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Nelarabine is a purine analog and antineoplastic agent used in the therapy of T-cell lymphoblastic leukemia or lymphoma. Nelarabine is associated with a low rate of transient serum enzyme elevations during therapy and has been linked to rare instances of clinically apparent acute liver injury with jaundice.
Nelarabine is a purine nucleoside analog and antineoplastic agent used for the treatment of acute T-cell lymphoblastic leukemia and T-cell lymphoblastic lymphoma with inadequate clinical response to prior chemotherapeutic treatments. Nelarabine is an arabinonucleoside antimetabolite with antineoplastic activity. Nelarabine is demethoxylated by adenosine deaminase to become biologically active 9-beta-D-arabinosylguanine (ara-G); ara-G incorporates into DNA, thereby inhibiting DNA synthesis and inducing an S phase-dependent apoptosis of tumor cells. (NCI04)
Nelarabine is a purine nucleoside in which O-methylguanine is attached to arabinofuranose via a beta-N(9)-glycosidic bond. Inhibits DNA synthesis and causes cell death; a prodrug of 9-beta-D-arabinofuranosylguanine (ara-G). It has a role as an antineoplastic agent, a DNA synthesis inhibitor, and a prodrug. It is a purine nucleoside, a beta-D-arabinoside, and a monosaccharide derivative. It is functionally related to guanine and a 9-beta-D-arabinofuranosylguanine.
Mechanism of Action
Once nelarabine is metabolized into ara-GTP, the metabolite accumulates in leukemic blasts and incorporates into DNA to exert its S phase-specific cytotoxic effects, leading to the induction of fragmentation and apoptosis. Ara-GTP competes with endogenous deoxyGTP (dGTP) for incorporation into DNA. Once ara-GTP is incorporated at the 3′ end of DNA, further DNA elongation is inhibited, which signals apoptosis and leads to cellular destruction. Additional cytotoxic activities may exist, but these are not fully understood.
Nelarabine is a prodrug of the cytotoxic deoxyguanosine analog 9-ß-D-arabinofuranosylguanine (ara-G). Nelarabine is demethylated by adenosine deaminase (ADA) to ara-G. Ara-G is then transported into cells, where it undergoes three phosphorylation steps, resulting in the formation of ara-G triphosphate (ara-GTP). In the first phosphorylation step, ara-G is converted to ara-G monophosphate (ara-GMP). Ara-GMP is then monophosphorylated by deoxyguanosine kinase and deoxycytidine kinase to ara-G diphosphate, and then subsequently to the active ara-G triphosphate (ara-GTP). Ara-GTP is the one that exerts the pharmacological effect. Pre-clinical studies have demonstrated that targeted T-cells possess marked sensitivity to the agent.
Indications
- For the treatment of pediatric and adult patients with acute T-cell lymphoblastic leukemia and T-cell lymphoblastic lymphoma whose disease has not responded to or has relapsed following treatment with at least two chemotherapy regimens.
- Nelarabine is indicated for the treatment of patients with T-cell acute lymphoblastic leukemia (T-ALL) and T-cell lymphoblastic lymphoma (T-LBL) whose disease has not responded to or has relapsed following treatment with at least two chemotherapy regimens. Due to the small patient populations in these disease settings, the information to support these indications is based on limited data
- Nelarabine is a purine analog and antineoplastic agent used in the therapy of T-cell lymphoblastic leukemia or lymphoma. Nelarabine is associated with a low rate of transient serum enzyme elevations during therapy and has been linked to rare instances of clinically apparent acute liver injury with jaundice.
- T-cell acute lymphoblastic leukemia (T-ALL)
- T-cell lymphoblastic lymphoma (T-LBL)
Use in Cancer
Nelarabine is approved to treat adults and children aged 1 year or older with:
- T-cell acute lymphoblastic leukemia.
- T-cell lymphoblastic lymphoma.
Nelarabine is used in patients whose cancer has not gotten better with other treatments or has come back after at least two chemotherapy regimens.
Contraindications
- Hypersensitivity to nelarabine or any component of the formulation
- Severe neurologic reactions have been reported. Monitor for signs and
- symptoms of neurologic toxicity.
- Hematologic Reactions: Complete blood counts including platelets should be monitored regularly.
- Fetal harm can occur if administered to a pregnant woman. Women should be advised not to become pregnant when taking
Dosage
Strengths: 5 mg/mL
Usual Adult Dose
Acute Lymphoblastic Leukemia
- 1500 mg/m2 IV over 2 hours on days 1, 3, and 5 repeated every 21 days
Lymphoma
- 1500 mg/m2 IV over 2 hours on days 1, 3, and 5 repeated every 21 days
Usual Pediatric Dose
Acute Lymphoblastic Leukemia
- 650 mg/m2 IV over 1 hour daily for 5 consecutive days repeated every 21 days
Lymphoma
- 650 mg/m2 IV over 1 hour daily for 5 consecutive days repeated every 21 days
Side Effects
The Most Common
- nausea
- vomiting
- diarrhea
- constipation
- loss of appetite
- stomach pain or swelling
- sores on the mouth or tongue
- pain in the head or upper neck. সহজ বাংলা: মাথাব্যথা।" data-rx-term="headache" data-rx-definition="Headache means pain in the head or upper neck. সহজ বাংলা: মাথাব্যথা।">headache
- dizziness
- difficulty falling asleep or staying asleep
- depression
- pain in your arms, legs, back, or muscles
- swelling of the hands, arms, feet, ankles, or lower legs
- blurred vision
- pale skin
- shortness of breath
- fast heartbeat
- Myelosuppression, somnolence, dizziness, peripheral neurologic disorders,
- hypoesthesia, pain in the head or upper neck. সহজ বাংলা: মাথাব্যথা।" data-rx-term="headache" data-rx-definition="Headache means pain in the head or upper neck. সহজ বাংলা: মাথাব্যথা।">headache, numbness. সহজ বাংলা: ঝিনঝিন/অবশ/জ্বালাভাব।" data-rx-term="paresthesia" data-rx-definition="Paresthesia means abnormal feelings such as tingling, pins and needles, burning, or numbness. সহজ বাংলা: ঝিনঝিন/অবশ/জ্বালাভাব।">paresthesia, fatigue, pyrexia, asthenia, edema, pain, myalgia
More Common
- chest pain
- cough
- wheezing
- unusual bleeding or bruising
- nosebleeds
- small red or purple dots on the skin
- fever, sore throat, chills, or other signs of infection
- extreme thirst
- decreased urination
- sunken eyes
- dry mouth and skin
Rare
- abdominal pain
- anxiety
- fever
- flu and flu-like symptoms (e.g., fatigue, sore throat, headache, fever, chills)
- symptoms of a chest or lung infection (bronchitis, pneumonia; e.g., shortness of breath, cough, chest pain)
- symptoms of infection (e.g., unusual fatigue, fever, aches, pain, flu-like symptoms)
- symptoms of shingles (e.g., “band” of severe pain, blistering rash, headache, burning, tingling, numbness or itchiness of the skin, general feeling of being unwell)
- symptoms of tuberculosis (e.g., persistent cough, fever, weight loss)
- vaginal yeast infection (e.g., itching, white, curd-like discharge)
Drug Interactions
| DRUG | INTERACTION |
|---|---|
| Abatacept | The adverse effects’ risk or severity can increase when Nelarabine is combined with Abatacept. |
| Abciximab | The risk or severity of bleeding can be increased when Abciximab is combined with Nelarabine. |
