Fludarabine is a purine analog and antineoplastic agent used in the therapy of chronic lymphocytic leukemia (CLL) and in immunosuppressive regimens in preparation for hematopoietic cell transplantation (HCT). Fludarabine is associated with a low rate of transient serum enzyme elevations during therapy and has only rarely been implicated in cases of clinically apparent acute liver injury with jaundice. Fludarabine has potent immunosuppressive activity and has been associated with many cases of reactivation of hepatitis B.
Fludarabine is a fluorinated nucleotide antimetabolite analog of the antiviral agent vidarabine (ara-A) with antineoplastic activity. Administered parenterally as a phosphate salt, fludarabine phosphate is rapidly dephosphorylated to 2-fluoro-ara-A and then phosphorylated intracellularly by deoxycytidine kinase to the active triphosphate, 2-fluoro-ara-ATP. This metabolite may inhibit DNA polymerase alpha, ribonucleotide reductase, and DNA primase, thereby interrupting DNA synthesis and inhibiting tumor cell growth. (NCI04)
Fludarabine phosphate is a purine arabinonucleoside monophosphate having 2-fluoroadenine as the nucleobase. A prodrug, it is rapidly dephosphorylated to 2-fluoro-ara-A and then phosphorylated intracellularly by deoxycytidine kinase to the active triphosphate, 2-fluoro-ara-ATP. Once incorporated into DNA, 2-fluoro-ara-ATP functions as a DNA chain terminator. It is used for the treatment of adult patients with B-cell chronic lymphocytic leukemia (CLL) who have not responded to, or whose disease has progressed during, treatment with at least one standard alkylating agent containing regimenas. It has a role as an antimetabolite, an antineoplastic agent, an immunosuppressive agent, an antiviral agent, a prodrug, and a DNA synthesis inhibitor. It is an organofluorine compound, a nucleoside analog, and a purine arabinonucleoside monophosphate. It is functionally related to a 2-fluoroadenine.
Fludarabine is a chemotherapeutic agent used in the treatment of hematological malignancies. It is commonly marketed under the brand name Fludara.
Mechanism of Action
Fludarabine phosphate is rapidly dephosphorylated to 2-fluoro-ara-A and then phosphorylated intracellularly by deoxycytidine kinase to the active triphosphate, 2-fluoro-ara-ATP. This metabolite appears to act by inhibiting DNA polymerase alpha, ribonucleotide reductase and DNA primase, thus inhibiting DNA synthesis. The mechanism of action of this antimetabolite is not completely characterized and may be multi-faceted. Fluorinated adenine analog causes inhibition of DNA synthesis by inhibiting ribonucleotide reductase & DNA polymerase.
Fludarabine is a purine antimetabolite. Activity occurs as the result of activation to 2-fluoro-ara-ATP and includes inhibition of DNA synthesis (primarily in the S-phase of cell division by inhibition of ribonucleotide reductase and the DNA polymerases. It is also postulated that fludarabine interferes with RNA by decreased incorporation of uridine and leucine into RNA and protein, respectively. Fludarabine is also active against non-proliferating cells.
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This review establishes the pharmacokinetic characteristics of the major nucleoside analogs with cytotoxic activity. Cytarabine, pentostatin, fludarabine, cladribine & gemcitabine are all prodrugs whose plasma pharmacokinetics do not fully reflect their therapeutic activity; after cellular uptake, these compounds undergo phosphorylation by deoxycytidine kinase before their incorporation into DNA results in cell death. Cytarabine is principally active in the S phase of the cell cycle & is most toxic to replicating cells, whereas pentostatin, fludarabine & cladribine are incorporated into DNA during the process in which strand breaks are repaired & are therefore cytotoxic to slowly replicating cells (although the action of pentostatin results from its inhibition of adenosine deaminase). Gemcitabine is unusual in being highly metabolized in solid tumor cells. The cytotoxic activity of pentostatin, fludarabine and cladribine against the clonal cells of lymphoproliferative disorders is accompanied by damage to normal lymphoid cells, which results in significant & long-lasting immunosuppression. Useful interactions between nucleoside analogs have been defined. Cells that are primed by exposure to fludarabine or cladribine exhibit enhanced accumulation of cytarabine triphosphate (the cytotoxic nucleotide of cytarabine) & an improved therapeutic effect against acute myeloid leukemia & chronic lymphocytic leukemia can be achieved by clinical schedules that exploit this effect. Combinations of alkylating agents & fludarabine or cladribine are also synergistic in producing significantly enhanced activity against refractory lymphoid malignancies, but at the cost of increased hematological toxicity. Developments in the clinical admin of gemcitabine are concentrating on efforts to extend the duration of exposure to the drug as a means of counteracting its rapid catabolism in circulation. Future developments with this group of agents will further explore the use of fludarabine-based combination therapies to produce a transient period of myelosuppression & immunosuppression that is sufficient to permit the engraftment of allogeneic hemopoietic stem cells & also exploit the immunological benefits of graft-versus-tumor reactions. In addition, the clinical spectrum of activity of gemcitabine is also being extended by combining the drug with other active chemotherapeutic agents, such as cisplatin, & by early studies of its role as a radiosensitizer.
Indications
- For the treatment of adult patients with B-cell chronic lymphocytic leukemia (CLL) who have not responded to or whose disease has progressed during treatment with at least one standard alkylating-agent-containing regimen
- Fludarabine is a purine analog and antineoplastic agent used in the therapy of chronic lymphocytic leukemia (CLL) and in immunosuppressive regimens in preparation for hematopoietic cell transplantation (HCT).
- Fludarabine phosphate is approved to treat: Chronic lymphocytic leukemia (CLL). It is used in adults with B-cell CLL that did not respond to or that got worse during or after treatment with standard therapy. Fludarabine phosphate is also being studied in the treatment of other types of cancer.
- Fludarabine is indicated for the treatment of patients with B-cell chronic lymphocytic leukemia (CLL) who have not responded to or whose disease has progressed during treatment with at least one standard alkylating agent-containing regimen.
- Fludarabine is indicated for the treatment of non-Hodgkin’s lymphomas.
- Fludarabine phosphate is a purine analog now commonly used in the treatment of low-grade lymphoid malignancies.
- For the treatment of adult patients with B-cell chronic lymphocytic leukemia (CLL) who have not responded to or whose disease has progressed during treatment with at least one standard alkylating-agent-containing regimen; the safety and effectiveness of this drug in previously untreated or non-refractory patients with CLL have not been established.
- B-cell chronic lymphocytic leukemia
- prolymphocytic leukemia
- small lymphocytic lymphoma refractory
- Refractory Non-Hodgkin’s lymphoma
Use in Cancer
Fludarabine phosphate is approved to treat:
- Chronic lymphocytic leukemia (CLL). It is used in adults with B-cell CLL that did not respond to or that got worse during or after treatment with standard therapy.
