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Cladribine is a purine analog and antineoplastic agent used primarily in the therapy of hairy cell leukemia. Cladribine is typically given intravenously daily for 7 days, usually as a single course, and has not been associated with serum enzyme elevations during therapy or with instances of clinically apparent acute liver injury with jaundice.
Cladribine is a purine nucleoside antimetabolite analogue. Cladribine triphosphate, a phosphorylated metabolite of cladribine, incorporates into DNA, resulting in single-strand breaks in DNA, depletion of nicotinamide adenine dinucleotide (NAD) and adenosine triphosphate (ATP), and apoptosis. Because this agent is resistant to adenosine deaminase, an enzyme that inactivates some antineoplastic agents, it is selectively toxic to lymphocytes and monocytes which exhibit little deoxynucleotide deaminase activity. (NCI04)
Cladribine is 2′-Deoxyadenosine in which the hydrogen at position 2 on the purine ring has been substituted by chlorine. It inhibits the synthesis and repair of DNA, particularly in lymphocytes and monocytes, and is used as an antimetabolite antineoplastic drug for the treatment of lymphoid malignancies including hairy-cell leukemia and chronic lymphocytic leukemia. It has a role as an antineoplastic agent and an immunosuppressive agent. It is a purine 2′-deoxyribonucleoside and an organochlorine compound.
Cladribine is a nucleoside metabolic inhibitor that interferes with DNA repair and synthesis, proposed by the applicant for the treatment of
relapsing forms of multiple sclerosis (MS). Cladribine causes significant depletion of circulating lymphocytes after administration which lasts
for months. Cladribine is approved in an intravenous form with an indication for the treatment of hairy cell leukemia. Relapsing forms of MS, which include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease (secondary progressive MS with relapses), are a group of chronic and potentially disabling MS phenotypes of apparent autoimmune etiology characterized by episodes of worsening focal neurological deficits and disseminated lesions of demyelination. Symptoms include recurrent paroxysms of diminished sensory or motor function that can be disabling and usually resolve within one month. Over several years, many, but not all, patients with relapsing forms of MS experience some degree of persistent disability that may gradually worsen over years. In some patients, disability may accrue progressively in the absence of obvious relapse events, a process termed secondary progressive disease. A secondary progressive disease that occurs with continued relapses is described as an active secondary progressive disease, with the relapses being the clinical
manifestation, in part, of inflammatory demyelination that is presumed to be distinct from the pathogenesis of the progressive component of the disease. In the active secondary progressive phase of the disease, patients can accrue disability both from acute relapses and from the progressive component of the disease. Active secondary progressive disease and relapsing-remitting disease overlap in evolution. Categorization as a secondary progressive disease is based on clinical judgment; there are no clinical findings or biomarkers that meaningfully define or predict the phenotypes of relapsing forms of MS.
Mechanism of Action
Cladribine is structurally related to fludarabine and pentostatin but has a different mechanism of action. Although the exact mechanism of action has not been fully determined, evidence shows that cladribine is phosphorylated by deoxycytidine kinase to the nucleotidecladribine triphosphate (CdATP; 2-chloro-2′-deoxyadenosine 5′-triphosphate), which accumulates and is incorporated into DNA in cells such as lymphocytes that contain high levels of deoxycytidine kinase and low levels of deoxynucleotides, resulting in DNA strand breakage and inhibition of DNA synthesis and repair. High levels of CdATP also appear to inhibit ribonucleotide reductase, which leads to an imbalance in triphosphorylated deoxynucleotide (dNTP) pools and subsequent DNA strand breaks, inhibition of DNA synthesis and repair, nicotinamide adenine dinucleotide (NAD) and ATP depletion, and cell death. Unlike other antimetabolite drugs, cladribine has cytotoxic effects on resting as well as proliferating lymphocytes. However, it does cause cells to accumulate at the G1/S phase junction, suggesting that cytotoxicity is associated with events critical to cell entry into S phase. It also binds purine nucleoside phosphorylase (PNP), however, no relationship between this binding and a mechanism of action has been established.
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Cladribine is an antimetabolite. The exact mechanism of action in hairy cell leukemia is unknown. Cladribine is resistant to the action of adenosine deaminase (ADA), which deaminates deoxyadenosine to deoxyinosine. The phosphorylated metabolites of cladribine accumulate in cells with a high ratio of deoxycytidine kinase activity to 5′ nucleotidase activity (lymphocytes, monocytes ) and are converted to the active triphosphate deoxynucleotide. Intracellular accumulation of toxic deoxynucleotides selectively kills these cells, which become unable to properly repair single-strand DNA breaks, leading to disruption of cell metabolism. In addition, there is some evidence that deoxynucleotides are incorporated into the DNA of dividing cells and impair DNA synthesis. Cladribine also induces apoptosis (a form of programmed cell death in sensitive cells). Cladribine’s action is cell cycle-phase nonspecific; cladribine equally affects dividing and resting lymphocytes.
Cladribine is a synthetic purine nucleoside that acts as an antineoplastic agent with immunosuppressive effects. Cladribine differs structurally from deoxyadenosine only by the presence of a chlorine atom at position 2 of the purine ring, which results in resistance to enzymatic degradation by adenosine deaminase. Due to this resistance, cladribine exhibits a more prolonged cytotoxic effect than deoxyadenosine against resting and proliferating lymphocytes. Cladribine is one of a group of chemotherapy drugs known as the anti-metabolites. Anti-metabolites stop cells from making and repairing DNA, which are processes that are necessary for cancer cells to grow and multiply.
Indications
- For the treatment of active hairy cell leukemia (leukemic reticuloendotheliosis) as defined by clinically significant anemia, neutropenia, thrombocytopenia, or disease-related symptoms. Also used as an alternative agent for the treatment of chronic lymphocytic leukemia (CLL), low-grade non-Hodgkin’s lymphoma, and cutaneous T-cell lymphoma.
- Treatment of adult patients with highly active relapsing multiple sclerosis (MS) as defined by clinical or imaging features.
- Litak is indicated for the treatment of hairy-cell leukemia.
- Multiple Sclerosis
- Chronic Lymphocytic Leukemia (CLL)
- Cutaneous T Cell Lymphomas (CTCL)
- Hairy Cell Leukemia (HCL)
- Non-Hodgkin’s Lymphoma (NHL)
- Active confirmed by clinical features, confirmed by imaging features relapsing multiple sclerosis (MS)
Use in Cancer
Cladribine is approved to treat:
Cladribine is also being studied in the treatment of other types of cancer.
Contraindications
- hepatic cirrhosis,
- chronic kidney disease,
- active malignancy,
- HIV, or tuberculosis.
- Other contraindications to cladribine include a history of use of other immunosuppressants, including cyclophosphamide, azathioprine, methotrexate, or mitoxantrone.
- Sexually active men and women should receive counseling about cladribine’s teratogenicity and its effects on sperm quality and viability.