| Acenocoumarol | The risk or severity of bleeding can be increased when Acenocoumarol is combined with Nelarabine. |
| Acetylsalicylic acid | The risk or severity of bleeding can be increased when Acetylsalicylic acid is combined with Nelarabine. |
| Adalimumab | The risk or severity of adverse effects can be increased when Adalimumab is combined with Nelarabine. |
| Adenovirus type 7 vaccine | The risk or severity of infection can be increased when the Adenovirus type 7 vaccine live is combined with Nelarabine. |
| Aldesleukin | The risk or severity of adverse effects can be increased when Aldesleukin is combined with Nelarabine. |
| Alefacept | The adverse effects’ risk or severity can increase when Alefacept is combined with Nelarabine. |
| Alemtuzumab | The adverse effects risk or severity can increase when Alemtuzumab is combined with Nelarabine. |
| Allogeneic processed | The therapeutic efficacy of Allogeneic processed thymus tissue can be decreased when used in combination with Nelarabine. |
| Allopurinol | The adverse effects risk or severity can increase when Allopurinol is combined with Nelarabine. |
| Alteplase | The risk or severity of bleeding can be increased when Alteplase is combined with Nelarabine. |
| Altretamine | The adverse effects risk or severity can increase when Altretamine is combined with Nelarabine. |
| Amsacrine | The adverse effects’ risk or severity can increase when Amsacrine is combined with Nelarabine. |
| Anagrelide | The risk or severity of bleeding can be increased when Anagrelide is combined with Nelarabine. |
| Anakinra | The risk or severity of adverse effects can be increased when Anakinra is combined with Nelarabine. |
| Ancrod | The risk or severity of bleeding can be increased when Ancrod is combined with Nelarabine. |
| Anifrolumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Anifrolumab. |
| Anistreplase | The risk or severity of bleeding can be increased when Anistreplase is combined with Nelarabine. |
| Anthrax immune globulin | The therapeutic efficacy of Anthrax immune globulin human can be decreased when used in combination with Nelarabine. |
| Anthrax vaccine | The risk or severity of infection can be increased when the Anthrax vaccine is combined with Nelarabine. |
| antilymphocyte | The adverse effects’ risk or severity can increase when Nelarabine is combined with Antilymphocyte immunoglobulin (horse). |
| Antithrombin Alfa | The risk or severity of bleeding can be increased when Antithrombin Alfa is combined with Nelarabine. |
| Antithrombin III human | The risk or severity of bleeding can be increased when Antithrombin III human is combined with Nelarabine. |
| Antithymocyte immunoglobulin | The risk or severity of adverse effects can be increased when Antithymocyte immunoglobulin (rabbit) is combined with Nelarabine. |
| Apixaban | The risk or severity of bleeding can be increased when Apixaban is combined with Nelarabine. |
| Apremilast | The adverse effects’ risk or severity can increase when Nelarabine is combined with Apremilast. |
| Ardeparin | The risk or severity of bleeding can be increased when Ardeparin is combined with Nelarabine. |
| Argatroban | The risk or severity of bleeding can be increased when Argatroban is combined with Nelarabine. |
| Arsenic trioxide | The adverse effects’ risk or severity can increase when Arsenic trioxide is combined with Nelarabine. |
| Articaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Articaine. |
| AstraZeneca COVID-19 Vaccine | The therapeutic efficacy of AstraZeneca COVID-19 Vaccine can be decreased when used in combination with Nelarabine. |
| Azacitidine | The risk or severity of adverse effects can be increased when Azacitidine is combined with Nelarabine. |
| Azathioprine | The risk or severity of adverse effects can be increased when Azathioprine is combined with Nelarabine. |
| Bacillus calmette-guerin | The risk or severity of infection can be increased when Bacillus calmette-guerin substrain connaught live antigen is combined with Nelarabine. |
| Bacillus calmette-guerin | The therapeutic efficacy of Bacillus calmette-guerin substrain russian BCG-I live antigen can be decreased when used in combination with Nelarabine. |
| Bacillus calmette-guerin substrain | The risk or severity of infection can be increased when Bacillus calmette-guerin substrain tice live antigen is combined with Nelarabine. |
| Baricitinib | The risk or severity of adverse effects can be increased when Nelarabine is combined with Baricitinib. |
| Basiliximab | The risk or severity of adverse effects can be increased when Basiliximab is combined with Nelarabine. |
| BCG vaccine | The risk or severity of infection can be increased when BCG vaccine is combined with Nelarabine. |
| Beclomethasone dipropionate | The risk or severity of adverse effects can be increased when Beclomethasone dipropionate is combined with Nelarabine. |
| Belatacept | The risk or severity of adverse effects can be increased when Nelarabine is combined with Belatacept. |
| Belimumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Belimumab. |
| Belinostat | The risk or severity of adverse effects can be increased when Nelarabine is combined with Belinostat. |
| Belumosudil | The risk or severity of adverse effects can be increased when Nelarabine is combined with Belumosudil. |
| Bemiparin | The risk or severity of bleeding can be increased when Bemiparin is combined with Nelarabine. |
| Bendamustine | The risk or severity of adverse effects can be increased when Nelarabine is combined with Bendamustine. |
| Bendroflumethiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Bendroflumethiazide is combined with Nelarabine. |
| Benzocaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Benzocaine. |
| Benzthiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Benzthiazide is combined with Nelarabine. |
| Benzyl alcohol | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Benzyl alcohol. |
| Betamethasone | The risk or severity of adverse effects can be increased when Betamethasone is combined with Nelarabine. |
| Betrixaban | The risk or severity of bleeding can be increased when Betrixaban is combined with Nelarabine. |
| Bexarotene | The risk or severity of adverse effects can be increased when Bexarotene is combined with Nelarabine. |
| Bimekizumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Bimekizumab. |
| Bivalirudin | The risk or severity of bleeding can be increased when Bivalirudin is combined with Nelarabine. |
| Bleomycin | The risk or severity of adverse effects can be increased when Bleomycin is combined with Nelarabine. |
| Blinatumomab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Blinatumomab. |
| Bordetella pertussis toxoid | The therapeutic efficacy of Bordetella pertussis toxoid antigen (formaldehyde, glutaraldehyde inactivated) can be decreased when used in combination with Nelarabine. |
| Bortezomib | The risk or severity of adverse effects can be increased when Bortezomib is combined with Nelarabine. |
| Bosutinib | The risk or severity of adverse effects can be increased when Nelarabine is combined with Bosutinib. |