Fludarabine phosphate is also being studied in the treatment of other types of cancer.
Contraindications
- Hypersensitivity, Concomitant pentostatin: risk of fatal pulmonary toxicity, Severe renal impairment.
- a bacterial infection
- shingles
- an infection due to a fungus
- a bad infection
- destruction of red blood cells by body’s own antibodies
- acquired hemolytic anemia, an anemia due to destruction of red cells
- a type of blood disorder with a decrease in all types of blood cells called pancytopenia
- decreased function of bone marrow
- anemia
- low platelet count and bleeding from immune response
- low levels of a type of white blood cell called neutrophils
- confusion
- sudden blindness and pain upon moving the eye
- optic neuropathy, a disease of the optic nerve
- abnormal heart rhythm
- sudden and serious symptoms of heart failure called acute decompensated heart failure
- inflammation in the lungs due to an allergic reaction
- a type of inflammation of the lung called interstitial pneumonitis
- uric acid kidney stones
- severe renal impairment
- mild to moderate kidney impairment
- coma
- seizures
- visible water retention
- abnormal liver function tests
- pregnancy
- a patient who is producing milk and breastfeeding
- a low platelet count due to an autoimmune reaction
- progressive multifocal leukoencephalopathy, a type of brain infection
- acquired factor VIII deficiency disease
- Evans syndrome, an autoimmune condition affecting blood cel
Dosage
Strengths: 10 mg; 25 mg/mL; 50 mg
Chronic Lymphocytic Leukemia
- 25 mg/m2 IV over 30 minutes for 5 days every 28 days; following a maximal tumor response, 3 additional cycles are recommended
- The optimal duration of treatment has not been clearly established.
- The dose may be decreased or delayed for hematologic or nonhematologic toxicity.
- Physicians should consider delaying or discontinuing the drug if neurotoxicity occurs.
US BOXED WARNINGS:
- This drug should be administered under the supervision of a physician experienced in the use of antineoplastic therapy.
- This drug can severely suppress bone marrow function.
- When used at high doses in dose-ranging studies in patients with acute leukemia it was associated with severe neurologic effects, including blindness, coma, and death. This severe central nervous system toxicity occurred in 36% of patients treated with doses approximately 4 times greater (96 mg/m2/day for 5 to 7 days) than the recommended dose. Similar severe central nervous system toxicity, including coma, seizures, agitation, and confusion have been reported in patients treated at doses in the range of the dose recommended for chronic lymphocytic leukemia.
- Instances of life-threatening and sometimes fatal autoimmune phenomena (e.g., hemolytic anemia, autoimmune thrombocytopenia/thrombocytopenic purpura (ITP), Evan’s syndrome, acquired hemophilia) have been reported after one or more cycles of therapy. Patients should be monitored for hemolysis.
Administration advice:
- Caution should be exercised in the handling and preparation of this drug.
- The use of latex gloves and safety glasses is recommended to avoid exposure in case of breakage of the vial or other accidental spillage.
- If the solution contacts the skin or mucous membranes, wash thoroughly with soap and water; rinse your eyes thoroughly with plain water.
- Avoid exposure by inhalation or by direct contact with the skin or mucous membranes.
Side Effects
The Most Common
- Abdominal pain
- increased sweating
- weight loss
- loss of appetite
- nausea
- vomiting
- constipation
- diarrhea
- mouth sores
- hair loss
- numbness, burning, pain, or tingling in the hands, arms, feet, or legs
- muscle or joint pain
- headache
- depression
- sleep problems
- chest pain or discomfort
- fast or irregular heartbeat
- hearing loss
- pain along the side of the body
- swelling of the arms, hands, feet, ankles, or lower legs
- rash
- hives
- difficulty breathing or swallowing
- peeling or blistering skin
More common
- Bloating or swelling of the face, arms, hands, lower legs, or feet
- body aches or pain
- burning or stinging of the skin
- chest pain
- cough or hoarseness
- cough producing mucus
- diarrhea
- difficult or labored breathing
- difficulty in breathing
- ear congestion
- fever or chills
- general feeling of discomfort or illness
- headache
- joint pain
- loss of appetite
- loss of voice
- lower back or side pain
- muscle aches and pains
- nasal congestion
- nausea
- painful cold sores or blisters on the lips, nose, eyes, or genitals
- painful or difficult urination
- rapid weight gain
- runny nose
- shivering
- shortness of breath
- sneezing
- sore throat
- stuffy nose
- sweating
- tightness in the chest
- tingling of hands or feet
- trouble sleeping
- troubled breathing
- unusual tiredness or weakness
- unusual weight gain or loss
- vomiting
- wheezing
Rare
- Bladder pain
- bloody or cloudy urine
- difficult, burning, or painful urination
- frequent urge to urinate
- pain or tenderness around the eyes and cheekbones
- Back pain
- bloody, black, or tarry stools
- blue lips, fingernails, or skin
- blurred vision
- confusion
- convulsions
- coughing up blood
- difficult or fast breathing
- dizziness
- drowsiness
- high fever
- irregular, fast or slow, or shallow breathing
- pale skin
- sores, ulcers, or white spots on the lips or in the mouth
- swollen glands
- unexplained bleeding or bruising
- unusual bleeding or bruising
Drug Interactions
| DRUG | INTERACTION |
|---|---|
| Abatacept | The risk or severity of adverse effects can be increased when Fludarabine is combined with Abatacept. |
| Abciximab | The risk or severity of bleeding can be increased when Abciximab is combined with Fludarabine. |
| Acenocoumarol | The risk or severity of bleeding can be increased when Acenocoumarol is combined with Fludarabine. |
| Acetyldigitoxin | Acetyldigitoxin may decrease the cardiotoxic activities of Fludarabine. |
| Acetylsalicylic acid | The risk or severity of bleeding can be increased when Acetylsalicylic acid is combined with Fludarabine. |
| Adalimumab | The risk or severity of adverse effects can be increased when Adalimumab is combined with Fludarabine. |
| Adenovirus | The risk or severity of infection can be increased when Adenovirus type 7 vaccine live is combined with Fludarabine. |
| Aldesleukin | The risk or severity of adverse effects can be increased when Aldesleukin is combined with Fludarabine. |
| Alefacept | The risk or severity of adverse effects can be increased when Alefacept is combined with Fludarabine. |
| Alemtuzumab | The risk or severity of adverse effects can be increased when Alemtuzumab is combined with Fludarabine. |
| Allogeneic | The therapeutic efficacy of Allogeneic processed thymus tissue can be decreased when used in combination with Fludarabine. |
| Allopurinol | The risk or severity of adverse effects can be increased when Allopurinol is combined with Fludarabine. |
| Alteplase | The risk or severity of bleeding can be increased when Alteplase is combined with Fludarabine. |
| Altretamine | The risk or severity of adverse effects can be increased when Altretamine is combined with Fludarabine. |
| Amsacrine | The risk or severity of adverse effects can be increased when Amsacrine is combined with Fludarabine. |
| Anagrelide | The risk or severity of bleeding can be increased when Anagrelide is combined with Fludarabine. |
| Anakinra | The risk or severity of adverse effects can be increased when Anakinra is combined with Fludarabine. |
| Anastrozole | The risk or severity of cardiotoxicity can be increased when Fludarabine is combined with Anastrozole. |
