy cell leukaemia and is an established option supported by long-term cohort data; consult current prescribing references for malignancy regimens.

Reference: NICE TA616; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

Pathways