| Brentuximab vedotin | The risk or severity of adverse effects can be increased when Nelarabine is combined with Brentuximab vedotin. |
| Brodalumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Brodalumab. |
| Budesonide | The risk or severity of adverse effects can be increased when Budesonide is combined with Nelarabine. |
| Bupivacaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Bupivacaine. |
| Busulfan | The risk or severity of adverse effects can be increased when Busulfan is combined with Nelarabine. |
| Butacaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Butacaine. |
| Butamben | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Butamben. |
| Cabazitaxel | The risk or severity of adverse effects can be increased when Nelarabine is combined with Cabazitaxel. |
| Canakinumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Canakinumab. |
| Cangrelor | The risk or severity of bleeding can be increased when Cangrelor is combined with Nelarabine. |
| Capecitabine | The risk or severity of adverse effects can be increased when Capecitabine is combined with Nelarabine. |
| Caplacizumab | The risk or severity of bleeding can be increased when Caplacizumab is combined with Nelarabine. |
| Capsaicin | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Capsaicin. |
| Carbamazepine | The risk or severity of adverse effects can be increased when Carbamazepine is combined with Nelarabine. |
| Carboplatin | The risk or severity of adverse effects can be increased when Carboplatin is combined with Nelarabine. |
| Carfilzomib | The risk or severity of adverse effects can be increased when Nelarabine is combined with Carfilzomib. |
| Carmustine | The risk or severity of adverse effects can be increased when Carmustine is combined with Nelarabine. |
| Certolizumab pegol | The risk or severity of adverse effects can be increased when Nelarabine is combined with Certolizumab pegol. |
| Chlorambucil | The risk or severity of adverse effects can be increased when Chlorambucil is combined with Nelarabine. |
| Chloramphenicol | The risk or severity of adverse effects can be increased when Chloramphenicol is combined with Nelarabine. |
| Chloroprocaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Chloroprocaine. |
| Chlorothiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Chlorothiazide is combined with Nelarabine. |
| Ciclesonide | The risk or severity of adverse effects can be increased when Nelarabine is combined with Ciclesonide. |
| Cilostazol | The risk or severity of bleeding can be increased when Cilostazol is combined with Nelarabine. |
| Cinchocaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Cinchocaine. |
| Cisplatin | The risk or severity of adverse effects can be increased when Cisplatin is combined with Nelarabine. |
| Cladribine | The risk or severity of adverse effects can be increased when Cladribine is combined with Nelarabine. |
| Clobetasol propionate | The risk or severity of adverse effects can be increased when Clobetasol propionate is combined with Nelarabine. |
| Clofarabine | The risk or severity of adverse effects can be increased when Clofarabine is combined with Nelarabine. |
| Clopidogrel | The risk or severity of bleeding can be increased when Clopidogrel is combined with Nelarabine. |
| Clostridium tetani toxoid antigen | The therapeutic efficacy of Clostridium tetani toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Nelarabine. |
| Clozapine | The risk or severity of neutropenia can be increased when Nelarabine is combined with Clozapine. |
| Cocaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Cocaine. |
| Corticotropin | The risk or severity of adverse effects can be increased when Nelarabine is combined with Corticotropin. |
| Cortisone acetate | The risk or severity of adverse effects can be increased when Nelarabine is combined with Cortisone acetate. |
| Corynebacterium diphtheriae | The therapeutic efficacy of Corynebacterium diphtheriae toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Nelarabine. |
| Cyanocobalamin | The therapeutic efficacy of Cyanocobalamin can be decreased when used in combination with Nelarabine. |
| Cyclopenthiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Cyclopenthiazide is combined with Nelarabine. |
| Cyclophosphamide | The risk or severity of adverse effects can be increased when Cyclophosphamide is combined with Nelarabine. |
| Cyclosporine | Nelarabine may increase the immunosuppressive activities of Cyclosporine. |
| Cyclothiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Cyclothiazide is combined with Nelarabine. |
| Cytarabine | The risk or severity of adverse effects can be increased when Cytarabine is combined with Nelarabine. |
| Dabigatran | The risk or severity of bleeding can be increased when Dabigatran is combined with Nelarabine. |
| Dabigatran etexilate | The risk or severity of bleeding can be increased when Dabigatran etexilate is combined with Nelarabine. |
| Dacarbazine | The risk or severity of adverse effects can be increased when Dacarbazine is combined with Nelarabine. |
| Dactinomycin | The risk or severity of adverse effects can be increased when Dactinomycin is combined with Nelarabine. |
| Dalteparin | The risk or severity of bleeding can be increased when Dalteparin is combined with Nelarabine. |
| Danaparoid | The risk or severity of bleeding can be increased when Danaparoid is combined with Nelarabine. |
| Darbepoetin alfa | The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Nelarabine. |
| Dasatinib | The risk or severity of adverse effects can be increased when Dasatinib is combined with Nelarabine. |
| Daunorubicin | The risk or severity of adverse effects can be increased when Daunorubicin is combined with Nelarabine. |
| Decitabine | The risk or severity of adverse effects can be increased when Decitabine is combined with Nelarabine. |
| Defibrotide | The risk or severity of bleeding can be increased when Defibrotide is combined with Nelarabine. |
| Deflazacort | The risk or severity of adverse effects can be increased when Nelarabine is combined with Deflazacort. |
| Denosumab | The risk or severity of adverse effects can be increased when Denosumab is combined with Nelarabine. |
| Desirudin | The risk or severity of bleeding can be increased when Desirudin is combined with Nelarabine. |
| Desoximetasone | The risk or severity of adverse effects can be increased when Desoximetasone is combined with Nelarabine. |
| Deucravacitinib | The risk or severity of adverse effects can be increased when Nelarabine is combined with Deucravacitinib. |
| Dexamethasone | The risk or severity of adverse effects can be increased when Dexamethasone is combined with Nelarabine. |
| Dexrazoxane | The risk or severity of adverse effects can be increased when Dexrazoxane is combined with Nelarabine. |
| Dextran | The risk or severity of bleeding can be increased when Dextran is combined with Nelarabine. |
| Dicoumarol | The risk or severity of bleeding can be increased when Dicoumarol is combined with Nelarabine. |