| Ancrod | The risk or severity of bleeding can be increased when Ancrod is combined with Fludarabine. |
| Anifrolumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Anifrolumab. |
| Anistreplase | The risk or severity of bleeding can be increased when Anistreplase is combined with Fludarabine. |
| Anthrax immune | The therapeutic efficacy of Anthrax immune globulin human can be decreased when used in combination with Fludarabine. |
| Anthrax vaccine | The risk or severity of infection can be increased when Anthrax vaccine is combined with Fludarabine. |
| Antilymphocyte | The risk or severity of adverse effects can be increased when Fludarabine is combined with Antilymphocyte immunoglobulin (horse). |
| Antithrombin Alfa | The risk or severity of bleeding can be increased when Antithrombin Alfa is combined with Fludarabine. |
| Antithrombin | The risk or severity of bleeding can be increased when Antithrombin III human is combined with Fludarabine. |
| Antithymocyte | The risk or severity of adverse effects can be increased when Antithymocyte immunoglobulin (rabbit) is combined with Fludarabine. |
| Apixaban | The risk or severity of bleeding can be increased when Apixaban is combined with Fludarabine. |
| Apremilast | The risk or severity of adverse effects can be increased when Fludarabine is combined with Apremilast. |
| Ardeparin | The risk or severity of bleeding can be increased when Ardeparin is combined with Fludarabine. |
| Argatroban | The risk or severity of bleeding can be increased when Argatroban is combined with Fludarabine. |
| Arsenic trioxide | The risk or severity of adverse effects can be increased when Fludarabine is combined with Arsenic trioxide. |
| Articaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Articaine. |
| COVID-19 Vaccine | The therapeutic efficacy of AstraZeneca COVID-19 Vaccine can be decreased when used in combination with Fludarabine. |
| Azacitidine | The risk or severity of adverse effects can be increased when Azacitidine is combined with Fludarabine. |
| Azathioprine | The risk or severity of adverse effects can be increased when Azathioprine is combined with Fludarabine. |
| Bacillus antigen | The risk or severity of infection can be increased when Bacillus calmette-guerin substrain connaught live antigen is combined with Fludarabine. |
| Bacillus antigen | The therapeutic efficacy of Bacillus calmette-guerin substrain russian BCG-I live antigen can be decreased when used in combination with Fludarabine. |
| Bacillus | The risk or severity of infection can be increased when Bacillus calmette-guerin substrain tice live antigen is combined with Fludarabine. |
| Baricitinib | The risk or severity of adverse effects can be increased when Fludarabine is combined with Baricitinib. |
| Basiliximab | The risk or severity of adverse effects can be increased when Basiliximab is combined with Fludarabine. |
| BCG vaccine | The risk or severity of infection can be increased when BCG vaccine is combined with Fludarabine. |
| Beclomethasone | The risk or severity of adverse effects can be increased when Beclomethasone dipropionate is combined with Fludarabine. |
| Belatacept | The risk or severity of adverse effects can be increased when Fludarabine is combined with Belatacept. |
| Belimumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Belimumab. |
| Belinostat | The risk or severity of adverse effects can be increased when Fludarabine is combined with Belinostat. |
| Belumosudil | The risk or severity of adverse effects can be increased when Fludarabine is combined with Belumosudil. |
| Bemiparin | The risk or severity of bleeding can be increased when Bemiparin is combined with Fludarabine. |
| Bendamustine | The risk or severity of adverse effects can be increased when Fludarabine is combined with Bendamustine. |
| Bendroflumethiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Bendroflumethiazide is combined with Fludarabine. |
| Benzocaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Benzocaine. |
| Benzthiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Benzthiazide is combined with Fludarabine. |
| Benzyl alcohol | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Benzyl alcohol. |
| Betamethasone | The risk or severity of adverse effects can be increased when Betamethasone is combined with Fludarabine. |
| Betrixaban | The risk or severity of bleeding can be increased when Betrixaban is combined with Fludarabine. |
| Bevacizumab | The risk or severity of cardiotoxicity can be increased when Bevacizumab is combined with Fludarabine. |
| Bexarotene | The risk or severity of adverse effects can be increased when Bexarotene is combined with Fludarabine. |
| Bimekizumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Bimekizumab. |
| Bivalirudin | The risk or severity of bleeding can be increased when Bivalirudin is combined with Fludarabine. |
| Bleomycin | The risk or severity of adverse effects can be increased when Bleomycin is combined with Fludarabine. |
| Blinatumomab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Blinatumomab. |
| Bordetella | The therapeutic efficacy of Bordetella pertussis toxoid antigen (formaldehyde, glutaraldehyde inactivated) can be decreased when used in combination with Fludarabine. |
| Bortezomib | The risk or severity of adverse effects can be increased when Bortezomib is combined with Fludarabine. |
| Bosutinib | The risk or severity of adverse effects can be increased when Fludarabine is combined with Bosutinib. |
| Brentuximab vedotin | The risk or severity of adverse effects can be increased when Fludarabine is combined with Brentuximab vedotin. |
| Brodalumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Brodalumab. |
| Budesonide | The risk or severity of adverse effects can be increased when Fludarabine is combined with Budesonide. |
| Bupivacaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Bupivacaine. |
| Busulfan | The risk or severity of adverse effects can be increased when Busulfan is combined with Fludarabine. |
| Butacaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Butacaine. |
| Butamben | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Butamben. |
| Cabazitaxel | The risk or severity of adverse effects can be increased when Fludarabine is combined with Cabazitaxel. |
| Canakinumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Canakinumab. |
| Cangrelor | The risk or severity of bleeding can be increased when Cangrelor is combined with Fludarabine. |
| Capecitabine | The risk or severity of adverse effects can be increased when Fludarabine is combined with Capecitabine. |
| Caplacizumab | The risk or severity of bleeding can be increased when Caplacizumab is combined with Fludarabine. |
| Capsaicin | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Capsaicin. |
| Carbamazepine | The risk or severity of adverse effects can be increased when Carbamazepine is combined with Fludarabine. |
| Carboplatin | The risk or severity of adverse effects can be increased when Carboplatin is combined with Fludarabine. |
| Carfilzomib | The risk or severity of adverse effects can be increased when Fludarabine is combined with Carfilzomib. |
| Carmustine | The risk or severity of adverse effects can be increased when Carmustine is combined with Fludarabine. |
| Certolizumab pegol | The risk or severity of adverse effects can be increased when Fludarabine is combined with Certolizumab pegol. |
| Chlorambucil | The risk or severity of adverse effects can be increased when Chlorambucil is combined with Fludarabine. |
| Chloramphenicol | The risk or severity of adverse effects can be increased when Chloramphenicol is combined with Fludarabine. |
| Chloroprocaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Chloroprocaine. |
| Chlorothiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Chlorothiazide is combined with Fludarabine. |
| Ciclesonide | The risk or severity of adverse effects can be increased when Fludarabine is combined with Ciclesonide. |
| Cilostazol | The risk or severity of bleeding can be increased when Cilostazol is combined with Fludarabine. |
| Cinchocaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Cinchocaine. |
| Cisplatin | The risk or severity of adverse effects can be increased when Cisplatin is combined with Fludarabine. |
| Cladribine | The risk or severity of adverse effects can be increased when Cladribine is combined with Fludarabine. |
| Clobetasol | The risk or severity of adverse effects can be increased when Clobetasol propionate is combined with Fludarabine. |
| Clofarabine | The risk or severity of adverse effects can be increased when Clofarabine is combined with Fludarabine. |
| Clopidogrel | The risk or severity of bleeding can be increased when Clopidogrel is combined with Fludarabine. |
| Clostridium tetani | The therapeutic efficacy of Clostridium tetani toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Fludarabine. |
| Clozapine | The risk or severity of neutropenia can be increased when Fludarabine is combined with Clozapine. |
| Cocaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Cocaine. |
| Corticotropin | The risk or severity of adverse effects can be increased when Fludarabine is combined with Corticotropin. |
| Cortisone acetate | The risk or severity of adverse effects can be increased when Fludarabine is combined with Cortisone acetate. |
| Cyanocobalamin | The therapeutic efficacy of Cyanocobalamin can be decreased when used in combination with Fludarabine. |
| Cyclopenthiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Cyclopenthiazide is combined with Fludarabine. |
| Cyclophosphamide | The risk or severity of adverse effects can be increased when Cyclophosphamide is combined with Fludarabine. |
| Cyclosporine | Fludarabine may increase the immunosuppressive activities of Cyclosporine. |
| Cyclothiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Cyclothiazide is combined with Fludarabine. |
| Cytarabine | The risk or severity of adverse effects can be increased when Cytarabine is combined with Fludarabine. |
| Dabigatran | The risk or severity of bleeding can be increased when Dabigatran is combined with Fludarabine. |
| Dabigatran | The risk or severity of bleeding can be increased when Dabigatran etexilate is combined with Fludarabine. |
| Dacarbazine | The risk or severity of adverse effects can be increased when Dacarbazine is combined with Fludarabine. |
| Dactinomycin | The risk or severity of adverse effects can be increased when Dactinomycin is combined with Fludarabine. |
| Dalteparin | The risk or severity of bleeding can be increased when Dalteparin is combined with Fludarabine. |
| Danaparoid | The risk or severity of bleeding can be increased when Danaparoid is combined with Fludarabine. |
| Darbepoetin alfa | The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Fludarabine. |
| Dasatinib | The risk or severity of adverse effects can be increased when Fludarabine is combined with Dasatinib. |
| Daunorubicin | The risk or severity of adverse effects can be increased when Daunorubicin is combined with Fludarabine. |
| Decitabine | The risk or severity of adverse effects can be increased when Fludarabine is combined with Decitabine. |
| Defibrotide | The risk or severity of bleeding can be increased when Defibrotide is combined with Fludarabine. |
| Deflazacort | The risk or severity of adverse effects can be increased when Fludarabine is combined with Deflazacort. |
| Denosumab | The risk or severity of adverse effects can be increased when Denosumab is combined with Fludarabine. |
| Desirudin | The risk or severity of bleeding can be increased when Desirudin is combined with Fludarabine. |
| Deslanoside | Deslanoside may decrease the cardiotoxic activities of Fludarabine. |
| Desoximetasone | The risk or severity of adverse effects can be increased when Desoximetasone is combined with Fludarabine. |
| Deucravacitinib | The risk or severity of adverse effects can be increased when Fludarabine is combined with Deucravacitinib. |
| Dexamethasone | The risk or severity of adverse effects can be increased when Fludarabine is combined with Dexamethasone. |
| Dexrazoxane | The risk or severity of adverse effects can be increased when Dexrazoxane is combined with Fludarabine. |
| Dextran | The risk or severity of bleeding can be increased when Dextran is combined with Fludarabine. |
| Dicoumarol | The risk or severity of bleeding can be increased when Dicoumarol is combined with Fludarabine. |
| Difluocortolone | The risk or severity of adverse effects can be increased when Fludarabine is combined with Difluocortolone. |
| Digitoxin | Digitoxin may decrease the cardiotoxic activities of Fludarabine. |
| Digoxin | Digoxin may decrease the cardiotoxic activities of Fludarabine. |
| Dimethyl fumarate | The risk or severity of adverse effects can be increased when Fludarabine is combined with Dimethyl fumarate. |
| Dinutuximab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Dinutuximab. |
| Diphenhydramine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Diphenhydramine. |
| Dipyridamole | The risk or severity of bleeding can be increased when Dipyridamole is combined with Fludarabine. |
| Diroximel fumarate | The risk or severity of adverse effects can be increased when Fludarabine is combined with Diroximel fumarate. |
| Docetaxel | The risk or severity of adverse effects can be increased when Fludarabine is combined with Docetaxel. |
| Doxorubicin | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Fludarabine. |
| Drotrecogin alfa | The risk or severity of bleeding can be increased when Drotrecogin alfa is combined with Fludarabine. |
| Dyclonine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Dyclonine. |
| Ebola Zaire | The therapeutic efficacy of Ebola Zaire vaccine (live, attenuated) can be decreased when used in combination with Fludarabine. |
| Eculizumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Eculizumab. |
| Edetic acid | The risk or severity of bleeding can be increased when Edetic acid is combined with Fludarabine. |
| Edoxaban | The risk or severity of bleeding can be increased when Edoxaban is combined with Fludarabine. |
| Efalizumab | The risk or severity of adverse effects can be increased when Efalizumab is combined with Fludarabine. |
| Emapalumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Emapalumab. |
| Enoxaparin | The risk or severity of bleeding can be increased when Enoxaparin is combined with Fludarabine. |
| Epirubicin | The risk or severity of adverse effects can be increased when Epirubicin is combined with Fludarabine. |
| Epoprostenol | The risk or severity of bleeding can be increased when Epoprostenol is combined with Fludarabine. |
| Eptifibatide | The risk or severity of bleeding can be increased when Eptifibatide is combined with Fludarabine. |
| Eribulin | The risk or severity of adverse effects can be increased when Fludarabine is combined with Eribulin. |
| Erythropoietin | The risk or severity of Thrombosis can be increased when Erythropoietin is combined with Fludarabine. |
| Estramustine | The risk or severity of adverse effects can be increased when Fludarabine is combined with Estramustine. |
| Etanercept | The risk or severity of adverse effects can be increased when Etanercept is combined with Fludarabine. |
