Clofarabine

Avoid being near people who are sick or have infections. Tell your doctor at once if you develop signs of infection.

Your doctor or pharmacist can provide more information about clofarabine.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

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Avoid being near people who are sick or have infections. Tell your doctor at once if you develop signs of infection.

This medicine can pass into body fluids (urine, feces, vomit). For at least 48 hours after you receive a dose, avoid allowing your body fluids to come into contact with your hands or other surfaces. Caregivers should wear rubber gloves while cleaning up a patient's body fluids, handling contaminated trash or laundry or changing diapers. Wash hands before and after removing gloves. Wash soiled clothing and linens separately from other laundry.

Distribution

Plasma Protein Binding

47% (mainly albumin) in pediatric patients.1

Elimination

Metabolism

Metabolized to active 5-triphosphate metabolite.1 5

Undergoes limited hepatic metabolism (0.2%) in pediatric patients.1

Elimination Route

Excreted in urine (49–60%) as unchanged drug in pediatric patients.1

Half-life

Estimated terminal half-life about 5.2 hours in pediatric patients.1

Special Populations

Pharmacokinetics not studied in patients with renal or hepatic impairment.1

• It is used to treat a type of leukemia.

Use clofarabine as ordered by your doctor. Read all information given to you. Follow all instructions closely.

• It is given as an infusion into a vein over a period of time.
• Other drugs may be given before this medicine to help avoid side effects.
• Talk with your doctor before getting any vaccines. Use with clofarabine may either raise the chance of an infection or make the vaccine not work as well.

What do I do if I miss a dose?

• Call your doctor to find out what to do.

• Clolar

Clofarabine, a purine (deoxyadenosine) nucleoside analog, is metabolized to clofarabine 5'-triphosphate. Clofarabine 5'-triphosphate decreases cell replication and repair as well as causing cell death. To decrease cell replication and repair, clofarabine 5'-triphosphate competes with deoxyadenosine triphosphate for the enzymes ribonucleotide reductase and DNA polymerase. Cell replication is decreased when clofarabine 5'-triphosphate inhibits ribonucleotide reductase from reacting with deoxyadenosine triphosphate to produce deoxynucleotide triphosphate which is needed for DNA synthesis. Cell replication is also decreased when clofarabine 5'-triphosphate competes with DNA polymerase for incorporation into the DNA chain; when done during the repair process, cell repair is affected. To cause cell death, clofarabine 5'-triphosphate alters the mitochondrial membrane by releasing proteins, an inducing factor and cytochrome C.

Distribution

Vd: Decreased with increasing age, based on pharmacokinetic simulations: 5.8 L/kg (3 years old); 3.1 L/kg (30 years old); 2.7 L/kg (82 years old) (Bonate 2011); Children and Adolescents 2 to 19 years: 172 L/m2

Metabolism

Intracellulary by deoxycytidine kinase and mono- and diphosphokinases to active metabolite clofarabine 5′-triphosphate; limited hepatic metabolism (0.2%)

Excretion

Urine (49% to 60%, as unchanged drug)

Half-Life Elimination

Children and Adolescents 2 to 19 years: 5.2 hours; Children and Adults: 7 hours; may be prolonged in in the elderly and in patients with renal impairment (Bonate, 2011)

Protein Binding

47%, primarily to albumin

Clofarabine undergoes renal elimination and exposure is increased as creatinine clearance decreases (Bonate 2011). In patients with CrCl 60 to <90 mL/minute, the AUC was increased by 60% and in patients with CrCl 30 to <60 mL/minute, the AUC was increased by 140%.

Clofarabine undergoes renal elimination and exposure is increased as creatinine clearance decreases (Bonate 2011).

Renal impairment at baseline:

CrCl >60 mL/minute: No dosage adjustment necessary.

CrCl 30 to 60 mL/minute: Reduce dose to 50% of the usual dose

CrCl <30 mL/minute: There are no dosage adjustments provided in the manufacturer's labeling; use with caution (has not been studied).

Dialysis: There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Renal toxicity during treatment: Grade 3 or higher increase in serum creatinine: Discontinue clofarabine; may reinitiate with a 25% dose reduction after patient is stable and organ function recovers to baseline

Hepatic impairment at baseline: There are no dosage adjustments provided in the manufacturer's labeling; use with caution (has not been studied).

Hepatotoxicity during treatment: Grade 3 or higher increase in hepatic enzymes/bilirubin: Discontinue clofarabine; may reinitiate with a 25% dose reduction after patient is stable and organ function recovers to baseline.