| Difluocortolone | The risk or severity of adverse effects can be increased when Nelarabine is combined with Difluocortolone. |
| Dimethyl fumarate | The risk or severity of adverse effects can be increased when Nelarabine is combined with Dimethyl fumarate. |
| Dinutuximab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Dinutuximab. |
| Diphenhydramine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Diphenhydramine. |
| Dipyridamole | The risk or severity of bleeding can be increased when Dipyridamole is combined with Nelarabine. |
| Diroximel fumarate | The risk or severity of adverse effects can be increased when Nelarabine is combined with Diroximel fumarate. |
| Docetaxel | The risk or severity of adverse effects can be increased when Docetaxel is combined with Nelarabine. |
| Doxorubicin | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Nelarabine. |
| Drotrecogin alfa | The risk or severity of bleeding can be increased when Drotrecogin alfa is combined with Nelarabine. |
| Dyclonine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Dyclonine. |
| Ebola Zaire vaccine | The therapeutic efficacy of Ebola Zaire vaccine (live, attenuated) can be decreased when used in combination with Nelarabine. |
| Eculizumab | The risk or severity of adverse effects can be increased when Eculizumab is combined with Nelarabine. |
| Edetic acid | The risk or severity of bleeding can be increased when Edetic acid is combined with Nelarabine. |
| Edoxaban | The risk or severity of bleeding can be increased when Edoxaban is combined with Nelarabine. |
| Efalizumab | The risk or severity of adverse effects can be increased when Efalizumab is combined with Nelarabine. |
| Emapalumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Emapalumab. |
| Enoxaparin | The risk or severity of bleeding can be increased when Enoxaparin is combined with Nelarabine. |
| Epirubicin | The risk or severity of adverse effects can be increased when Epirubicin is combined with Nelarabine. |
| Epoprostenol | The risk or severity of bleeding can be increased when Epoprostenol is combined with Nelarabine. |
| Eptifibatide | The risk or severity of bleeding can be increased when Eptifibatide is combined with Nelarabine. |
| Eribulin | The adverse effects’ risk or severity can increase when Nelarabine is combined with Eribulin. |
| Erythropoietin | The risk or severity of Thrombosis can be increased when Erythropoietin is combined with Nelarabine. |
| Estramustine | The adverse effects’ risk or severity can increase when Estramustine is combined with Nelarabine. |
| Etanercept | The risk or severity of adverse effects can be increased when Etanercept is combined with Nelarabine. |
| Ethyl chloride | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Ethyl chloride. |
| Etidocaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Etidocaine. |
| Etoposide | The risk or severity of adverse effects can be increased when Etoposide is combined with Nelarabine. |
| Everolimus | The risk or severity of adverse effects can be increased when Nelarabine is combined with Everolimus. |
| Filgotinib | The risk or severity of adverse effects can be increased when Nelarabine is combined with Filgotinib. |
| Fingolimod | Nelarabine may increase the immunosuppressive activities of Fingolimod. |
| Floxuridine | The risk or severity of adverse effects can be increased when Floxuridine is combined with Nelarabine. |
| Flucytosine | The risk or severity of adverse effects can be increased when Flucytosine is combined with Nelarabine. |
| Fludarabine | The risk or severity of adverse effects can be increased when Fludarabine is combined with Nelarabine. |
| Fludrocortisone | The risk or severity of adverse effects can be increased when Fludrocortisone is combined with Nelarabine. |
| Fluindione | The risk or severity of bleeding can be increased when Fluindione is combined with Nelarabine. |
| Flunisolide | The risk or severity of adverse effects can be increased when Flunisolide is combined with Nelarabine. |
| Fluocinolone acetonide | The risk or severity of adverse effects can be increased when Fluocinolone acetonide is combined with Nelarabine. |
| Fluocinonide | The risk or severity of adverse effects can be increased when Fluocinonide is combined with Nelarabine. |
| Fluocortolone | The risk or severity of adverse effects can be increased when Nelarabine is combined with Fluocortolone. |
| Fluorometholone | The risk or severity of adverse effects can be increased when Fluorometholone is combined with Nelarabine. |
| Fluorouracil | The risk or severity of adverse effects can be increased when Fluorouracil is combined with Nelarabine. |
| Flupentixol | The risk or severity of myelosuppression can be increased when Flupentixol is combined with Nelarabine. |
| Fluprednisolone | The risk or severity of adverse effects can be increased when Nelarabine is combined with Fluprednisolone. |
| Fluticasone | The risk or severity of adverse effects can be increased when Nelarabine is combined with Fluticasone. |
| Fluticasone furoate | The risk or severity of adverse effects can be increased when Nelarabine is combined with Fluticasone furoate. |
| Fluticasone propionate | The risk or severity of adverse effects can be increased when Fluticasone propionate is combined with Nelarabine. |
| Fondaparinux | The risk or severity of bleeding can be increased when Fondaparinux is combined with Nelarabine. |
| Gallium nitrate | The risk or severity of adverse effects can be increased when Nelarabine is combined with Gallium nitrate. |
| Gemcitabine | The risk or severity of adverse effects can be increased when Gemcitabine is combined with Nelarabine. |
| Gemtuzumab ozogamicin | The risk or severity of adverse effects can be increased when Gemtuzumab ozogamicin is combined with Nelarabine. |
| Glatiramer | The risk or severity of adverse effects can be increased when Nelarabine is combined with Glatiramer. |
| Golimumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Golimumab. |
| Guselkumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Guselkumab. |
| Haemophilus influenzae | The therapeutic efficacy of Haemophilus influenzae type B strain 20752 capsular polysaccharide tetanus toxoid conjugate antigen can be decreased when used in combination with Nelarabine. |
| Heparin | The risk or severity of bleeding can be increased when Heparin is combined with Nelarabine. |
| Hepatitis A Vaccine | The therapeutic efficacy of Hepatitis A Vaccine can be decreased when used in combination with Nelarabine. |
| Hepatitis B Vaccine (Recombinant) | The therapeutic efficacy of Hepatitis B Vaccine (Recombinant) can be decreased when used in combination with Nelarabine. |
| Human adenovirus | The risk or severity of infection can be increased when Human adenovirus e serotype 4 strain cl-68578 antigen is combined with Nelarabine. |
| Hydrochlorothiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Hydrochlorothiazide is combined with Nelarabine. |
| Hydrocortisone acetate | The risk or severity of adverse effects can be increased when Nelarabine is combined with Hydrocortisone acetate. |