- a bad infection
- decreased function of bone marrow
- anemia
- a reduction in the body’s resistance to infection
- decreased function of bone marrow
- anemia
- a decreased number of lymphocytes in the blood
- inflammation of the liver called hepatitis
- severe liver disease
- decreased kidney function
- abnormal liver function tests
- decreased blood platelets
- low levels of a type of white blood cell called neutrophils
- a painful condition that affects the nerves in the legs and arms called peripheral neuropathy
- severe liver disease
- the high amount of uric acid in the blood
- abnormal liver function tests
- pregnancy
- a patient who is producing milk and breastfeeding
- progressive multifocal leukoencephalopathy, a type of brain infection
- chronic kidney disease stage 3A (moderate)
- chronic kidney disease stage 3B (moderate)
- chronic kidney disease stage 4 (severe)
- chronic kidney disease stage 5 (failure)
- Child-Pugh class B liver impairment
- Child-Pugh class C liver impairment
Dosage
Strengths: 1 mg/mL; 10 mg
Hairy Cell Leukemia
- 0.09 mg/kg/day by continuous IV infusion for 7 days
Alternate dosing recommendation:
- Subcutaneous bolus injection: 0.14 mg/kg/day subcutaneously for 5 consecutive days
- IV infusion: 0.1 mg/kg/day IV for 7 consecutive days
- Under certain hematological conditions (e.g., recovery of severe myelosuppression) a small number of patients may require a second cycle and occasionally a third cycle to achieve a stable and prolonged response.
Cladribine for multiple sclerosis is an orally administered drug. The FDA-approved dose is 3.5 mg/kg given over two years, administered as 1.75 mg/kg per year. Two treatment courses are separated by twelve months. The first course is given over four to five consecutive days in the first month, followed by an equivalent dose over four to five consecutive days in the second month.
The second course of cladribine follows twelve months later with the same frequency and dosing. For an adult of average body weight, dosing is estimated at approximately 10 to 20 mg daily for 4 to 5 days. Prescribers need to follow the manufacturer’s specific guidelines for weight-based dosing according to approved federal guidelines of the Risk Evaluation and Mitigation Strategies (REMS) program. Monitoring occurs as described below to assure safe remission of the disease without severe lymphopenia or other adverse events.[rx]
Side Effects
The Most Common
- nausea
- vomiting
- diarrhea
- stomach pain
- constipation
- loss of appetite
- skin rash
- headache
- excessive sweating
- pain, redness, swelling, or sores in the place where the medication was injected
- pale skin
- excessive tiredness
- shortness of breath
- dizziness
- fast heartbeat
More Common
- constipation
- diarrhea
- dizziness
- headache
- joint pain
- loss of appetite
- muscle pain
- nausea
- the overall feeling of discomfort or illness
- sleeping problems
- unusual tiredness
- heart problems–swelling, rapid weight gain, feeling short of breath;
- low blood cell counts–fever, swollen glands, stomach pain, cough, runny nose, joint pain, mouth sores, skin sores or rash, easy bruising, unusual bleeding;
- liver problems–nausea, vomiting, stomach pain, tiredness, loss of appetite, yellowing of your skin or eyes, dark urine;
- signs of shingles–flu-like symptoms, tingly or painful blistering rash on one side of your body; or
- signs of tuberculosis: fever, cough, night sweats, loss of appetite, weight loss, and feeling very tired.
- low white blood cell counts; or
- cold symptoms such as stuffy nose, sneezing, and sore throat.
Rare
- numbness or tingling of the hands or feet
- pain, swelling, or redness at the site of injection
- shortness of breath
- signs of bleeding (e.g., bloody nose, blood in urine, coughing blood, cuts that don’t stop bleeding)
- skin rash
- stomach pain
- sweating, pale skin
- swelling of feet or lower legs
- unusually fast heartbeat
- fever or chills
- flu-like symptoms (e.g., cough, hoarseness, sore throat, fever or chills)
- difficulty moving arms or legs
- shortness of breath
- signs of bleeding in the stomach (e.g., bloody, black, or tarry stools, spitting up of blood, vomiting blood or material that looks like coffee grounds)
- signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
- signs of a severe skin reaction (such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort)
- signs of a skin reaction at the injection site (e.g., red streaks along vein where medication was injected, pain at injection site, redness, or warmth at site of injection)
Drug Interaction
| DRUG | INTERACTION |
|---|---|
| Abatacept | The risk or severity of adverse effects can be increased when Cladribine is combined with Abatacept. |
| Abciximab | The risk or severity of bleeding can be increased when Abciximab is combined with Cladribine. |
| Abemaciclib | Abemaciclib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Acenocoumarol | The risk or severity of bleeding can be increased when Acenocoumarol is combined with Cladribine. |
| Acetyldigitoxin | Acetyldigitoxin may decrease the cardiotoxic activities of Cladribine. |
| Acetylsalicylic acid | The risk or severity of bleeding can be increased when Acetylsalicylic acid is combined with Cladribine. |
| Acipimox | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Acipimox. |
| Adalimumab | The risk or severity of adverse effects can be increased when Adalimumab is combined with Cladribine. |
| Adenovirus type | The risk or severity of infection can be increased when Adenovirus type 7 vaccine live is combined with Cladribine. |
| Afatinib | Afatinib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Aldesleukin | The risk or severity of adverse effects can be increased when Aldesleukin is combined with Cladribine. |
| Alectinib | Alectinib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Alefacept | The risk or severity of adverse effects can be increased when Alefacept is combined with Cladribine. |
| Alemtuzumab | The risk or severity of adverse effects can be increased when Alemtuzumab is combined with Cladribine. |
| Alendronic acid | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Alendronic acid. |
| Allogeneic thymus tissue | The therapeutic efficacy of Allogeneic processed thymus tissue can be decreased when used in combination with Cladribine. |
| Allopurinol | The risk or severity of adverse effects can be increased when Allopurinol is combined with Cladribine. |
| Alteplase | The risk or severity of bleeding can be increased when Alteplase is combined with Cladribine. |
| Altretamine | The risk or severity of adverse effects can be increased when Cladribine is combined with Altretamine. |
| Amiodarone | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Amiodarone. |
| Amphotericin B | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Amphotericin B. |
| Amsacrine | The risk or severity of adverse effects can be increased when Cladribine is combined with Amsacrine. |
| Anagrelide | The risk or severity of bleeding can be increased when Anagrelide is combined with Cladribine. |
| Anakinra | The risk or severity of adverse effects can be increased when Anakinra is combined with Cladribine. |
| Anastrozole | The risk or severity of cardiotoxicity can be increased when Cladribine is combined with Anastrozole. |
| Ancrod | The risk or severity of bleeding can be increased when Ancrod is combined with Cladribine. |
| Anifrolumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Anifrolumab. |
| Anistreplase | The risk or severity of bleeding can be increased when Anistreplase is combined with Cladribine. |
| immune globulin | The therapeutic efficacy of Anthrax immune globulin human can be decreased when used in combination with Cladribine. |
| Anthrax vaccine | The risk or severity of infection can be increased when Anthrax vaccine is combined with Cladribine. |
| Antilymphocyte | The risk or severity of adverse effects can be increased when Cladribine is combined with Antilymphocyte immunoglobulin (horse). |
| Antithrombin Alfa | The risk or severity of bleeding can be increased when Antithrombin Alfa is combined with Cladribine. |
| Antithrombin III | The risk or severity of bleeding can be increased when Antithrombin III human is combined with Cladribine. |
| Antithymocyte | The risk or severity of adverse effects can be increased when Antithymocyte immunoglobulin (rabbit) is combined with Cladribine. |
| Apalutamide | Apalutamide may increase the excretion rate of Cladribine which could result in a lower serum level and potentially a reduction in efficacy. |
| Apixaban | The risk or severity of bleeding can be increased when Apixaban is combined with Cladribine. |
| Apremilast | The risk or severity of adverse effects can be increased when Cladribine is combined with Apremilast. |
| Ardeparin | The risk or severity of bleeding can be increased when Ardeparin is combined with Cladribine. |
| Argatroban | The risk or severity of bleeding can be increased when Argatroban is combined with Cladribine. |
