Purine analogue
Fludarabine phosphate (Specialist drug)
Brand names: Fludara
Adult dose
Dose: Specialist initiation only — refer to BNF/SmPC
Route: IV/PO
Frequency: per protocol
Clinical pearls
- CLL, indolent NHL
- PCP and HSV/VZV prophylaxis often required
Contraindications
- Severe renal impairment
- Decompensated haemolytic anaemia
- Pregnancy
Side effects
- Severe myelosuppression
- Profound prolonged lymphopenia
- Increased opportunistic infection risk
- Tumour lysis syndrome
- Autoimmune haemolysis
- Neurotoxicity at high doses
Interactions
- Pentostatin (avoid — fatal pulmonary toxicity)
- Live vaccines
- CMV reactivation risk
Monitoring
- FBC
- U&E
- LFTs
- Direct Coombs
- Lymphocyte subsets
Reference: BNF; SmPC; https://bnf.nice.org.uk/drugs/fludarabine-phosphate-specialist-drug/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- Vancomycin Dosing Calculator · Drug Dosing
- Phenytoin Correction for Albumin / Renal Failure · Drug Dosing
- Local Anaesthetic Maximum Dose Calculator · Drug Dosing
- Tisdale Risk Score for QT Prolongation · Arrhythmia
- Bazett Corrected QT Interval (QTc) Calculator · Arrhythmia
- DAPT Score for Dual Antiplatelet Therapy Duration · Antiplatelet Therapy
Pathways
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158
- Sickle Cell Crisis · BSH 2021 / BCSH
- Neutropenic Sepsis · NICE CG151 2012 / ESMO