| Hydrocortisone butyrate | The risk or severity of adverse effects can be increased when Nelarabine is combined with Hydrocortisone butyrate. |
| Hydrocortisone succinate | The risk or severity of adverse effects can be increased when Nelarabine is combined with Hydrocortisone succinate. |
| Hydroflumethiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Hydroflumethiazide is combined with Nelarabine. |
| Hydroxychloroquine | The risk or severity of adverse effects can be increased when Nelarabine is combined with Hydroxychloroquine. |
| Hydroxyurea | The risk or severity of adverse effects can be increased when Hydroxyurea is combined with Nelarabine. |
| Ibritumomab tiuxetan | The risk or severity of adverse effects can be increased when Ibritumomab tiuxetan is combined with Nelarabine. |
| Ibrutinib | The risk or severity of adverse effects can be increased when Nelarabine is combined with Ibrutinib. |
| Icosapent ethyl | The risk or severity of bleeding can be increased when Icosapent ethyl is combined with Nelarabine. |
| Idarubicin | The risk or severity of adverse effects can be increased when Idarubicin is combined with Nelarabine. |
| Idelalisib | The risk or severity of adverse effects can be increased when Nelarabine is combined with Idelalisib. |
| Ifosfamide | The risk or severity of adverse effects can be increased when Ifosfamide is combined with Nelarabine. |
| Iloprost | The risk or severity of bleeding can be increased when Iloprost is combined with Nelarabine. |
| Imatinib | The risk or severity of adverse effects can be increased when Imatinib is combined with Nelarabine. |
| Indomethacin | The risk or severity of adverse effects can be increased when Indomethacin is combined with Nelarabine. |
| Inebilizumab | The risk or severity of infection can be increased when Nelarabine is combined with Inebilizumab. |
| Infliximab | The risk or severity of adverse effects can be increased when Infliximab is combined with Nelarabine. |
| Irinotecan | The risk or severity of adverse effects can be increased when Irinotecan is combined with Nelarabine. |
| Ixabepilone | The risk or severity of adverse effects can be increased when Nelarabine is combined with Ixabepilone. |
| Ixekizumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Ixekizumab. |
| JCOVID-19 Vaccine | The therapeutic efficacy of Janssen COVID-19 Vaccine can be decreased when used in combination with Nelarabine. |
| Japanese encephalitis | The therapeutic efficacy of Japanese encephalitis virus strain sa 14-14-2 antigen (formaldehyde inactivated) can be decreased when used in combination with Nelarabine. |
| Leflunomide | The risk or severity of adverse effects can be increased when Nelarabine is combined with Leflunomide. |
| Lenalidomide | The risk or severity of adverse effects can be increased when Lenalidomide is combined with Nelarabine. |
| Lepirudin | The risk or severity of bleeding can be increased when Lepirudin is combined with Nelarabine. |
| Levobupivacaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Levobupivacaine. |
| Lidocaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Lidocaine. |
| Linezolid | The risk or severity of adverse effects can be increased when Linezolid is combined with Nelarabine. |
| Lipegfilgrastim | Nelarabine may increase the myelosuppressive activities of Lipegfilgrastim. |
| Lomustine | The risk or severity of adverse effects can be increased when Lomustine is combined with Nelarabine. |
| Lopinavir | The serum concentration of Nelarabine can be increased when it is combined with Lopinavir. |
| Magnesium | The serum concentration of Magnesium can be decreased when it is combined with Nelarabine. |
| Measles virus vaccine | The therapeutic efficacy of Measles virus vaccine live attenuated can be decreased when used in combination with Nelarabine. |
| Mechlorethamine | The risk or severity of adverse effects can be increased when Mechlorethamine is combined with Nelarabine. |
| Meloxicam | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Meloxicam. |
| Melphalan | The risk or severity of adverse effects can be increased when Melphalan is combined with Nelarabine. |
| Meningococcal oligosaccharide | 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 Nelarabine. |
| Mepivacaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Mepivacaine. |
| Mepolizumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Mepolizumab. |
| Meprednisone | The risk or severity of adverse effects can be increased when Nelarabine is combined with Meprednisone. |
| Mercaptopurine | The risk or severity of adverse effects can be increased when Mercaptopurine is combined with Nelarabine. |
| Methimazole | The risk or severity of adverse effects can be increased when Methimazole is combined with Nelarabine. |
| Methotrexate | The risk or severity of adverse effects can be increased when Methotrexate is combined with Nelarabine. |
| Methoxy polyethylene | The risk or severity of Thrombosis can be increased when Methoxy polyethylene glycol-epoetin beta is combined with Nelarabine. |
| Methylprednisolone | The risk or severity of adverse effects can be increased when Methylprednisolone is combined with Nelarabine. |
| Mitomycin | The risk or severity of adverse effects can be increased when Mitomycin is combined with Nelarabine. |
| Mitoxantrone | The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Nelarabine. |
| COVID-19 Vaccine | The therapeutic efficacy of Moderna COVID-19 Vaccine can be decreased when used in combination with Nelarabine. |
| Modified vaccinia ankara | The therapeutic efficacy of Modified vaccinia ankara can be decreased when used in combination with Nelarabine. |
| Mometasone furoate | The risk or severity of adverse effects can be increased when Nelarabine is combined with Mometasone furoate. |
| Monomethyl fumarate | The risk or severity of adverse effects can be increased when Nelarabine is combined with Monomethyl fumarate. |
| Mosunetuzumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Mosunetuzumab. |
| Mumps virus strain B | The therapeutic efficacy of Mumps virus strain B level jeryl lynn live antigen can be decreased when used in combination with Nelarabine. |
| Muromonab | The risk or severity of adverse effects can be increased when Muromonab is combined with Nelarabine. |
| Mycophenolate mofetil | The risk or severity of adverse effects can be increased when Mycophenolate mofetil is combined with Nelarabine. |
| Mycophenolic acid | The risk or severity of adverse effects can be increased when Mycophenolic acid is combined with Nelarabine. |
| Nadroparin | The risk or severity of bleeding can be increased when Nadroparin is combined with Nelarabine. |
| Natalizumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Natalizumab. |
| Nilotinib | The risk or severity of adverse effects can be increased when Nelarabine is combined with Nilotinib. |
| Nimesulide | The risk or severity of bleeding can be increased when Nimesulide is combined with Nelarabine. |
| Nuvaxovid | The therapeutic efficacy of Nuvaxovid can be decreased when used in combination with Nelarabine. |
| Obinutuzumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Obinutuzumab. |
| Ocrelizumab | Ocrelizumab may increase the immunosuppressive activities of Nelarabine. |
| Ofatumumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Ofatumumab. |
| Olaparib | The risk or severity of adverse effects can be increased when Nelarabine is combined with Olaparib. |
| Oxaliplatin | The risk or severity of adverse effects can be increased when Oxaliplatin is combined with Nelarabine. |
| Oxetacaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Oxetacaine. |
| Oxybuprocaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Oxybuprocaine. |
| Ozanimod | The risk or severity of adverse effects can be increased when Nelarabine is combined with Ozanimod. |
| Paclitaxel | The risk or severity of adverse effects can be increased when Paclitaxel is combined with Nelarabine. |
| Palbociclib | The risk or severity of adverse effects can be increased when Nelarabine is combined with Palbociclib. |
| Palifermin | The therapeutic efficacy of Palifermin can be decreased when used in combination with Nelarabine. |
| Panobinostat | The risk or severity of adverse effects can be increased when Nelarabine is combined with Panobinostat. |
| Parnaparin | The risk or severity of bleeding can be increased when Parnaparin is combined with Nelarabine. |
| Pazopanib | The risk or severity of adverse effects can be increased when Nelarabine is combined with Pazopanib. |
| Pegaspargase | The risk or severity of adverse effects can be increased when Pegaspargase is combined with Nelarabine. |
| Pegcetacoplan | The risk or severity of adverse effects can be increased when Nelarabine is combined with Pegcetacoplan. |
| Peginesatide | The risk or severity of Thrombosis can be increased when Peginesatide is combined with Nelarabine. |
| Peginterferon alfa-2a | The risk or severity of adverse effects can be increased when Peginterferon alfa-2a is combined with Nelarabine. |
| Peginterferon alfa-2b | The risk or severity of adverse effects can be increased when Peginterferon alfa-2b is combined with Nelarabine. |
| Peginterferon beta-1a | The risk or severity of adverse effects can be increased when Nelarabine is combined with Peginterferon beta-1a. |
| Pemetrexed | The risk or severity of adverse effects can be increased when Pemetrexed is combined with Nelarabine. |
| Penicillamine | The risk or severity of adverse effects can be increased when Penicillamine is combined with Nelarabine. |
| Pentosan polysulfate | The risk or severity of bleeding can be increased when Pentosan polysulfate is combined with Nelarabine. |
| Pentostatin | The therapeutic efficacy of Nelarabine can be decreased when used in combination with Pentostatin. |
| Pentoxifylline | The risk or severity of bleeding can be increased when Pentoxifylline is combined with Nelarabine. |
| Pertussis vaccine | The therapeutic efficacy of Pertussis vaccine can be decreased when used in combination with Nelarabine. |
| Phenindione | The risk or severity of bleeding can be increased when Phenindione is combined with Nelarabine. |
| Phenol | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Phenol. |
| Phenprocoumon | The risk or severity of bleeding can be increased when Phenprocoumon is combined with Nelarabine. |
| Phenylalanine | The risk or severity of adverse effects can be increased when Phenylalanine is combined with Nelarabine. |
| Pimecrolimus | The risk or severity of adverse effects can be increased when Pimecrolimus is combined with Nelarabine. |
| Pirfenidone | The risk or severity of adverse effects can be increased when Nelarabine is combined with Pirfenidone. |
| Polythiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Polythiazide is combined with Nelarabine. |
| Pomalidomide | The risk or severity of adverse effects can be increased when Nelarabine is combined with Pomalidomide. |
| Ponatinib | The risk or severity of adverse effects can be increased when Nelarabine is combined with Ponatinib. |
| Ponesimod | The risk or severity of adverse effects can be increased when Nelarabine is combined with Ponesimod. |
| Pralatrexate | The risk or severity of adverse effects can be increased when Nelarabine is combined with Pralatrexate. |
| Pramocaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Pramocaine. |
| Prasugrel | The risk or severity of bleeding can be increased when Prasugrel is combined with Nelarabine. |
| Prednisolone | The risk or severity of adverse effects can be increased when Prednisolone is combined with Nelarabine. |
| Prednisone | The risk or severity of adverse effects can be increased when Prednisone is combined with Nelarabine. |
| Prilocaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Prilocaine. |
| Procaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Procaine. |
| Procarbazine | The risk or severity of adverse effects can be increased when Procarbazine is combined with Nelarabine. |
| Proparacaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Proparacaine. |
| Propoxycaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Propoxycaine. |
| Propylthiouracil | The risk or severity of adverse effects can be increased when Propylthiouracil is combined with Nelarabine. |
| Protein C | The risk or severity of bleeding can be increased when Protein C is combined with Nelarabine. |
| Protein S human | The risk or severity of bleeding can be increased when Protein S human is combined with Nelarabine. |
| Rabies immune globulin, human | The therapeutic efficacy of Rabies immune globulin, human can be decreased when used in combination with Nelarabine. |
| Rabies virus inactivated antigen, A | The therapeutic efficacy of Rabies virus inactivated antigen, A can be decreased when used in combination with Nelarabine. |
| Rabies virus inactivated antigen, B | The therapeutic efficacy of Rabies virus inactivated antigen, B can be decreased when used in combination with Nelarabine. |
| Raltitrexed | The risk or severity of adverse effects can be increased when Raltitrexed is combined with Nelarabine. |
| Ravulizumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Ravulizumab. |
| Reteplase | The risk or severity of bleeding can be increased when Reteplase is combined with Nelarabine. |
| Reviparin | The risk or severity of bleeding can be increased when Reviparin is combined with Nelarabine. |
| Rilonacept | The risk or severity of adverse effects can be increased when Nelarabine is combined with Rilonacept. |
| Risankizumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Risankizumab. |
| Rituximab | The risk or severity of adverse effects can be increased when Rituximab is combined with Nelarabine. |
| Rivaroxaban | The risk or severity of bleeding can be increased when Rivaroxaban is combined with Nelarabine. |
| Roflumilast | Roflumilast may increase the immunosuppressive activities of Nelarabine. |
| Ropeginterferon alfa-2b | The risk or severity of adverse effects can be increased when Nelarabine is combined with Ropeginterferon alfa-2b. |
| Ropivacaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Ropivacaine. |