| Arsenic trioxide | The risk or severity of adverse effects can be increased when Cladribine is combined with Arsenic trioxide. |
| Articaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Articaine. |
| COVID-19 Vaccine | The therapeutic efficacy of AstraZeneca COVID-19 Vaccine can be decreased when used in combination with Cladribine. |
| Atorvastatin | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Atorvastatin. |
| Avanafil | Avanafil may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Avatrombopag | Avatrombopag may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Azacitidine | The risk or severity of adverse effects can be increased when Cladribine is combined with Azacitidine. |
| Azathioprine | The risk or severity of adverse effects can be increased when Cladribine is combined with Azathioprine. |
| Bacillus | The risk or severity of infection can be increased when Bacillus calmette-guerin substrain connaught live antigen is combined with Cladribine. |
| live antigen | The therapeutic efficacy of Bacillus calmette-guerin substrain russian BCG-I live antigen can be decreased when used in combination with Cladribine. |
| Bacillus calmette | The risk or severity of infection can be increased when Bacillus calmette-guerin substrain tice live antigen is combined with Cladribine. |
| Baclofen | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Baclofen is combined with Cladribine. |
| Baricitinib | The risk or severity of adverse effects can be increased when Cladribine is combined with Baricitinib. |
| Basiliximab | The risk or severity of adverse effects can be increased when Basiliximab is combined with Cladribine. |
| BCG vaccine | The risk or severity of infection can be increased when BCG vaccine is combined with Cladribine. |
| Beclomethasone | The risk or severity of adverse effects can be increased when Cladribine is combined with Beclomethasone dipropionate. |
| Belatacept | The risk or severity of adverse effects can be increased when Cladribine is combined with Belatacept. |
| Belimumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Belimumab. |
| Belinostat | The risk or severity of adverse effects can be increased when Cladribine is combined with Belinostat. |
| Belumosudil | The risk or severity of adverse effects can be increased when Cladribine is combined with Belumosudil. |
| Bemiparin | The risk or severity of bleeding can be increased when Bemiparin is combined with Cladribine. |
| Bendamustine | The risk or severity of adverse effects can be increased when Cladribine is combined with Bendamustine. |
| Bendroflumethiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Bendroflumethiazide is combined with Cladribine. |
| Benzocaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Benzocaine. |
| Benzthiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Benzthiazide is combined with Cladribine. |
| Benzyl alcohol | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Benzyl alcohol. |
| Betamethasone | The risk or severity of adverse effects can be increased when Cladribine is combined with Betamethasone. |
| Betrixaban | The risk or severity of bleeding can be increased when Betrixaban is combined with Cladribine. |
| Bevacizumab | The risk or severity of cardiotoxicity can be increased when Bevacizumab is combined with Cladribine. |
| Bexarotene | The risk or severity of adverse effects can be increased when Cladribine is combined with Bexarotene. |
| Bezafibrate | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Bezafibrate. |
| Bimekizumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Bimekizumab. |
| Bivalirudin | The risk or severity of bleeding can be increased when Bivalirudin is combined with Cladribine. |
| Bleomycin | The risk or severity of adverse effects can be increased when Cladribine is combined with Bleomycin. |
| Blinatumomab | The risk or severity of adverse effects can be increased when Cladribine is combined with Blinatumomab. |
| Bordetella | The therapeutic efficacy of Bordetella pertussis toxoid antigen (formaldehyde, glutaraldehyde inactivated) can be decreased when used in combination with Cladribine. |
| Bortezomib | The risk or severity of adverse effects can be increased when Bortezomib is combined with Cladribine. |
| Bosutinib | The risk or severity of adverse effects can be increased when Cladribine is combined with Bosutinib. |
| Brentuximab | The risk or severity of adverse effects can be increased when Cladribine is combined with Brentuximab vedotin. |
| Brigatinib | Brigatinib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Brodalumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Brodalumab. |
| Budesonide | The risk or severity of adverse effects can be increased when Cladribine is combined with Budesonide. |
| Bumetanide | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Bumetanide. |
| Bupivacaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Bupivacaine. |
| Buprenorphine | Buprenorphine may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Busulfan | The risk or severity of adverse effects can be increased when Cladribine is combined with Busulfan. |
| Butacaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Butacaine. |
| Butamben | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Butamben. |
| Cabazitaxel | The risk or severity of adverse effects can be increased when Cladribine is combined with Cabazitaxel. |
| Caffeine | Caffeine may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Canakinumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Canakinumab. |
| Cangrelor | The risk or severity of bleeding can be increased when Cangrelor is combined with Cladribine. |
| Cannabidiol | Cannabidiol may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Capecitabine | The risk or severity of adverse effects can be increased when Cladribine is combined with Capecitabine. |
| Caplacizumab | The risk or severity of bleeding can be increased when Caplacizumab is combined with Cladribine. |
| Capmatinib | The serum concentration of Cladribine can be increased when it is combined with Capmatinib. |
| Capsaicin | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Capsaicin. |
| Captopril | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Captopril. |
| Carbamazepine | The risk or severity of adverse effects can be increased when Cladribine is combined with Carbamazepine. |
| Carbimazole | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Carbimazole. |
| Carboplatin | The risk or severity of adverse effects can be increased when Cladribine is combined with Carboplatin. |
| Carfilzomib | The risk or severity of adverse effects can be increased when Cladribine is combined with Carfilzomib. |
| Carmustine | The risk or severity of adverse effects can be increased when Cladribine is combined with Carmustine. |
| Cerivastatin | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Cerivastatin. |
| Certolizumab pegol | The risk or severity of adverse effects can be increased when Cladribine is combined with Certolizumab pegol. |
| Chlorambucil | The risk or severity of adverse effects can be increased when Cladribine is combined with Chlorambucil. |
| Chloramphenicol | The risk or severity of adverse effects can be increased when Cladribine is combined with Chloramphenicol. |
| Chloroprocaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Chloroprocaine. |
| Chloroquine | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Chloroquine. |
| Chlorothiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Chlorothiazide is combined with Cladribine. |
| Cholesterol | Cholesterol may increase the excretion rate of Cladribine which could result in a lower serum level and potentially a reduction in efficacy. |
| Ciclesonide | The risk or severity of adverse effects can be increased when Cladribine is combined with Ciclesonide. |
| Cilostazol | The risk or severity of bleeding can be increased when Cilostazol is combined with Cladribine. |
| Cimetidine | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Cimetidine. |
| Cinchocaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Cinchocaine. |
| Ciprofibrate | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Ciprofibrate. |
| Ciprofloxacin | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Ciprofloxacin. |
| Cisplatin | The risk or severity of adverse effects can be increased when Cladribine is combined with Cisplatin. |
| Clobetasol | The risk or severity of adverse effects can be increased when Cladribine is combined with Clobetasol propionate. |
| Clofarabine | The risk or severity of adverse effects can be increased when Cladribine is combined with Clofarabine. |
| Clofazimine | Clofazimine may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Clofibrate | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Clofibrate. |
| Clopidogrel | The risk or severity of bleeding can be increased when Clopidogrel is combined with Cladribine. |
| Clostridium tetani | The therapeutic efficacy of Clostridium tetani toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Cladribine. |
| Clozapine | The risk or severity of neutropenia can be increased when Cladribine is combined with Clozapine. |
