Cladribine – Uses, Dosage, Side Effects, Interaction 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. or 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: Hairy cell leukemia. 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. You Might Also Read Ubiquinone - Uses, Dosage, Side Effects, Interactions 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. You Might Also Read Nitazoxanide, Indications, Dosage, Side Effects, Interactions, Pregnancy 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. You Might Also Read Gemcitabine; Uses, Dosage, Side Effects, Interactions 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 https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/022561s000lbl.pdf https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/022561Orig1s000SumR.pdf https://pubchem.ncbi.nlm.nih.gov/compound/Cladribine https://pubchem.ncbi.nlm.nih.gov/compound/Cladribine-5_-monophosphate-diammonium https://www.cancer.gov/about-cancer/treatment/drugs/cladribine https://www.medbroadcast.com/drug/getdrug/cladribine-for-injection https://go.drugbank.com/drugs/DB00242 https://en.wikipedia.org/wiki/Cladribine https://medlineplus.gov/druginfo/meds/a693015.htm https://www.ncbi.nlm.nih.gov/books/NBK545307/ https://www.drugs.com/mtm/cladribine.html ChemIDplus LICENSE https://www.nlm.nih.gov/copyright.html Cladribine [USAN:USP:INN:BAN] https://chem.nlm.nih.gov/chemidplus/sid/0004291638 ChemIDplus Chemical Information Classification https://chem.nlm.nih.gov/chemidplus/ DrugBank https://www.drugbank.ca/legal/terms_of_use Cladribine https://www.drugbank.ca/drugs/DB00242 EPA DSSTox LICENSE https://www.epa.gov/privacy/privacy-act-laws-policies-and-resources Cladribine https://comptox.epa.gov/dashboard/DTXSID8022828 CompTox Chemicals Dashboard Chemical Lists https://comptox.epa.gov/dashboard/chemical-lists/ European Chemicals Agency (ECHA) https://echa.europa.eu/web/guest/legal-notice (2R,3S,5R)-5-(6-Amino-2-chloropurin-9-yl)-2-(hydroxymethyl)oxalan-3-ol https://echa.europa.eu/information-on-chemicals (2R,3S,5R)-5-(6-Amino-2-chloropurin-9-yl)-2-(hydroxymethyl)oxalan-3-ol https://echa.europa.eu/information-on-chemicals/cl-inventory-database/-/discli/details/169547 FDA Global Substance Registration System (GSRS) https://www.fda.gov/about-fda/about-website/website-policies#linking CLADRIBINE https://gsrs.ncats.nih.gov/ginas/app/beta/substances/47M74X9YT5 Hazardous Substances Data Bank (HSDB) CLADRIBINE https://pubchem.ncbi.nlm.nih.gov/source/hsdb/7564 Human Metabolome Database (HMDB) http://www.hmdb.ca/citing Cladribine http://www.hmdb.ca/metabolites/HMDB0014387 HMDB0014387_msms_2231640 https://hmdb.ca/metabolites/HMDB0014387#spectra ChEBI Cladribine http://www.ebi.ac.uk/chebi/searchId.do?chebiId=CHEBI:567361 ChEBI Ontology http://www.ebi.ac.uk/chebi/userManualForward.do#ChEBI%20Ontology FDA Pharm Classes https://www.fda.gov/about-fda/about-website/website-policies#linking CLADRIBINE https://dailymed.nlm.nih.gov/dailymed/browse-drug-classes.cfm FDA Pharmacological Classification https://www.fda.gov/ForIndustry/DataStandards/StructuredProductLabeling/ucm162549.htm LiverTox LICENSE https://www.nlm.nih.gov/copyright.html Cladribine https://www.ncbi.nlm.nih.gov/books/n/livertox/Cladribine/ NCI Thesaurus (NCIt) https://www.cancer.gov/policies/copyright-reuse https://ncithesaurus.nci.nih.gov/ncitbrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&ns=ncit&code=C1336 NCI Thesaurus Tree https://ncit.nci.nih.gov ChEMBL http://www.ebi.ac.uk/Information/termsofuse.html https://www.ebi.ac.uk/chembl/compound_report_card/CHEMBL1619/ ChEMBL Protein Target Tree https://www.ebi.ac.uk/chembl/g/#browse/targets Comparative Toxicogenomics Database (CTD) http://ctdbase.org/about/legal.jsp https://ctdbase.org/detail.go?type=chem&acc=D017338 Drug Gene Interaction database (DGIdb) http://www.dgidb.org/downloads https://www.dgidb.org/drugs/CLADRIBINE Therapeutic Target Database (TTD) Cladribine http://idrblab.net/ttd/data/drug/details/D05GJW ClinicalTrials.gov https://clinicaltrials.gov/ct2/about-site/terms-conditions#Use https://clinicaltrials.gov/ DailyMed LICENSE https://www.nlm.nih.gov/copyright.html CLADRIBINE https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=CLADRIBINE Drug Induced Liver Injury Rank (DILIrank) Dataset https://www.fda.gov/about-fda/about-website/website-policies#linking cladribine https://www.fda.gov/science-research/liver-toxicity-knowledge-base-ltkb/drug-induced-liver-injury-rank-dilirank-dataset European Medicines Agency (EMA) https://www.ema.europa.eu/en/about-us/legal-notice Mavenclad (EMEA/H/C/004230) https://www.ema.europa.eu/en/medicines/human/EPAR/mavenclad