| Rotavirus vaccine | The therapeutic efficacy of the Rotavirus vaccine can be decreased when used in combination with Nelarabine. |
| Rubella virus vaccine | The risk or severity of infection can be increased when the Rubella virus vaccine is combined with Nelarabine. |
| Ruxolitinib | The risk or severity of adverse effects can be increased when Nelarabine is combined with Ruxolitinib. |
| Sarilumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Sarilumab. |
| Natalizumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Satralizumab. |
| Secukinumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Secukinumab. |
| Siltuximab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Siltuximab. |
| Siponimod | The risk or severity of adverse effects can be increased when Nelarabine is combined with Siponimod. |
| Sipuleucel-T | The therapeutic efficacy of Sipuleucel-T can be decreased when used in combination with Nelarabine. |
| Sirolimus | The risk or severity of adverse effects can be increased when Sirolimus is combined with Nelarabine. |
| Smallpox | The therapeutic efficacy of Smallpox (Vaccinia) Vaccine, Live can be decreased when used in combination with Nelarabine. |
| Sodium citrate | The risk or severity of bleeding can be increased when Sodium citrate is combined with Nelarabine. |
| Sorafenib | The risk or severity of adverse effects can be increased when Sorafenib is combined with Nelarabine. |
| Spesolimab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Spesolimab. |
| Streptokinase | The risk or severity of bleeding can be increased when Streptokinase is combined with Nelarabine. |
| Streptozocin | The risk or severity of adverse effects can be increased when Streptozocin is combined with Nelarabine. |
| Sulfamethoxazole | The risk or severity of myelosuppression can be increased when Sulfamethoxazole is combined with Nelarabine. |
| Sulfasalazine | The risk or severity of adverse effects can be increased when Sulfasalazine is combined with Nelarabine. |
| Sulfinpyrazone | The risk or severity of bleeding can be increased when Sulfinpyrazone is combined with Nelarabine. |
| Sulodexide | The risk or severity of bleeding can be increased when Sulodexide is combined with Nelarabine. |
| Sunitinib | The risk or severity of adverse effects can be increased when Sunitinib is combined with Nelarabine. |
| Tacrolimus | Tacrolimus may increase the immunosuppressive activities of Nelarabine. |
| Tedizolid phosphate | The risk or severity of myelosuppression can be increased when Nelarabine is combined with Tedizolid phosphate. |
| Temozolomide | The risk or severity of adverse effects can be increased when Temozolomide is combined with Nelarabine. |
| Temsirolimus | The risk or severity of adverse effects can be increased when Nelarabine is combined with Temsirolimus. |
| Tenecteplase | The risk or severity of bleeding can be increased when Tenecteplase is combined with Nelarabine. |
| Teniposide | The risk or severity of adverse effects can be increased when Teniposide is combined with Nelarabine. |
| Teprotumumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Teprotumumab. |
| Teriflunomide | The risk or severity of adverse effects can be increased when Nelarabine is combined with Teriflunomide. |
| Tetracaine | The risk or severity of methemoglobinemia can be increased when Nelarabine is combined with Tetracaine. |
| Thalidomide | The risk or severity of adverse effects can be increased when Thalidomide is combined with Nelarabine. |
| Thiotepa | The risk or severity of adverse effects can be increased when Nelarabine is combined with Thiotepa. |
| Ticagrelor | The risk or severity of bleeding can be increased when Ticagrelor is combined with Nelarabine. |
| Tick-borne encephalitis | The therapeutic efficacy of Tick-borne encephalitis vaccine (whole virus, inactivated) can be decreased when used in combination with Nelarabine. |
| Ticlopidine | The risk or severity of bleeding can be increased when Ticlopidine is combined with Nelarabine. |
| Tinzaparin | The risk or severity of bleeding can be increased when Tinzaparin is combined with Nelarabine. |
| Tioguanine | The risk or severity of adverse effects can be increased when Tioguanine is combined with Nelarabine. |
| Tirofiban | The risk or severity of bleeding can be increased when Tirofiban is combined with Nelarabine. |
| Tixocortol | The risk or severity of adverse effects can be increased when Nelarabine is combined with Tixocortol. |
| Tocilizumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Tocilizumab. |
| Tofacitinib | Nelarabine may increase the immunosuppressive activities of Tofacitinib. |
| Topotecan | The risk or severity of adverse effects can be increased when Topotecan is combined with Nelarabine. |
| Tositumomab | The risk or severity of adverse effects can be increased when Tositumomab is combined with Nelarabine. |
| Trabectedin | The risk or severity of adverse effects can be increased when Nelarabine is combined with Trabectedin. |
| Trastuzumab | Trastuzumab may increase the neutropenic activities of Nelarabine. |
| Trastuzumab emtansine | The risk or severity of adverse effects can be increased when Nelarabine is combined with Trastuzumab emtansine. |
| Tretinoin | The risk or severity of adverse effects can be increased when Tretinoin is combined with Nelarabine. |
| Triamcinolone | The risk or severity of adverse effects can be increased when Triamcinolone is combined with Nelarabine. |
| Trichlormethiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Trichlormethiazide is combined with Nelarabine. |
| Trifluridine | The risk or severity of adverse effects can be increased when Trifluridine is combined with Nelarabine. |
| Triflusal | The risk or severity of bleeding can be increased when Triflusal is combined with Nelarabine. |
| Trilostane | The risk or severity of adverse effects can be increased when Trilostane is combined with Nelarabine. |
| Typhoid vaccine | The therapeutic efficacy of Typhoid vaccine can be decreased when used in combination with Nelarabine. |
| Typhoid Vaccine Live | The risk or severity of infection can be increased when Typhoid Vaccine Live is combined with Nelarabine. |
| Typhoid Vi polysaccharide vaccine | The therapeutic efficacy of Typhoid Vi polysaccharide vaccine can be decreased when used in combination with Nelarabine. |
| Upadacitinib | The risk or severity of adverse effects can be increased when Nelarabine is combined with Upadacitinib. |
| Urokinase | The risk or severity of bleeding can be increased when Urokinase is combined with Nelarabine. |
| Varicella zoster vaccine | The risk or severity of infection can be increased when Varicella zoster vaccine (live/attenuated) is combined with Nelarabine. |
| Varicella zoster vaccine | The therapeutic efficacy of Varicella zoster vaccine (recombinant) can be decreased when used in combination with Nelarabine. |
| Vedolizumab | The risk or severity of adverse effects can be increased when Nelarabine is combined with Vedolizumab. |
| Vibrio cholerae CVD 103 | The therapeutic efficacy of Vibrio cholerae CVD 103-HgR strain live antigen can be decreased when used in combination with Nelarabine. |