| Ethyl chloride | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Ethyl chloride. |
| Etidocaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Etidocaine. |
| Etoposide | The risk or severity of adverse effects can be increased when Etoposide is combined with Fludarabine. |
| Everolimus | The risk or severity of adverse effects can be increased when Fludarabine is combined with Everolimus. |
| Famtozinameran | The therapeutic efficacy of Famtozinameran can be decreased when used in combination with Fludarabine. |
| Filgotinib | The risk or severity of adverse effects can be increased when Fludarabine is combined with Filgotinib. |
| Fingolimod | Fludarabine may increase the immunosuppressive activities of Fingolimod. |
| Floxuridine | The risk or severity of adverse effects can be increased when Floxuridine is combined with Fludarabine. |
| Flucytosine | The risk or severity of adverse effects can be increased when Fludarabine is combined with Flucytosine. |
| Fludrocortisone | The risk or severity of adverse effects can be increased when Fludrocortisone is combined with Fludarabine. |
| Fluindione | The risk or severity of bleeding can be increased when Fluindione is combined with Fludarabine. |
| Flunisolide | The risk or severity of adverse effects can be increased when Flunisolide is combined with Fludarabine. |
| Fluocinolone | The risk or severity of adverse effects can be increased when Fluocinolone acetonide is combined with Fludarabine. |
| Fluocinonide | The risk or severity of adverse effects can be increased when Fluocinonide is combined with Fludarabine. |
| Fluocortolone | The risk or severity of adverse effects can be increased when Fludarabine is combined with Fluocortolone. |
| Fluorometholone | The risk or severity of adverse effects can be increased when Fluorometholone is combined with Fludarabine. |
| Fluorouracil | The risk or severity of adverse effects can be increased when Fluorouracil is combined with Fludarabine. |
| Flupentixol | The risk or severity of myelosuppression can be increased when Flupentixol is combined with Fludarabine. |
| Fluprednisolone | The risk or severity of adverse effects can be increased when Fludarabine is combined with Fluprednisolone. |
| Fluticasone | The risk or severity of adverse effects can be increased when Fludarabine is combined with Fluticasone. |
| Fluticasone | The risk or severity of adverse effects can be increased when Fludarabine is combined with Fluticasone furoate. |
| Fluticasone | The risk or severity of adverse effects can be increased when Fluticasone propionate is combined with Fludarabine. |
| Fondaparinux | The risk or severity of bleeding can be increased when Fondaparinux is combined with Fludarabine. |
| Gallium nitrate | The risk or severity of adverse effects can be increased when Fludarabine is combined with Gallium nitrate. |
| Gemcitabine | The risk or severity of adverse effects can be increased when Gemcitabine is combined with Fludarabine. |
| Gemtuzumab | The risk or severity of adverse effects can be increased when Gemtuzumab ozogamicin is combined with Fludarabine. |
| Glatiramer | The risk or severity of adverse effects can be increased when Fludarabine is combined with Glatiramer. |
| Golimumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Golimumab. |
| Guselkumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Guselkumab. |
| Haemophilus | The therapeutic efficacy of Haemophilus influenzae type B strain 20752 capsular polysaccharide tetanus toxoid conjugate antigen can be decreased when used in combination with Fludarabine. |
| Heparin | The risk or severity of bleeding can be increased when Heparin is combined with Fludarabine. |
| Hepatitis A Vaccine | The therapeutic efficacy of Hepatitis A Vaccine can be decreased when used in combination with Fludarabine. |
| Hepatitis B Vaccine | The therapeutic efficacy of Hepatitis B Vaccine (Recombinant) can be decreased when used in combination with Fludarabine. |
| Human adenovirus | The risk or severity of infection can be increased when Human adenovirus e serotype 4 strain cl-68578 antigen is combined with Fludarabine. |
| Hydrochlorothiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Hydrochlorothiazide is combined with Fludarabine. |
| Hydrocortisone | The risk or severity of adverse effects can be increased when Fludarabine is combined with Hydrocortisone acetate. |
| Hydrocortisone | The risk or severity of adverse effects can be increased when Fludarabine is combined with Hydrocortisone butyrate. |
| Hydrocortisone | The risk or severity of adverse effects can be increased when Fludarabine is combined with Hydrocortisone succinate. |
| Hydroflumethiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Hydroflumethiazide is combined with Fludarabine. |
| Hydroxychloroquine | The risk or severity of adverse effects can be increased when Fludarabine is combined with Hydroxychloroquine. |
| Hydroxyurea | The risk or severity of adverse effects can be increased when Hydroxyurea is combined with Fludarabine. |
| Ibritumomab | The risk or severity of adverse effects can be increased when Ibritumomab tiuxetan is combined with Fludarabine. |
| Ibrutinib | The risk or severity of adverse effects can be increased when Fludarabine is combined with Ibrutinib. |
| Icosapent ethyl | The risk or severity of bleeding can be increased when Icosapent ethyl is combined with Fludarabine. |
| Idarubicin | The risk or severity of adverse effects can be increased when Fludarabine is combined with Idarubicin. |
| Idelalisib | The risk or severity of adverse effects can be increased when Fludarabine is combined with Idelalisib. |
| Ifosfamide | The risk or severity of adverse effects can be increased when Fludarabine is combined with Ifosfamide. |
| Irinotecan | The risk or severity of adverse effects can be increased when Irinotecan is combined with Fludarabine. |
| Ixabepilone | The risk or severity of adverse effects can be increased when Fludarabine is combined with Ixabepilone. |
| Ixekizumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Ixekizumab. |
| COVID-19 Vaccine | The therapeutic efficacy of Janssen COVID-19 Vaccine can be decreased when used in combination with Fludarabine. |
| Japanese | The therapeutic efficacy of Japanese encephalitis virus strain sa 14-14-2 antigen (formaldehyde inactivated) can be decreased when used in combination with Fludarabine. |
| Leflunomide | The risk or severity of adverse effects can be increased when Fludarabine is combined with Leflunomide. |
| Lenalidomide | The risk or severity of adverse effects can be increased when Lenalidomide is combined with Fludarabine. |
| Lepirudin | The risk or severity of bleeding can be increased when Lepirudin is combined with Fludarabine. |
| Levobupivacaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Levobupivacaine. |
| Lidocaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Lidocaine. |
| Linezolid | The risk or severity of adverse effects can be increased when Linezolid is combined with Fludarabine. |
| Lipegfilgrastim | Fludarabine may increase the myelosuppressive activities of Lipegfilgrastim. |
| Lomustine | The risk or severity of adverse effects can be increased when Fludarabine is combined with Lomustine. |
| Lopinavir | The serum concentration of Fludarabine can be increased when it is combined with Lopinavir. |
| Magnesium | The serum concentration of Magnesium can be decreased when it is combined with Fludarabine. |
| Measles virus | The therapeutic efficacy of Measles virus vaccine live attenuated can be decreased when used in combination with Fludarabine. |