| Cobicistat | Cobicistat may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Cocaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Cocaine. |
| Colchicine | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Colchicine. |
| Corticotropin | The risk or severity of adverse effects can be increased when Cladribine is combined with Corticotropin. |
| Cortisone acetate | The risk or severity of adverse effects can be increased when Cladribine is combined with Cortisone acetate. |
| Corynebacterium | The therapeutic efficacy of Corynebacterium diphtheriae toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Cladribine. |
| Cyanocobalamin | The therapeutic efficacy of Cyanocobalamin can be decreased when used in combination with Cladribine. |
| Cyclopenthiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Cyclopenthiazide is combined with Cladribine. |
| Cyclophosphamide | The risk or severity of adverse effects can be increased when Cladribine is combined with Cyclophosphamide. |
| Cyclosporine | Cladribine may increase the immunosuppressive activities of Cyclosporine. |
| Cyclothiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Cyclothiazide is combined with Cladribine. |
| Cytarabine | The risk or severity of adverse effects can be increased when Cladribine is combined with Cytarabine. |
| Dabigatran | The risk or severity of bleeding can be increased when Dabigatran is combined with Cladribine. |
| Dabigatran etexilate | The risk or severity of bleeding can be increased when Dabigatran etexilate is combined with Cladribine. |
| Dabrafenib | Dabrafenib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Dacarbazine | The risk or severity of adverse effects can be increased when Cladribine is combined with Dacarbazine. |
| Daclatasvir | Daclatasvir may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Dacomitinib | Dacomitinib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Dactinomycin | The risk or severity of adverse effects can be increased when Cladribine is combined with Dactinomycin. |
| Dalteparin | The risk or severity of bleeding can be increased when Dalteparin is combined with Cladribine. |
| Danaparoid | The risk or severity of bleeding can be increased when Danaparoid is combined with Cladribine. |
| Daptomycin | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Daptomycin is combined with Cladribine. |
| Darbepoetin alfa | The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Cladribine. |
| Darolutamide | The serum concentration of Cladribine can be increased when it is combined with Darolutamide. |
| Dasabuvir | Dasabuvir may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Dasatinib | The risk or severity of adverse effects can be increased when Cladribine is combined with Dasatinib. |
| Daunorubicin | The risk or severity of adverse effects can be increased when Cladribine is combined with Daunorubicin. |
| Decitabine | The risk or severity of adverse effects can be increased when Cladribine is combined with Decitabine. |
| Defibrotide | The risk or severity of bleeding can be increased when Defibrotide is combined with Cladribine. |
| Deflazacort | The risk or severity of adverse effects can be increased when Cladribine is combined with Deflazacort. |
| Denosumab | The risk or severity of adverse effects can be increased when Denosumab is combined with Cladribine. |
| Desirudin | The risk or severity of bleeding can be increased when Desirudin is combined with Cladribine. |
| Deslanoside | Deslanoside may decrease the cardiotoxic activities of Cladribine. |
| Desoximetasone | The risk or severity of adverse effects can be increased when Cladribine is combined with Desoximetasone. |
| Deucravacitinib | The risk or severity of adverse effects can be increased when Cladribine is combined with Deucravacitinib. |
| Dexamethasone | The risk or severity of adverse effects can be increased when Cladribine is combined with Dexamethasone. |
| Dexamethasone | Dexamethasone acetate may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Dexrazoxane | The risk or severity of adverse effects can be increased when Cladribine is combined with Dexrazoxane. |
| Dextran | The risk or severity of bleeding can be increased when Dextran is combined with Cladribine. |
| Dicoumarol | The risk or severity of bleeding can be increased when Dicoumarol is combined with Cladribine. |
| Diethylstilbestrol | Diethylstilbestrol may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Difluocortolone | The risk or severity of adverse effects can be increased when Cladribine is combined with Difluocortolone. |
| Digitoxin | Digitoxin may decrease the cardiotoxic activities of Cladribine. |
| Digoxin | Digoxin may decrease the cardiotoxic activities of Cladribine. |
| Dimethyl fumarate | The risk or severity of adverse effects can be increased when Cladribine is combined with Dimethyl fumarate. |
| Dinutuximab | The risk or severity of adverse effects can be increased when Cladribine is combined with Dinutuximab. |
| Diphenhydramine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Diphenhydramine. |
| Dipyridamole | The risk or severity of bleeding can be increased when Dipyridamole is combined with Cladribine. |
| Diroximel fumarate | The risk or severity of adverse effects can be increased when Cladribine is combined with Diroximel fumarate. |
| Docetaxel | The risk or severity of adverse effects can be increased when Cladribine is combined with Docetaxel. |
| Doxorubicin | The risk or severity of adverse effects can be increased when Cladribine is combined with Doxorubicin. |
| Drotrecogin alfa | The risk or severity of bleeding can be increased when Drotrecogin alfa is combined with Cladribine. |
| Dyclonine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Dyclonine. |
| Ebola Zaire vaccine | The therapeutic efficacy of Ebola Zaire vaccine (live, attenuated) can be decreased when used in combination with Cladribine. |
| Eculizumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Eculizumab. |
| Edetic acid | The risk or severity of bleeding can be increased when Edetic acid is combined with Cladribine. |
| Edoxaban | The risk or severity of bleeding can be increased when Edoxaban is combined with Cladribine. |
| Efalizumab | The risk or severity of adverse effects can be increased when Efalizumab is combined with Cladribine. |
| Elbasvir | Elbasvir may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Eltrombopag | Eltrombopag may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Emapalumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Emapalumab. |
| Enalapril | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Enalapril. |
| Enasidenib | Enasidenib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Enoxaparin | The risk or severity of bleeding can be increased when Enoxaparin is combined with Cladribine. |
| Epirubicin | The risk or severity of adverse effects can be increased when Cladribine is combined with Epirubicin. |
| Epoprostenol | The risk or severity of bleeding can be increased when Epoprostenol is combined with Cladribine. |
| Eprosartan | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Eprosartan. |
| Eptifibatide | The risk or severity of bleeding can be increased when Eptifibatide is combined with Cladribine. |
| Eribulin | The risk or severity of adverse effects can be increased when Cladribine is combined with Eribulin. |
| Erlotinib | Erlotinib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Erythropoietin | The risk or severity of Thrombosis can be increased when Erythropoietin is combined with Cladribine. |
| Estradiol | Estradiol may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Estradiol acetate | Estradiol acetate may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Estradiol benzoate | Estradiol benzoate may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Estradiol cypionate | Estradiol cypionate may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Estradiol dienanthate | Estradiol dienanthate may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Etanercept | The risk or severity of adverse effects can be increased when Etanercept is combined with Cladribine. |
| Ethanol | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Ethanol. |
| Ethyl chloride | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Ethyl chloride. |
| Etidocaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Etidocaine. |
| Etoposide | The risk or severity of adverse effects can be increased when Cladribine is combined with Etoposide. |
| Everolimus | The risk or severity of adverse effects can be increased when Cladribine is combined with Everolimus. |
| Famtozinameran | The therapeutic efficacy of Famtozinameran can be decreased when used in combination with Cladribine. |
| Febuxostat | The excretion of Cladribine can be decreased when combined with Febuxostat. |
| Fedratinib | Fedratinib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Fenofibrate | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Fenofibrate. |