Litak (EMEA/H/C/000504) https://www.ema.europa.eu/en/medicines/human/EPAR/litak Cladribine (P/101/2009) https://www.ema.europa.eu/en/medicines/human/paediatric-investigation-plans/cladribine Drugs and Lactation Database (LactMed) LICENSE https://www.nlm.nih.gov/copyright.html Cladribine https://www.ncbi.nlm.nih.gov/books/NBK500815/ EU Clinical Trials Register https://www.clinicaltrialsregister.eu/ FDA Orange Book https://www.fda.gov/about-fda/about-website/website-policies#linking https://www.fda.gov/drugs/drug-approvals-and-databases/approved-drug-products-therapeutic-equivalence-evaluations-orange-book NORMAN Suspect List Exchange https://creativecommons.org/licenses/by/4.0/ NORMAN Suspect List Exchange Classification https://www.norman-network.com/nds/SLE/ WHO Anatomical Therapeutic Chemical (ATC) Classification https://www.whocc.no/copyright_disclaimer/ https://www.whocc.no/atc/ ATC Code https://www.whocc.no/atc_ddd_index/ FDA Medication Guides https://www.fda.gov/about-fda/about-website/website-policies#linking Mavenclad https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=medguide.page National Drug Code (NDC) Directory https://www.fda.gov/about-fda/about-website/website-policies#linking CLADRIBINE https://www.fda.gov/drugs/drug-approvals-and-databases/national-drug-code-directory MassBank Europe LICENSE https://github.com/MassBank/MassBank-web/blob/main/MassBank-Project/LICENSE.txt PTOAARAWEBMLNO-KVQBGUIXSA-N https://massbank.eu/MassBank/Result.jsp?inchikey=PTOAARAWEBMLNO-KVQBGUIXSA-N MassBank of North America (MoNA) LICENSE The content of the MoNA database is licensed under CC BY 4.0. https://mona.fiehnlab.ucdavis.edu/documentation/license Cladribine https://mona.fiehnlab.ucdavis.edu/spectra/browse?query=compound.metaData%3Dq%3D%27name%3D%3D%22InChIKey%22%20and%20value%3D%3D%22PTOAARAWEBMLNO-KVQBGUIXSA-N%22%27 NCI Cancer Drugs LICENSE https://www.cancer.gov/policies/copyright-reuse Cladribine https://www.cancer.gov/about-cancer/treatment/drugs/cladribine NCI Investigational Drugs LICENSE https://www.cancer.gov/policies/copyright-reuse 2-CHLORO-2′-DEOXYADENOSINE http://dtp.nci.nih.gov/NCI-InvestigationalDrugsCI92/105014%20(1992).txt NIPH Clinical Trials Search of Japan https://rctportal.niph.go.jp/en/ NLM RxNorm Terminology https://www.nlm.nih.gov/research/umls/rxnorm/docs/termsofservice.html cladribine https://rxnav.nlm.nih.gov/id/rxnorm/44157 Protein Data Bank in Europe (PDBe) http://www.ebi.ac.uk/pdbe-srv/pdbechem/chemicalCompound/show/CL9 PubChem https://pubchem.ncbi.nlm.nih.gov RCSB Protein Data Bank (RCSB PDB) https://www.rcsb.org/pages/policies https://www.rcsb.org/ SpectraBase 2-CHLORO-2′-DEOXYADENOSINE https://spectrabase.com/spectrum/23uj7cgBPAQ 2-CHLORO-2′-DEOXYADENOSINE https://spectrabase.com/spectrum/BJAG5OrPuxc 2-CHLORO-9-(2-DEOXY-BETA-L-ERYTHRO-PENTOFURANOSYL)-ADENINE https://spectrabase.com/spectrum/6YcaMdBqvOQ Springer Nature https://pubchem.ncbi.nlm.nih.gov/substance/?source=15745&sourceid=19051127-254490963 https://pubchem.ncbi.nlm.nih.gov/substance/?source=15745&sourceid=19051127-254499481 The Cambridge Structural Database https://www.ccdc.cam.ac.uk/structures/Search?Ccdcid=707181 Thieme Chemistry https://creativecommons.org/licenses/by-nc-nd/4.0/ https://pubchem.ncbi.nlm.nih.gov/substance/?source=22163&sourceid=19051127-254501435 Wikidata LICENSE CCZero https://creativecommons.org/publicdomain/zero/1.0/ Cladribine https://www.wikidata.org/wiki/Q414030 Medical Subject Headings (MeSH) https://www.nlm.nih.gov/copyright.html Cladribine https://www.ncbi.nlm.nih.gov/mesh/68017338 MeSH Tree http://www.nlm.nih.gov/mesh/meshhome.html Antineoplastic Agents https://www.ncbi.nlm.nih.gov/mesh/68000970 Immunosuppressive Agents https://www.ncbi.nlm.nih.gov/mesh/68007166 KEGG https://www.kegg.jp/kegg/legal.html Therapeutic category of drugs in Japan http://www.genome.jp/kegg-bin/get_htext?br08301.keg USP drug classification http://www.genome.jp/kegg-bin/get_htext?br08302.keg Anatomical Therapeutic Chemical (ATC) classification http://www.genome.jp/kegg-bin/get_htext?br08303.keg Target-based classification of drugs http://www.genome.jp/kegg-bin/get_htext?br08310.keg Drug Groups http://www.genome.jp/kegg-bin/get_htext?br08330.keg Drug Classes http://www.genome.jp/kegg-bin/get_htext?br08332.keg UN Globally Harmonized System of Classification and Labelling of Chemicals (GHS) GHS Classification Tree http://www.unece.org/trans/danger/publi/ghs/ghs_welcome_e.html PATENTSCOPE (WIPO) SID 388503984 https://pubchem.ncbi.nlm.nih.gov/substance/388503984 NCBI https://www.ncbi.nlm.nih.gov/projects/linkout Show More