| Mechlorethamine | The risk or severity of adverse effects can be increased when Mechlorethamine is combined with Fludarabine. |
| Meloxicam | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Meloxicam. |
| Melphalan | The risk or severity of adverse effects can be increased when Melphalan is combined with Fludarabine. |
| Meningococcal | The therapeutic efficacy of Meningococcal (groups A, C, Y and W-135) oligosaccharide diphtheria CRM197 conjugate vaccine can be decreased when used in combination with Fludarabine. |
| Mepivacaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Mepivacaine. |
| Mepolizumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Mepolizumab. |
| Meprednisone | The risk or severity of adverse effects can be increased when Fludarabine is combined with Meprednisone. |
| Mercaptopurine | The risk or severity of adverse effects can be increased when Mercaptopurine is combined with Fludarabine. |
| Metamizole | The risk or severity of myelosuppression can be increased when Metamizole is combined with Fludarabine. |
| Methimazole | The risk or severity of adverse effects can be increased when Methimazole is combined with Fludarabine. |
| Methotrexate | The risk or severity of adverse effects can be increased when Methotrexate is combined with Fludarabine. |
| Methoxy | The risk or severity of Thrombosis can be increased when Methoxy polyethylene glycol-epoetin beta is combined with Fludarabine. |
| Methylprednisolone | The risk or severity of adverse effects can be increased when Methylprednisolone is combined with Fludarabine. |
| Mitomycin | The risk or severity of adverse effects can be increased when Mitomycin is combined with Fludarabine. |
| Mitoxantrone | The risk or severity of adverse effects can be increased when Fludarabine is combined with Mitoxantrone. |
| COVID-19 Vaccine | The therapeutic efficacy of Moderna COVID-19 Vaccine can be decreased when used in combination with Fludarabine. |
| Modified vaccinia | The therapeutic efficacy of Modified vaccinia ankara can be decreased when used in combination with Fludarabine. |
| Mometasone furoate | The risk or severity of adverse effects can be increased when Fludarabine is combined with Mometasone furoate. |
| Monomethyl | The risk or severity of adverse effects can be increased when Fludarabine is combined with Monomethyl fumarate. |
| Mosunetuzumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Mosunetuzumab. |
| Mumps virus | The therapeutic efficacy of Mumps virus strain B level jeryl lynn live antigen can be decreased when used in combination with Fludarabine. |
| Muromonab | The risk or severity of adverse effects can be increased when Muromonab is combined with Fludarabine. |
| Mycophenolate | The risk or severity of adverse effects can be increased when Mycophenolate mofetil is combined with Fludarabine. |
| Mycophenolic acid | The risk or severity of adverse effects can be increased when Mycophenolic acid is combined with Fludarabine. |
| Nadroparin | The risk or severity of bleeding can be increased when Nadroparin is combined with Fludarabine. |
| Natalizumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Natalizumab. |
| Nelarabine | The risk or severity of adverse effects can be increased when Fludarabine is combined with Nelarabine. |
| Nilotinib | The risk or severity of adverse effects can be increased when Fludarabine is combined with Nilotinib. |
| Nimesulide | The risk or severity of bleeding can be increased when Nimesulide is combined with Fludarabine. |
| Nuvaxovid | The therapeutic efficacy of Nuvaxovid can be decreased when used in combination with Fludarabine. |
| Obinutuzumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Obinutuzumab. |
| Ocrelizumab | Ocrelizumab may increase the immunosuppressive activities of Fludarabine. |
| Ofatumumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Ofatumumab. |
| Olaparib | The risk or severity of adverse effects can be increased when Fludarabine is combined with Olaparib. |
| Ouabain | Ouabain may decrease the cardiotoxic activities of Fludarabine. |
| Oxaliplatin | The risk or severity of adverse effects can be increased when Oxaliplatin is combined with Fludarabine. |
| Oxetacaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Oxetacaine. |
| Oxybuprocaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Oxybuprocaine. |
| Ozanimod | The risk or severity of adverse effects can be increased when Fludarabine is combined with Ozanimod. |
| Paclitaxel | The risk or severity of adverse effects can be increased when Fludarabine is combined with Paclitaxel. |
| Palbociclib | The risk or severity of adverse effects can be increased when Fludarabine is combined with Palbociclib. |
| Palifermin | The therapeutic efficacy of Palifermin can be decreased when used in combination with Fludarabine. |
| Panobinostat | The risk or severity of adverse effects can be increased when Fludarabine is combined with Panobinostat. |
| Parnaparin | The risk or severity of bleeding can be increased when Parnaparin is combined with Fludarabine. |
| Pazopanib | The risk or severity of adverse effects can be increased when Fludarabine is combined with Pazopanib. |
| Pegaspargase | The risk or severity of adverse effects can be increased when Pegaspargase is combined with Fludarabine. |
| Pegcetacoplan | The risk or severity of adverse effects can be increased when Fludarabine is combined with Pegcetacoplan. |
| Peginesatide | The risk or severity of Thrombosis can be increased when Peginesatide is combined with Fludarabine. |
| Peginterferon 2a | The risk or severity of adverse effects can be increased when Peginterferon alfa-2a is combined with Fludarabine. |
| Peginterferon alfa | The risk or severity of adverse effects can be increased when Peginterferon alfa-2b is combined with Fludarabine. |
| Peginterferon | The risk or severity of adverse effects can be increased when Fludarabine is combined with Peginterferon beta-1a. |
| Pemetrexed | The risk or severity of adverse effects can be increased when Pemetrexed is combined with Fludarabine. |
| Penicillamine | The risk or severity of adverse effects can be increased when Penicillamine is combined with Fludarabine. |
| Pentosan polysulfate | The risk or severity of bleeding can be increased when Pentosan polysulfate is combined with Fludarabine. |
| Pentostatin | The risk or severity of pulmonary toxicity can be increased when Fludarabine is combined with Pentostatin. |
| Pentoxifylline | The risk or severity of bleeding can be increased when Pentoxifylline is combined with Fludarabine. |
| Pertussis vaccine | The therapeutic efficacy of Pertussis vaccine can be decreased when used in combination with Fludarabine. |
| Pertuzumab | The risk or severity of cardiotoxicity can be increased when Fludarabine is combined with Pertuzumab. |
| Phenindione | The risk or severity of bleeding can be increased when Phenindione is combined with Fludarabine. |
| Phenol | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Phenol. |
| Phenprocoumon | The risk or severity of bleeding can be increased when Phenprocoumon is combined with Fludarabine. |
| Phenylalanine | The risk or severity of adverse effects can be increased when Phenylalanine is combined with Fludarabine. |
| Pimecrolimus | The risk or severity of adverse effects can be increased when Pimecrolimus is combined with Fludarabine. |
| Pirfenidone | The risk or severity of adverse effects can be increased when Fludarabine is combined with Pirfenidone. |
| Polythiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Polythiazide is combined with Fludarabine. |