| Fenofibric acid | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Fenofibric acid. |
| Filgotinib | The risk or severity of adverse effects can be increased when Cladribine is combined with Filgotinib. |
| Fingolimod | Cladribine may increase the immunosuppressive activities of Fingolimod. |
| Floxuridine | The risk or severity of adverse effects can be increased when Cladribine is combined with Floxuridine. |
| Flucytosine | The risk or severity of adverse effects can be increased when Cladribine is combined with Flucytosine. |
| Fludarabine | The risk or severity of adverse effects can be increased when Cladribine is combined with Fludarabine. |
| Fludrocortisone | The risk or severity of adverse effects can be increased when Cladribine is combined with Fludrocortisone. |
| Fluindione | The risk or severity of bleeding can be increased when Fluindione is combined with Cladribine. |
| Flunisolide | The risk or severity of adverse effects can be increased when Flunisolide is combined with Cladribine. |
| Fluocinolone | The risk or severity of adverse effects can be increased when Cladribine is combined with Fluocinolone acetonide. |
| Fluocinonide | The risk or severity of adverse effects can be increased when Cladribine is combined with Fluocinonide. |
| Fluocortolone | The risk or severity of adverse effects can be increased when Cladribine is combined with Fluocortolone. |
| Fluorometholone | The risk or severity of adverse effects can be increased when Cladribine is combined with Fluorometholone. |
| Fluorouracil | The risk or severity of adverse effects can be increased when Cladribine is combined with Fluorouracil. |
| Flupentixol | The risk or severity of myelosuppression can be increased when Flupentixol is combined with Cladribine. |
| Fluprednisolone | The risk or severity of adverse effects can be increased when Cladribine is combined with Fluprednisolone. |
| Fluticasone | The risk or severity of adverse effects can be increased when Cladribine is combined with Fluticasone. |
| Fluticasone furoate | The risk or severity of adverse effects can be increased when Cladribine is combined with Fluticasone furoate. |
| Fluticasone | The risk or severity of adverse effects can be increased when Cladribine is combined with Fluticasone propionate. |
| Fluvastatin | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Fluvastatin. |
| Fondaparinux | The risk or severity of bleeding can be increased when Fondaparinux is combined with Cladribine. |
| Fostamatinib | Fostamatinib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Fostemsavir | Fostemsavir may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Fusidic acid | Fusidic acid may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Gallium nitrate | The risk or severity of adverse effects can be increased when Cladribine is combined with Gallium nitrate. |
| Ganciclovir | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Ganciclovir. |
| Gefitinib | Gefitinib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Gemcitabine | The risk or severity of adverse effects can be increased when Cladribine is combined with Gemcitabine. |
| Gemfibrozil | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Gemfibrozil. |
| Gemtuzumab | The risk or severity of adverse effects can be increased when Gemtuzumab ozogamicin is combined with Cladribine. |
| Gilteritinib | Gilteritinib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Glasdegib | Glasdegib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Glatiramer | The risk or severity of adverse effects can be increased when Cladribine is combined with Glatiramer. |
| Glecaprevir | Glecaprevir may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Golimumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Golimumab. |
| Grazoprevir | Grazoprevir may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Guselkumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Guselkumab. |
| Hydrochlorothiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Hydrochlorothiazide is combined with Cladribine. |
| Hydrocortisone | The risk or severity of adverse effects can be increased when Cladribine is combined with Hydrocortisone acetate. |
| Hydrocortisone | The risk or severity of adverse effects can be increased when Cladribine is combined with Hydrocortisone butyrate. |
| Hydrocortisone succinate | The risk or severity of adverse effects can be increased when Cladribine is combined with Hydrocortisone succinate. |
| Hydroflumethiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Hydroflumethiazide is combined with Cladribine. |
| Hydroxychloroquine | The risk or severity of adverse effects can be increased when Cladribine is combined with Hydroxychloroquine. |
| Hydroxyurea | The risk or severity of adverse effects can be increased when Cladribine is combined with Hydroxyurea. |
| Ibandronate | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Ibandronate. |
| Ibritumomab tiuxetan | The risk or severity of adverse effects can be increased when Ibritumomab tiuxetan is combined with Cladribine. |
| Ibrutinib | The risk or severity of adverse effects can be increased when Cladribine is combined with Ibrutinib. |
| Icosapent ethyl | The risk or severity of bleeding can be increased when Icosapent ethyl is combined with Cladribine. |
| Idarubicin | The risk or severity of adverse effects can be increased when Cladribine is combined with Idarubicin. |
| Idelalisib | The risk or severity of adverse effects can be increased when Cladribine is combined with Idelalisib. |
| Ifosfamide | The risk or severity of adverse effects can be increased when Cladribine is combined with Ifosfamide. |
| Iloprost | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Iloprost. |
| Imatinib | The risk or severity of adverse effects can be increased when Cladribine is combined with Imatinib. |
| Indinavir | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Indinavir is combined with Cladribine. |
| Indomethacin | The risk or severity of adverse effects can be increased when Cladribine is combined with Indomethacin. |
| Inebilizumab | The risk or severity of infection can be increased when Cladribine is combined with Inebilizumab. |
| Infliximab | The risk or severity of adverse effects can be increased when Infliximab is combined with Cladribine. |
| Itraconazole | Itraconazole may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Ivermectin | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Ivermectin. |
| Ixabepilone | The risk or severity of adverse effects can be increased when Cladribine is combined with Ixabepilone. |
| Ixekizumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Ixekizumab. |
| COVID-19 Vaccine | The therapeutic efficacy of Janssen COVID-19 Vaccine can be decreased when used in combination with Cladribine. |
| encephalitis virus | The therapeutic efficacy of Japanese encephalitis virus strain sa 14-14-2 antigen (formaldehyde inactivated) can be decreased when used in combination with Cladribine. |
| Lamivudine | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Lamivudine. |
| Lansoprazole | Lansoprazole may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Lasmiditan | The serum concentration of Cladribine can be increased when it is combined with Lasmiditan. |
| Ledipasvir | Ledipasvir may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Leflunomide | The risk or severity of adverse effects can be increased when Cladribine is combined with Leflunomide. |
| Lenalidomide | The risk or severity of adverse effects can be increased when Cladribine is combined with Lenalidomide. |
| Lepirudin | The risk or severity of bleeding can be increased when Lepirudin is combined with Cladribine. |
| Lercanidipine | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Lercanidipine. |
| Letermovir | Letermovir may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Letrozole | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Letrozole. |
| Leuprolide | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Leuprolide is combined with Cladribine. |
| Levobupivacaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Levobupivacaine. |
| Lidocaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Lidocaine. |
| Linezolid | The risk or severity of adverse effects can be increased when Cladribine is combined with Linezolid. |
| Lipegfilgrastim | Cladribine may increase the myelosuppressive activities of Lipegfilgrastim. |
| Lomustine | The risk or severity of adverse effects can be increased when Cladribine is combined with Lomustine. |
| Lopinavir | The serum concentration of Cladribine can be increased when it is combined with Lopinavir. |
| Lovastatin | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Lovastatin is combined with Cladribine. |
| Magnesium | The serum concentration of Magnesium can be decreased when it is combined with Cladribine. |
| Maribavir | Maribavir may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Measles virus vaccine | The therapeutic efficacy of Measles virus vaccine live attenuated can be decreased when used in combination with Cladribine. |
