Clofarabine - Intravenous

Clofarabine is used to treat a type of blood cancer that starts in the white blood cells in the bone marrow. It is used in children (at least 1 year old), adolescents, and young adults (up to 21 years old) when previous treatments have not worked or have stopped working.

Clofarabine injection is to be given intravenously (into the vein). It is delivered directly into the bloodstream via the blood vessel.

Your doctor or nurse will administer the injection for you.

Ensure that you drink plenty of water during treatment.

The dose of this medicine will be decided by your doctor. Your doctor will advise you on the course of treatment depending on your response to the medication.

Ensure that you keep all appointments with your doctor so that you do not miss any doses. Your doctor also needs to regularly monitor your response to Clofarabine.

If you miss an appointment or miss an injection, alert your doctor or nurse. A replacement appointment or injection should be given as soon as possible.

Alert your doctor if you have the following conditions:

• severe kidney disease
• severe liver disease

as Clofarabine may not be suitable for you.

Do not breastfeed before starting, during treatment, and within 2 weeks after the last dose.

Inform your doctor if you have the following conditions:

• heart disease
• previous haematopoietic stem cell transplant (a procedure performed to replace damaged or abnormal blood-forming cells with healthy ones)
• mild to moderate kidney disease
• mild to moderate liver disease

Let your doctor know if you are pregnant.

It is important that you do not get pregnant while being treated with Clofarabine and for 6 months after the last dose. You may wish to discuss birth control methods with your doctor or pharmacist.

Men should not father a child while being treated with this medicine. Men must use proven birth control methods during Clofarabine therapy and for 3 months after stopping the treatment. You may wish to discuss other reliable methods of birth control with your doctor.

Why is it important to keep my appointments with the doctor?

Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.

• Pregnancy tests must be done before treatment to know if this medicine is suited for you to use.
• Routine tests (e.g. complete blood count, liver, kidney and lung function) may be done while you are being treated with this medicine. Your doctor will advise you about how often you need to have these tests.
• Regular monitoring of signs and symptoms of infection, liver problems, bowel problems, kidney problems, skin problems, and bleeding may also be needed.

Clofarabine may cause any of the following side effects: headache, dizziness, drowsiness, nausea, vomiting, diarrhoea, mouth ulcers, tiredness, pain, feeling hot or abnormal, muscle or joint pain, neck and back pain, bone pain, and numbness or tingling sensation in the hands and feet.

Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:

• pass out bloody or black as tar stools and vomiting blood or ground coffee-like material, coughing up blood
• rashes with peeling of the skin or blistering of the lips, mouth or eyes accompanied by fever
• yellowing of the skin or eyes, abdominal pain, dark coloured urine, tiredness, swelling in the legs and ankles
• pain or difficulty in passing urine, change in how much urine is passed, blood in the urine

This medicine may cause the level of your red blood cells, white blood cells and platelets to drop.

Red blood cells carry oxygen around your body. A fall in the level of red blood cells may make you feel tired and worn out.

White blood cells help your body to fight infections. A fall in the level of your white blood cells may put you at higher risk for infections, such as coughs, colds and flu, which may lead to more serious infections. Avoid crowded places and people who are sick. Inform your doctor if you have a fever, cough, or flu that does not go away.

Platelets help your blood to clot when there is a cut in the skin. A fall in the level of your platelets may put you at risk of bleeding more than usual. Do not take part in activities where you may fall or get injured, such as contact sports. Inform your doctor if you get any unusual bruising (large bruises or several bruises, especially if the bruises appeared on their own) or bleeding that takes a long time to stop (for example, too much bleeding when you floss or brush your teeth).

Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.

Inform your doctor and pharmacist if you are taking any of these medicines:

• NSAIDs (medicines for pain and inflammation)
• certain medicines to treat viral infection e.g. aciclovir, valganciclovir, foscarnet
• certain medicines used in organ transplants or certain immune disorders e.g. ciclosporin, tacrolimus
• methotrexate (medicine for cancer)
• pentamidine (medicine to treat fungal infection)

This list does not include all medicines that may interact with Clofarabine.

Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements, and medicines that you buy without a prescription.

Avoid alcohol.

Store in a cool, dry place away from the reach of children.

Do not freeze.

Medicines must not be used past the expiry date.

As Clofarabine is a cancer medicine, always return any unused or expired medicine to the clinic, hospital, or pharmacy for disposal. Do not throw it away in the household waste.