| Pomalidomide | The risk or severity of adverse effects can be increased when Fludarabine is combined with Pomalidomide. |
| Ponatinib | The risk or severity of adverse effects can be increased when Fludarabine is combined with Ponatinib. |
| Ponesimod | The risk or severity of adverse effects can be increased when Fludarabine is combined with Ponesimod. |
| Pralatrexate | The risk or severity of adverse effects can be increased when Fludarabine is combined with Pralatrexate. |
| Pramocaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Pramocaine. |
| Prasugrel | The risk or severity of bleeding can be increased when Prasugrel is combined with Fludarabine. |
| Prednisolone | The risk or severity of adverse effects can be increased when Prednisolone is combined with Fludarabine. |
| Prednisone | The risk or severity of adverse effects can be increased when Prednisone is combined with Fludarabine. |
| Prilocaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Prilocaine. |
| Procaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Procaine. |
| Procarbazine | The risk or severity of adverse effects can be increased when Fludarabine is combined with Procarbazine. |
| Proparacaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Proparacaine. |
| Propoxycaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Propoxycaine. |
| Propylthiouracil | The risk or severity of adverse effects can be increased when Propylthiouracil is combined with Fludarabine. |
| Protein C | The risk or severity of bleeding can be increased when Protein C is combined with Fludarabine. |
| Protein S | The risk or severity of bleeding can be increased when Protein S human is combined with Fludarabine. |
| Rabies immune | The therapeutic efficacy of Rabies immune globulin, human can be decreased when used in combination with Fludarabine. |
| Rabies antigen, A | The therapeutic efficacy of Rabies virus inactivated antigen, A can be decreased when used in combination with Fludarabine. |
| Rabies antigen, B | The therapeutic efficacy of Rabies virus inactivated antigen, B can be decreased when used in combination with Fludarabine. |
| Raltitrexed | The risk or severity of adverse effects can be increased when Raltitrexed is combined with Fludarabine. |
| Ravulizumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Ravulizumab. |
| Reteplase | The risk or severity of bleeding can be increased when Reteplase is combined with Fludarabine. |
| Reviparin | The risk or severity of bleeding can be increased when Reviparin is combined with Fludarabine. |
| Rilonacept | The risk or severity of adverse effects can be increased when Fludarabine is combined with Rilonacept. |
| Risankizumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Risankizumab. |
| Rituximab | The risk or severity of adverse effects can be increased when Rituximab is combined with Fludarabine. |
| Rivaroxaban | The risk or severity of bleeding can be increased when Rivaroxaban is combined with Fludarabine. |
| Roflumilast | Roflumilast may increase the immunosuppressive activities of Fludarabine. |
| Ropeginterferon | The risk or severity of adverse effects can be increased when Fludarabine is combined with Ropeginterferon alfa-2b. |
| Ropivacaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Ropivacaine. |
| Rotavirus vaccine | The therapeutic efficacy of Rotavirus vaccine can be decreased when used in combination with Fludarabine. |
| Rubella virus vaccine | The risk or severity of infection can be increased when Rubella virus vaccine is combined with Fludarabine. |
| Ruxolitinib | The risk or severity of adverse effects can be increased when Fludarabine is combined with Ruxolitinib. |
| Sarilumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Sarilumab. |
| Natalizumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Satralizumab. |
| Secukinumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Secukinumab. |
| Siltuximab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Siltuximab. |
| Siponimod | The risk or severity of adverse effects can be increased when Fludarabine is combined with Siponimod. |
| Sipuleucel-T | The therapeutic efficacy of Sipuleucel-T can be decreased when used in combination with Fludarabine. |
| Sirolimus | The risk or severity of adverse effects can be increased when Sirolimus is combined with Fludarabine. |
| Smallpox (Vaccinia | The therapeutic efficacy of Smallpox (Vaccinia) Vaccine, Live can be decreased when used in combination with Fludarabine. |
| Sodium citrate | The risk or severity of bleeding can be increased when Sodium citrate is combined with Fludarabine. |
| Sorafenib | The risk or severity of adverse effects can be increased when Sorafenib is combined with Fludarabine. |
| Spesolimab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Spesolimab. |
| Streptokinase | The risk or severity of bleeding can be increased when Streptokinase is combined with Fludarabine. |
| Streptozocin | The risk or severity of adverse effects can be increased when Streptozocin is combined with Fludarabine. |
| Sulfamethoxazole | The risk or severity of myelosuppression can be increased when Sulfamethoxazole is combined with Fludarabine. |
| Sulfasalazine | The risk or severity of adverse effects can be increased when Sulfasalazine is combined with Fludarabine. |
| Sulfinpyrazone | The risk or severity of bleeding can be increased when Sulfinpyrazone is combined with Fludarabine. |
| Sulodexide | The risk or severity of bleeding can be increased when Sulodexide is combined with Fludarabine. |
| Sunitinib | The risk or severity of adverse effects can be increased when Fludarabine is combined with Sunitinib. |
| Tacrolimus | Tacrolimus may increase the immunosuppressive activities of Fludarabine. |
| Tamoxifen | The risk or severity of cardiotoxicity can be increased when Tamoxifen is combined with Fludarabine. |
| Tedizolid phosphate | The risk or severity of myelosuppression can be increased when Fludarabine is combined with Tedizolid phosphate. |
| Temozolomide | The risk or severity of adverse effects can be increased when Temozolomide is combined with Fludarabine. |
| Temsirolimus | The risk or severity of adverse effects can be increased when Fludarabine is combined with Temsirolimus. |
| Tenecteplase | The risk or severity of bleeding can be increased when Tenecteplase is combined with Fludarabine. |
| Teniposide | The risk or severity of adverse effects can be increased when Teniposide is combined with Fludarabine. |
| Teprotumumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Teprotumumab. |
| Teriflunomide | The risk or severity of adverse effects can be increased when Fludarabine is combined with Teriflunomide. |
| Tetracaine | The risk or severity of methemoglobinemia can be increased when Fludarabine is combined with Tetracaine. |
| Thalidomide | The risk or severity of adverse effects can be increased when Thalidomide is combined with Fludarabine. |
| Thiotepa | The risk or severity of adverse effects can be increased when Fludarabine is combined with Thiotepa. |
| Ticagrelor | The risk or severity of bleeding can be increased when Ticagrelor is combined with Fludarabine. |
| Tick-borne encephalitis | The therapeutic efficacy of Tick-borne encephalitis vaccine (whole virus, inactivated) can be decreased when used in combination with Fludarabine. |
| Ticlopidine | The risk or severity of bleeding can be increased when Ticlopidine is combined with Fludarabine. |
| Tinzaparin | The risk or severity of bleeding can be increased when Tinzaparin is combined with Fludarabine. |
| Tioguanine | The risk or severity of adverse effects can be increased when Tioguanine is combined with Fludarabine. |