| Mebeverine | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Mebeverine. |
| Mechlorethamine | The risk or severity of adverse effects can be increased when Cladribine is combined with Mechlorethamine. |
| Mefloquine | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Mefloquine. |
| Meloxicam | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Meloxicam. |
| Melphalan | The risk or severity of adverse effects can be increased when Cladribine is combined with Melphalan. |
| 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 Cladribine. |
| Mepivacaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Mepivacaine. |
| Mepolizumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Mepolizumab. |
| Meprednisone | The risk or severity of adverse effects can be increased when Cladribine is combined with Meprednisone. |
| Mercaptopurine | The risk or severity of adverse effects can be increased when Cladribine is combined with Mercaptopurine. |
| Metamizole | The risk or severity of myelosuppression can be increased when Metamizole is combined with Cladribine. |
| Methimazole | The risk or severity of adverse effects can be increased when Cladribine is combined with Methimazole. |
| Methotrexate | The risk or severity of adverse effects can be increased when Cladribine is combined with Methotrexate. |
| Methoxy polyethylene | The risk or severity of Thrombosis can be increased when Methoxy polyethylene glycol-epoetin beta is combined with Cladribine. |
| Methyldopa | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Methyldopa. |
| Methylprednisolone | The risk or severity of adverse effects can be increased when Cladribine is combined with Methylprednisolone. |
| Metoclopramide | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Metoclopramide. |
| Minocycline | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Minocycline. |
| Mitomycin | The risk or severity of adverse effects can be increased when Cladribine is combined with Mitomycin. |
| Mitoxantrone | The risk or severity of adverse effects can be increased when Cladribine is combined with Mitoxantrone. |
| COVID-19 Vaccine | The therapeutic efficacy of Moderna COVID-19 Vaccine can be decreased when used in combination with Cladribine. |
| Modified vaccinia ankara | The therapeutic efficacy of Modified vaccinia ankara can be decreased when used in combination with Cladribine. |
| Mometasone furoate | The risk or severity of adverse effects can be increased when Cladribine is combined with Mometasone furoate. |
| Monomethyl fumarate | The risk or severity of adverse effects can be increased when Cladribine is combined with Monomethyl fumarate. |
| Montelukast | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Montelukast. |
| Mosunetuzumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Mosunetuzumab. |
| Mumps virus strain | The therapeutic efficacy of Mumps virus strain B level jeryl lynn live antigen can be decreased when used in combination with Cladribine. |
| Muromonab | The risk or severity of adverse effects can be increased when Muromonab is combined with Cladribine. |
| Mycophenolate l | The risk or severity of adverse effects can be increased when Cladribine is combined with Mycophenolate mofetil. |
| Mycophenolic acid | The risk or severity of adverse effects can be increased when Cladribine is combined with Mycophenolic acid. |
| Nadroparin | The risk or severity of bleeding can be increased when Nadroparin is combined with Cladribine. |
| Nafarelin | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Nafarelin. |
| Naltrexone | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Naltrexone. |
| Natalizumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Natalizumab. |
| Nelarabine | The risk or severity of adverse effects can be increased when Cladribine is combined with Nelarabine. |
| Nelfinavir | Nelfinavir may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Niacin | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Niacin. |
| Nilotinib | The risk or severity of adverse effects can be increased when Cladribine is combined with Nilotinib. |
| Nimesulide | The risk or severity of bleeding can be increased when Nimesulide is combined with Cladribine. |
| Nizatidine | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Nizatidine. |
| Norfloxacin | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Norfloxacin. |
| Novobiocin | Novobiocin may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Nuvaxovid | The therapeutic efficacy of Nuvaxovid can be decreased when used in combination with Cladribine. |
| Obinutuzumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Obinutuzumab. |
| Ocrelizumab | Ocrelizumab may increase the immunosuppressive activities of Cladribine. |
| Ofatumumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Ofatumumab. |
| Ofloxacin | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Ofloxacin. |
| Olaparib | The risk or severity of adverse effects can be increased when Cladribine is combined with Olaparib. |
| Omeprazole | Omeprazole may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Osimertinib | Osimertinib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Oteseconazole | The serum concentration of Cladribine can be increased when it is combined with Oteseconazole. |
| Ouabain | Ouabain may decrease the cardiotoxic activities of Cladribine. |
| Oxaliplatin | The risk or severity of adverse effects can be increased when Cladribine is combined with Oxaliplatin. |
| Oxetacaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Oxetacaine. |
| Oxybuprocaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Oxybuprocaine. |
| Ozanimod | The risk or severity of adverse effects can be increased when Cladribine is combined with Ozanimod. |
| Paclitaxel | The risk or severity of adverse effects can be increased when Cladribine is combined with Paclitaxel. |
| Pacritinib | The serum concentration of Cladribine can be increased when it is combined with Pacritinib. |
| Palbociclib | The risk or severity of adverse effects can be increased when Cladribine is combined with Palbociclib. |
| Palifermin | The therapeutic efficacy of Palifermin can be decreased when used in combination with Cladribine. |
| Pamidronic acid | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Pamidronic acid. |
| Panobinostat | The risk or severity of adverse effects can be increased when Cladribine is combined with Panobinostat. |
| Pantoprazole | Pantoprazole may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Paritaprevir | Paritaprevir may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Parnaparin | The risk or severity of bleeding can be increased when Parnaparin is combined with Cladribine. |
| Pazopanib | The risk or severity of adverse effects can be increased when Cladribine is combined with Pazopanib. |
| Pegaspargase | The risk or severity of adverse effects can be increased when Pegaspargase is combined with Cladribine. |
| Pegcetacoplan | The risk or severity of adverse effects can be increased when Cladribine is combined with Pegcetacoplan. |
| Peginesatide | The risk or severity of Thrombosis can be increased when Peginesatide is combined with Cladribine. |
| Peginterferon alfa-2a | The risk or severity of adverse effects can be increased when Peginterferon alfa-2a is combined with Cladribine. |
| Peginterferon alfa-2b | The risk or severity of adverse effects can be increased when Peginterferon alfa-2b is combined with Cladribine. |
| Peginterferon beta-1a | The risk or severity of adverse effects can be increased when Cladribine is combined with Peginterferon beta-1a. |
| Pemetrexed | The risk or severity of adverse effects can be increased when Cladribine is combined with Pemetrexed. |
| Pentosan polysulfate | The risk or severity of bleeding can be increased when Pentosan polysulfate is combined with Cladribine. |
| Pentostatin | The risk or severity of adverse effects can be increased when Cladribine is combined with Pentostatin. |
| Pentoxifylline | The risk or severity of bleeding can be increased when Pentoxifylline is combined with Cladribine. |
| Pertussis vaccine | The therapeutic efficacy of Pertussis vaccine can be decreased when used in combination with Cladribine. |
| Pertuzumab | The risk or severity of cardiotoxicity can be increased when Cladribine is combined with Pertuzumab. |
| Phenindione | The risk or severity of bleeding can be increased when Phenindione is combined with Cladribine. |
| Phenol | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Phenol. |
| Phenprocoumon | The risk or severity of bleeding can be increased when Phenprocoumon is combined with Cladribine. |
| Phenylalanine | The risk or severity of adverse effects can be increased when Phenylalanine is combined with Cladribine. |
| Phenytoin | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Phenytoin. |
| Pibrentasvir | Pibrentasvir may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Pimecrolimus | The risk or severity of adverse effects can be increased when Pimecrolimus is combined with Cladribine. |
