Cytarabine

How it works

It is phosphorylated intracellularly to cytarabine triphosphate, which inhibits DNA polymerase and is incorporated into DNA, halting chain elongation and DNA synthesis in the S-phase.

Prescribing in practice

• High-dose regimens can cause cerebellar and other neurotoxicity, severe myelosuppression, conjunctivitis and a cytarabine (flu-like) syndrome; the correct formulation and route must be confirmed as intrathecal use requires preservative-free product.
• Profound bone marrow suppression with infection and bleeding risk is expected.
• A specialist cytotoxic agent administered only within haemato-oncology protocols per the SPC.

Monitoring

Monitor full blood count, hepatic and renal function, and perform neurological assessment particularly with high-dose regimens.

Counselling the patient

• Report fever, bruising, bleeding or signs of infection promptly.
• Report unsteadiness, confusion or eye irritation, which may need treatment adjustment.
• Effective contraception is required during treatment as the drug can harm a pregnancy.

Evidence & guidelines

Cytarabine is a long-established backbone of acute myeloid leukaemia therapy, supported by extensive trial evidence and the SPC.