| Vilanterol | The risk or severity of adverse effects can be increased when Nelarabine is combined with Vilanterol. |
| Vinblastine | The risk or severity of adverse effects can be increased when Vinblastine is combined with Nelarabine. |
| Vincristine | The risk or severity of adverse effects can be increased when Vincristine is combined with Nelarabine. |
| Vindesine | The risk or severity of adverse effects can be increased when Vindesine is combined with Nelarabine. |
| Vinorelbine | The risk or severity of adverse effects can be increased when Vinorelbine is combined with Nelarabine. |
| Voclosporin | The risk or severity of adverse effects can be increased when Nelarabine is combined with Voclosporin. |
| Vorapaxar | The risk or severity of bleeding can be increased when Vorapaxar is combined with Nelarabine. |
| Vorinostat | The risk or severity of adverse effects can be increased when Nelarabine is combined with Vorinostat. |
| Warfarin | The risk or severity of bleeding can be increased when Warfarin is combined with Nelarabine. |
| Ximelagatran | The risk or severity of bleeding can be increased when Ximelagatran is combined with Nelarabine. |
| Yellow fever vaccine | The risk or severity of infection can be increased when Yellow fever vaccine is combined with Nelarabine. |
| Zidovudine | The adverse effects’ risk or severity can increase when Zidovudine is combined with Nelarabine. |
Pregnancy and Lactation
Pregnancy Category D
Pregnancy
Based on its mechanism of action and findings in animal studies, this drug can cause fetal harm when administered to a pregnant woman. Administration to pregnant animals during the period of organogenesis resulted in teratogenicity at maternal doses below the recommended human adult dose. Limited available data on pregnant women are insufficient to determine a drug-associated risk for major birth defects, miscarriage, or adverse maternal or fetal outcomes. There are risks to the pregnant woman associated with untreated leukemia or lymphoma including anemia, thrombocytopenia, and death.
Breastfeeding
There are no data on the presence of this drug in human or animal milk, the effect on the breastfed child, or the effect on milk production. Because of the potential for serious adverse reactions in the breastfed child such as severe neurological reactions, women should not breastfeed during therapy.
Use should be avoided.
Excreted into human milk: Unknown
Excreted into animal milk: Data not available
What special precautions should I follow?
Before using nelarabine injection,
- tell your doctor and pharmacist if you are allergic to nelarabine, any other medications, or any of the ingredients in nelarabine 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 adenosine deaminase inhibitors such as pentostatin (Nipent). 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 or liver disease.
- tell your doctor if you or your partner are pregnant or plan to become pregnant. If you are female, you will need to take a pregnancy test before you begin receiving nelarabine and should not become pregnant while you are using nelarabine. If you are male, you and your female partner should use birth control during your treatment and for 3 months after your final dose. Talk to your doctor about birth control methods that you can use during your treatment. If you or your partner become pregnant while using nelarabine, call your doctor immediately. Nelarabine may harm the fetus.
- tell your doctor if you are breastfeeding. You should not breastfeed while you are using nelarabine.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are receiving nelarabine.
- you should know that nelarabine may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
- do not have any vaccinations during your treatment with nelarabine without talking with your doctor.
When to Contact Your Doctor or Health Care Provider:
Contact your healthcare provider immediately, day or night, if you should experience any of the following symptoms:
- Fever of 100.4 F (38C) or higher, chills (possible signs of infection).
- Seizures, confusion, extreme sleepiness, numbness/tingling or extreme weakness.
- Nausea (interferes with the ability to eat and is unrelieved with prescribed medication)
- Vomiting (vomiting more than 4-5 times in a 24-hour period)
- Diarrhea (4-6 episodes in a 24-hour period)
- Extreme fatigue (unable to carry on self-care activities)
- Constipation unrelieved by laxative use
- Numbness and tingling in the hands, fingers, feet or toes
- Problems with fine motor skills such as buttoning clothes
- Unsteady while walking or increased tripping while walking
- Weakness when getting out of a chair or walking upstairs
- Swelling of the feet or ankles. Sudden weight gain.
- Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decreased amount of urine, or dizziness
- Unable to urinate
- Unusual bleeding or bruising
- Black or tarry stools, or blood in your stools
- Blood in the urine
- Chest pain or pressure or a fast heartbeat
Always inform your healthcare provider if you experience any unusual symptoms.
Self-Care Tips
- Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
- You may be at risk of infection so try to avoid crowds or people with colds and those not feeling well, and report fever or any other signs of infection immediately to your healthcare provider.
- Wash your hands often.
- Use an electric razor and a soft toothbrush to minimize bleeding.
- Avoid contact sports or activities that could cause injury.
- This medication causes little nausea. But if you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals. Sucking on lozenges and chewing gum may also help.
- Keep your bowels moving. Your healthcare provider may prescribe a stool softener to help prevent constipation that may be caused by this medicine.
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition.
- If you experience symptoms or side effects, be sure to discuss them with your healthcare team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
- Acetaminophen or ibuprofen may help relieve discomfort from fever, headache, and/or generalized aches and pains. However, be sure to talk with your doctor before taking it.
References
Nelarabine [USAN:INN:BAN]
ChemIDplus Chemical Information Classification
Nelarabine
CompTox Chemicals Dashboard Chemical Lists
(2R,3S,4S,5R)-2-(2-amino-6-methoxypurin-9-yl)-5-(hydroxymethyl)oxolane-3,4-diol
(2R,3S,4S,5R)-2-(2-amino-6-methoxypurin-9-yl)-5-(hydroxymethyl)oxolane-3,4-diol
Nelarabine
HMDB0015401_msms_450594
FDA Pharmacological Classification
NCI Thesaurus Tree
ChEMBL Protein Target Tree
Atriance (EMEA/H/C/000752)
LICENSE
Data: CC-BY 4.0; Code (hosted by ECI, LCSB): Artistic-2.0
NORMAN Suspect List Exchange Classification
ATC Code
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Arranon (Nelarabine)
Nelarabine
PubChem
nelarabine
Therapeutic category of drugs in Japan
Anatomical Therapeutic Chemical (ATC) classification
Drug Classes
GHS Classification Tree
SID 403733741
NCBI
RX Medical Knowledge Graph
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