| Pirfenidone | The risk or severity of adverse effects can be increased when Cladribine is combined with Pirfenidone. |
| Pitavastatin | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Pitavastatin. |
| Polythiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Polythiazide is combined with Cladribine. |
| Pomalidomide | The risk or severity of adverse effects can be increased when Cladribine is combined with Pomalidomide. |
| Ponatinib | The risk or severity of adverse effects can be increased when Cladribine is combined with Ponatinib. |
| Ponesimod | The risk or severity of adverse effects can be increased when Cladribine is combined with Ponesimod. |
| Pralatrexate | The risk or severity of adverse effects can be increased when Cladribine is combined with Pralatrexate. |
| Pralsetinib | Pralsetinib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Pramocaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Pramocaine. |
| Prasugrel | The risk or severity of bleeding can be increased when Prasugrel is combined with Cladribine. |
| Pravastatin | Pravastatin may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Prednisolone | The risk or severity of adverse effects can be increased when Cladribine is combined with Prednisolone. |
| Prednisone | The risk or severity of adverse effects can be increased when Cladribine is combined with Prednisone. |
| Prilocaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Prilocaine. |
| Procainamide | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Procainamide. |
| Procaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Procaine. |
| Procarbazine | The risk or severity of adverse effects can be increased when Cladribine is combined with Procarbazine. |
| Progesterone | Progesterone may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Proparacaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Proparacaine. |
| Propofol | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Propofol. |
| Propoxycaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Propoxycaine. |
| Propylthiouracil | The risk or severity of adverse effects can be increased when Cladribine is combined with Propylthiouracil. |
| Protein C | The risk or severity of bleeding can be increased when Protein C is combined with Cladribine. |
| Protein S human | The risk or severity of bleeding can be increased when Protein S human is combined with Cladribine. |
| Rabeprazole | Rabeprazole may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Rabies immune | The therapeutic efficacy of Rabies immune globulin, human can be decreased when used in combination with Cladribine. |
| Rabies virus | The therapeutic efficacy of Rabies virus inactivated antigen, A can be decreased when used in combination with Cladribine. |
| Rabies virus | The therapeutic efficacy of Rabies virus inactivated antigen, B can be decreased when used in combination with Cladribine. |
| Raltegravir | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Raltegravir. |
| Raltitrexed | The risk or severity of adverse effects can be increased when Cladribine is combined with Raltitrexed. |
| Ranitidine | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Ranitidine. |
| Ravulizumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Ravulizumab. |
| Regorafenib | Regorafenib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Reteplase | The risk or severity of bleeding can be increased when Reteplase is combined with Cladribine. |
| Reviparin | The risk or severity of bleeding can be increased when Reviparin is combined with Cladribine. |
| Rilonacept | The risk or severity of adverse effects can be increased when Cladribine is combined with Rilonacept. |
| Rilpivirine | Rilpivirine may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Ripretinib | Ripretinib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Risankizumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Risankizumab. |
| Risedronic acid | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Risedronic acid. |
| Ritonavir | Ritonavir may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Rituximab | The risk or severity of adverse effects can be increased when Rituximab is combined with Cladribine. |
| Rivaroxaban | The risk or severity of bleeding can be increased when Rivaroxaban is combined with Cladribine. |
| Roflumilast | Roflumilast may increase the immunosuppressive activities of Cladribine. |
| Rolapitant | Rolapitant may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Ropeginterferon | The risk or severity of adverse effects can be increased when Cladribine is combined with Ropeginterferon alfa-2b. |
| Ropivacaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Ropivacaine. |
| Rosuvastatin | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Rosuvastatin. |
| Rotavirus vaccine | The therapeutic efficacy of Rotavirus vaccine can be decreased when used in combination with Cladribine. |
| Roxadustat | The serum concentration of Cladribine can be increased when it is combined with Roxadustat. |
| Rubella virus | The risk or severity of infection can be increased when Rubella virus vaccine is combined with Cladribine. |
| Rucaparib | Rucaparib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Ruxolitinib | The risk or severity of adverse effects can be increased when Cladribine is combined with Ruxolitinib. |
| Safinamide | Safinamide may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Salmeterol | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Salmeterol. |
| Saquinavir | Saquinavir may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Sarilumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Sarilumab. |
| Satralizumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Satralizumab. |
| Secukinumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Secukinumab. |
| Sildenafil | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Sildenafil is combined with Cladribine. |
| Siltuximab | The risk or severity of adverse effects can be increased when Cladribine is combined with Siltuximab. |
| Simeprevir | Simeprevir may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Simvastatin | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Simvastatin. |
| Siponimod | The risk or severity of adverse effects can be increased when Cladribine is combined with Siponimod. |
| Sipuleucel-T | The therapeutic efficacy of Sipuleucel-T can be decreased when used in combination with Cladribine. |
| Sirolimus | The risk or severity of adverse effects can be increased when Cladribine is combined with Sirolimus. |
| Smallpox | The therapeutic efficacy of Smallpox (Vaccinia) Vaccine, Live can be decreased when used in combination with Cladribine. |
| Sodium citrate | The risk or severity of bleeding can be increased when Sodium citrate is combined with Cladribine. |
| Somatotropin | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Somatotropin is combined with Cladribine. |
| Sorafenib | The risk or severity of adverse effects can be increased when Cladribine is combined with Sorafenib. |
| Sotagliflozin | Sotagliflozin may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Spesolimab | The risk or severity of adverse effects can be increased when Cladribine is combined with Spesolimab. |
| Stavudine | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Stavudine. |
| Stiripentol | The excretion of Cladribine can be decreased when combined with Stiripentol. |
| Streptokinase | The risk or severity of bleeding can be increased when Streptokinase is combined with Cladribine. |
| Streptozocin | The risk or severity of adverse effects can be increased when Cladribine is combined with Streptozocin. |
| Sulfamethoxazole | The risk or severity of myelosuppression can be increased when Sulfamethoxazole is combined with Cladribine. |
| Sulfasalazine | The risk or severity of adverse effects can be increased when Cladribine is combined with Sulfasalazine. |
| Sulfinpyrazone | The risk or severity of bleeding can be increased when Sulfinpyrazone is combined with Cladribine. |
| Sulodexide | The risk or severity of bleeding can be increased when Sulodexide is combined with Cladribine. |
| Sunitinib | The risk or severity of adverse effects can be increased when Cladribine is combined with Sunitinib. |
| Tacrine | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Tacrine. |
| Tacrolimus | Tacrolimus may increase the immunosuppressive activities of Cladribine. |
| Tafamidis | The serum concentration of Cladribine can be increased when it is combined with Tafamidis. |
| Tamoxifen | The risk or severity of cardiotoxicity can be increased when Cladribine is combined with Tamoxifen. |
| Taurocholic acid | Taurocholic acid may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Tedizolid phosphate | The risk or severity of myelosuppression can be increased when Cladribine is combined with Tedizolid phosphate. |
| Telmisartan | Telmisartan may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Temozolomide | The risk or severity of adverse effects can be increased when Cladribine is combined with Temozolomide. |
