Dosing & Uses
Dosage Forms & Strengths
Hairy Cell Leukemia
Monitor: CBC, chemistries
Acute Myeloid Leukemia
Chronic Lymphocytic Leukemia
Orphan indications sponsor
- Orphan indication sponsor: Ortho Biotech Oncology Research & Development, Unit of J & J Pharmaceutical Research & Dev., LLC; 920 Route 202 South, P.O. Box 300; Raritan, NJ 08869-0602
Other Indications & Uses
Off-label: Cutaneous T-cell lymphoma, AML, CLL, NHL, autoimmune hemolytic anemia, mycosis fungoides, Sezary syndrome
Safety and efficacy not established
Serious - Use Alternative
Significant - Monitor Closely
Appetite decreased (17%)
Abdominal pain (6%)
Black Box Warnings
The drug should be administered under the supervision of an experienced cancer chemotherapy physician
Bone marrow suppression may occur but is usually reversible and appears to be dose dependent
Continuous infusion of high doses of 4 to 9 times the recommended dose for hairy cell leukemia has been associated with serious acute nephrotoxicity and neurological toxicity resulting in irreversible paraparesis and quadraparesis. Standard cladribine dosing regimens have also been associated with severe neurological toxicity
Allopurinol and IV hydration recommended for patients with high tumor burden to prevent tumor lysis syndrome
May impair fertility; shown to suppress rapidly generating cells, including testicular cells
Do not administer live virus vaccines; risk of infection in setting of immunosuppression
Pregnancy & Lactation
Pregnancy Category: D
Lactation: not known if excreted in breast milk, do not nurse
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Purine analog, impairs DNA repair
Half-Life: 5.4 hr
Protein bound: 20%
Vd: 4.5 L/kg
Clearance: 978 mL/hr/kg
Y-site: none reported
Y-site (partial list): carboplatin, cisplatin, cyclophosphamide, cytarabine, diphenhydramine, dopamine, etoposide, heparin, lorazepam, metoclopramide, morphine, ondansetron, paclitaxel, KCl, prochlorperazine, promethazine, NaHCO3, teniposide, vincristine
Prepare with bacteriostatic NS
Both cladribine and diluent should be passed through a sterile 0.22 micron hydrophilic filter as they are being introduced into infusion reservoir
The calculated dose of cladribine (7 days x 0.09 mg/kg) should first be added to the infusion reservoir through a filter, then the bacteriostatic NS should be added to the reservoir to obtain a total volume of 100 mL
Standard IV 24 hr infusion dilution: 24 hr dose/500 mL NS
Standard IV 7 day infusion dilution: 7 day dose/QS to 100 mL with bacteriostatic NS
Do not dilute in D5W
Single daily infusion: administer diluted in an infusion bag containing 500 mL of NS and repeated for a total of 7 consecutive days
7 day infusion: administer via ambulatory infusion pump into central line; use 0.22 micron filter to infuse
Store intact vials under refrigeration
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
|1||This drug is available at the lowest co-pay. Most commonly, these are generic drugs.|
|2||This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.|
|3||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.|
|4||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|5||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|6||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|NC||NOT COVERED – Drugs that are not covered by the plan.|
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.