| Tirofiban | The risk or severity of bleeding can be increased when Tirofiban is combined with Fludarabine. |
| Tixocortol | The risk or severity of adverse effects can be increased when Fludarabine is combined with Tixocortol. |
| Tocilizumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Tocilizumab. |
| Tofacitinib | Fludarabine may increase the immunosuppressive activities of Tofacitinib. |
| Topotecan | The risk or severity of adverse effects can be increased when Topotecan is combined with Fludarabine. |
| Tositumomab | The risk or severity of adverse effects can be increased when Tositumomab is combined with Fludarabine. |
| Trabectedin | The risk or severity of adverse effects can be increased when Fludarabine is combined with Trabectedin. |
| Trastuzumab | Trastuzumab may increase the neutropenic activities of Fludarabine. |
| Trastuzumab emtansine | The risk or severity of adverse effects can be increased when Fludarabine is combined with Trastuzumab emtansine. |
| Tretinoin | The risk or severity of adverse effects can be increased when Tretinoin is combined with Fludarabine. |
| Triamcinolone | The risk or severity of adverse effects can be increased when Triamcinolone is combined with Fludarabine. |
| Trichlormethiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Trichlormethiazide is combined with Fludarabine. |
| Trifluridine | The risk or severity of adverse effects can be increased when Trifluridine is combined with Fludarabine. |
| Triflusal | The risk or severity of bleeding can be increased when Triflusal is combined with Fludarabine. |
| Trilostane | The risk or severity of adverse effects can be increased when Fludarabine is combined with Trilostane. |
| Typhoid vaccine | The therapeutic efficacy of Typhoid vaccine can be decreased when used in combination with Fludarabine. |
| Typhoid Vaccine | The risk or severity of infection can be increased when Typhoid Vaccine Live is combined with Fludarabine. |
| Typhoid Vi | The therapeutic efficacy of Typhoid Vi polysaccharide vaccine can be decreased when used in combination with Fludarabine. |
| Upadacitinib | The risk or severity of adverse effects can be increased when Fludarabine is combined with Upadacitinib. |
| Urokinase | The risk or severity of bleeding can be increased when Urokinase is combined with Fludarabine. |
| Varicella zoster | The risk or severity of infection can be increased when Varicella zoster vaccine (live/attenuated) is combined with Fludarabine. |
| Varicella zoster vaccine | The therapeutic efficacy of Varicella zoster vaccine (recombinant) can be decreased when used in combination with Fludarabine. |
| Vedolizumab | The risk or severity of adverse effects can be increased when Fludarabine is combined with Vedolizumab. |
| Vibrio antigen | The therapeutic efficacy of Vibrio cholerae CVD 103-HgR strain live antigen can be decreased when used in combination with Fludarabine. |
| Vilanterol | The risk or severity of adverse effects can be increased when Fludarabine is combined with Vilanterol. |
| Vinblastine | The risk or severity of adverse effects can be increased when Vinblastine is combined with Fludarabine. |
| Vincristine | The risk or severity of adverse effects can be increased when Vincristine is combined with Fludarabine. |
| Vindesine | The risk or severity of adverse effects can be increased when Vindesine is combined with Fludarabine. |
| Vinorelbine | The risk or severity of adverse effects can be increased when Vinorelbine is combined with Fludarabine. |
| Voclosporin | The risk or severity of adverse effects can be increased when Fludarabine is combined with Voclosporin. |
| Vorapaxar | The risk or severity of bleeding can be increased when Vorapaxar is combined with Fludarabine. |
| Vorinostat | The risk or severity of adverse effects can be increased when Fludarabine is combined with Vorinostat. |
| Warfarin | The risk or severity of bleeding can be increased when Warfarin is combined with Fludarabine. |
| Ximelagatran | The risk or severity of bleeding can be increased when Ximelagatran is combined with Fludarabine. |
| Yellow fever vaccine | The risk or severity of infection can be increased when Yellow fever vaccine is combined with Fludarabine. |
| Zidovudine | The risk or severity of adverse effects can be increased when Zidovudine is combined with Fludarabine. |
Pregnancy and Lactation
FDA Pregnancy Category D
AU TGA pregnancy category: D
Pregnancy
Based on its mechanism of action this drug can cause fetal harm when administered to a pregnant woman. Adequate methods of contraception should be encouraged. Women of childbearing potential and fertile males should take contraceptive measures during therapy and at for at least 6 months after. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential harm to the fetus.
Lactation
It is not known whether fludarabine phosphate is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions including tumorigenicity in nursing infants, a decision should be made to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.
Other uses for this medicine
Fludarabine injection is also sometimes used to treat non-Hodgkin’s lymphoma (NHL; cancer that begins in a type of white blood cell that normally fights infection) and mycosis fungoides (a type of lymphoma that affects the skin). Talk to your doctor about the risks of using this medication for your condition. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
What special precautions should I follow?
Before receiving fludarabine injection,
- tell your doctor and pharmacist if you are allergic to fludarabine, any other medications, or any of the ingredients in fludarabine injection. Ask your pharmacist for a list of the ingredients.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention the medication listed in the IMPORTANT WARNING section or cytarabine (Cytosar-U, DepoCyt). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had kidney disease.Also tell your doctor about all the other chemotherapy medications you have received and if you have ever been treated with radiation therapy (cancer treatment that uses waves of high energy particles to kill cancer cells). Before you receive chemotherapy or radiation therapy in the future, tell your doctor that you have been treated with fludarabine.
- you should know that fludarabine injection may interfere with the normal menstrual cycle (period) in women and may stop sperm production in men. However, you should not assume that you or your partner cannot become pregnant. If you are pregnant or breast-feeding, you should tell your doctor before you begin receiving this medication. You should not plan to have children while receiving fludarabine injection or for at least 6 months after treatments. Use a reliable method of birth control to prevent pregnancy during this time. Talk to your doctor for further details. Fludarabine injection may harm the fetus.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are receiving fludarabine injection.
- you should know that fludarabine injection may cause tiredness, weakness, confusion, agitation, seizures, and vision changes. Do not drive a car or operate machinery until you know how this medication affects you.
- talk to your doctor before you receive any vaccinations during your treatment with fludarabine injection.
- you should know that you may develop a serious or life-threatening reaction if you need to receive a blood transfusion during your treatment with fludarabine injection or at any time after your treatment. Be sure to tell your doctor that you are receiving or have received fludarabine injection before you receive a blood transfusion.
References