| Temsirolimus | The risk or severity of adverse effects can be increased when Cladribine is combined with Temsirolimus. |
| Tenecteplase | The risk or severity of bleeding can be increased when Tenecteplase is combined with Cladribine. |
| Teniposide | The risk or severity of adverse effects can be increased when Cladribine is combined with Teniposide. |
| Tepotinib | Tepotinib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Teprotumumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Teprotumumab. |
| Terbinafine | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Terbinafine. |
| Teriflunomide | The risk or severity of adverse effects can be increased when Cladribine is combined with Teriflunomide. |
| Tetracaine | The risk or severity of methemoglobinemia can be increased when Cladribine is combined with Tetracaine. |
| Thalidomide | The risk or severity of adverse effects can be increased when Cladribine is combined with Thalidomide. |
| Thiotepa | The risk or severity of adverse effects can be increased when Cladribine is combined with Thiotepa. |
| Ticagrelor | The risk or severity of bleeding can be increased when Ticagrelor is combined with Cladribine. |
| Encephalitis vaccine | The therapeutic efficacy of the Tick-borne encephalitis vaccine (whole virus, inactivated) can be decreased when used in combination with Cladribine. |
| Ticlopidine | The risk or severity of bleeding can be increased when Ticlopidine is combined with Cladribine. |
| Tinzaparin | The risk or severity of bleeding can be increased when Tinzaparin is combined with Cladribine. |
| Tioguanine | The risk or severity of adverse effects can be increased when Cladribine is combined with Tioguanine. |
| Tirofiban | The risk or severity of bleeding can be increased when Tirofiban is combined with Cladribine. |
| Tivozanib | Tivozanib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Tixocortol | The risk or severity of adverse effects can be increased when Cladribine is combined with Tixocortol. |
| Tocilizumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Tocilizumab. |
| Tofacitinib | Cladribine may increase the immunosuppressive activities of Tofacitinib. |
| Topotecan | The risk or severity of adverse effects can be increased when Cladribine is combined with Topotecan. |
| Tositumomab | The risk or severity of adverse effects can be increased when Tositumomab is combined with Cladribine. |
| Trabectedin | The risk or severity of adverse effects can be increased when Cladribine is combined with Trabectedin. |
| Trastuzumab | Trastuzumab may increase the neutropenic activities of Cladribine. |
| Trastuzumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Trastuzumab emtansine. |
| Tretinoin | The risk or severity of adverse effects can be increased when Cladribine is combined with Tretinoin. |
| Triamcinolone | The risk or severity of adverse effects can be increased when Cladribine is combined with Triamcinolone. |
| Triazolam | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Triazolam. |
| Trichlormethiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Trichlormethiazide is combined with Cladribine. |
| Trifluridine | The risk or severity of adverse effects can be increased when Cladribine is combined with Trifluridine. |
| Triflusal | The risk or severity of bleeding can be increased when Triflusal is combined with Cladribine. |
| Trilostane | The risk or severity of adverse effects can be increased when Cladribine is combined with Trilostane. |
| Trimethoprim | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Trimethoprim. |
| Typhoid vaccine | The therapeutic efficacy of Typhoid vaccine can be decreased when used in combination with Cladribine. |
| Typhoid Vaccine | The risk or severity of infection can be increased when Typhoid Vaccine Live is combined with Cladribine. |
| Typhoid | The therapeutic efficacy of Typhoid Vi polysaccharide vaccine can be decreased when used in combination with Cladribine. |
| Ubidecarenone | The risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Cladribine is combined with Ubidecarenone. |
| Upadacitinib | The risk or severity of adverse effects can be increased when Cladribine is combined with Upadacitinib. |
| Urokinase | The risk or severity of bleeding can be increased when Urokinase is combined with Cladribine. |
| Vandetanib | Vandetanib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Varicella zoster | The risk or severity of infection can be increased when Varicella zoster vaccine (live/attenuated) is combined with Cladribine. |
| Varicella zoster | The therapeutic efficacy of Varicella zoster vaccine (recombinant) can be decreased when used in combination with Cladribine. |
| Vedolizumab | The risk or severity of adverse effects can be increased when Cladribine is combined with Vedolizumab. |
| Velpatasvir | Velpatasvir may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Vemurafenib | Vemurafenib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Venetoclax | Venetoclax may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Venlafaxine | Venlafaxine may increase the excretion rate of Cladribine which could result in a lower serum level and potentially a reduction in efficacy. |
| Vibrio cholerae | The therapeutic efficacy of Vibrio cholerae CVD 103-HgR strain live antigen can be decreased when used in combination with Cladribine. |
| Vilanterol | The risk or severity of adverse effects can be increased when Cladribine is combined with Vilanterol. |
| Vinblastine | The risk or severity of adverse effects can be increased when Cladribine is combined with Vinblastine. |
| Vincristine | The risk or severity of adverse effects can be increased when Cladribine is combined with Vincristine. |
| Vindesine | The risk or severity of adverse effects can be increased when Cladribine is combined with Vindesine. |
| Vinorelbine | The risk or severity of adverse effects can be increased when Cladribine is combined with Vinorelbine. |
| Vismodegib | Vismodegib may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Voclosporin | The risk or severity of adverse effects can be increased when Cladribine is combined with Voclosporin. |
| Vorapaxar | The risk or severity of bleeding can be increased when Vorapaxar is combined with Cladribine. |
| Vorinostat | The risk or severity of adverse effects can be increased when Cladribine is combined with Vorinostat. |
| Voxilaprevir | Voxilaprevir may decrease the excretion rate of Cladribine which could result in a higher serum level. |
| Warfarin | The risk or severity of bleeding can be increased when Warfarin is combined with Cladribine. |
| Ximelagatran | The risk or severity of bleeding can be increased when Ximelagatran is combined with Cladribine. |
| Yfever vaccine | The risk or severity of infection can be increased when Yellow fever vaccine is combined with Cladribine. |
| Zidovudine | The risk or severity of adverse effects can be increased when Cladribine is combined with Zidovudine. |
Pregnancy and Lactation
AU TGA pregnancy category: D
US FDA pregnancy category: D
Pregnancy
This drug can cause fetal harm when administered to a pregnant woman. Women of childbearing potential should use effective contraception during therapy and for 6 months after the last dose. 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 hazard to the fetus. Men being treated with this drug should be advised not to father a child up to 6 months after the last dose.
Lactation
Data in one patient indicates that the drug is rapidly eliminated over 24 hours and undetectable at 48 hours after a dose. It is suggested that breastfeeding be withheld for at least 48 hours after a dose of cladribine and perhaps up to a week,[1,2] although the manufacturers recommend a 7-day (Europe) or 10-day (US) abstinence period. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breast milk.[3] Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
How should this medicine be used?
Cladribine injection comes as a solution (liquid) to be injected intravenously (into a vein) by a doctor or nurse in a medical facility. It is usually given slowly over 7 days as a continuous intravenous injection.
What special precautions should I follow?
Before receiving cladribine,
- tell your doctor and pharmacist if you are allergic to cladribine, any other medications, or any of the ingredients in cladribine 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 medications listed in the IMPORTANT WARNING section and any of the following: immunosuppressants such as azathioprine (Imuran), cyclosporine (Neoral, Sandimmune), methotrexate (Rheumatrex), sirolimus (Rapamune), and tacrolimus (Prograf). Your doctor will need to monitor you carefully for side effects. Many other medications may also interact with cladribine, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
- tell your doctor if you have or have ever had liver disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. You should not become pregnant while you are receiving cladribine. If you become pregnant while receiving cladribine, call your doctor. Cladribine may harm the fetus.
References
