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ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS › ANTINEOPLASTIC AGENTS › ANTIMETABOLITES › Purine analogues
cladribine
L01BB04
Forms & Strengths
- Injection: 10 mg/10 mL (1 mg/mL) in single-dose vials
- Tablets: 10 mg
Adult Dosing
- Hairy Cell Leukemia: 0.09 mg/kg/day by continuous IV infusion for 7 consecutive days
- Multiple Sclerosis (Relapsing): 3.5 mg/kg total cumulative dose administered orally as two treatment courses (1.75 mg/kg per course) over 2 years
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
Indications
- Hairy cell leukemia
- Relapsing-remitting multiple sclerosis (RRMS) and active secondary progressive MS (SPMS)
Mechanism of Action
- Purine antimetabolite that accumulates intracellularly, inhibiting DNA synthesis and repair while inducing apoptosis in lymphocytes and monocytes
Contraindications
- Hypersensitivity to cladribine
- Active chronic infections (HIV, tuberculosis, hepatitis)
- Malignancies (except hairy cell leukemia or MS under specific protocols)
- Pregnancy and lactation
- Moderate to severe renal impairment (for MS indication)
Adverse Reactions
- Myelosuppression (neutropenia, thrombocytopenia, anemia)
- Lymphopenia and increased risk of opportunistic infections
- Nausea, fatigue, headache, rash
- Increased risk of malignancies
Drug Interactions
- Immunosuppressive therapies (increased risk of myelosuppression and infection)
- Live vaccines (avoid concomitant use due to risk of disseminated infection)
- Strong inhibitors or inducers of BCRP and ENT1 transporters (potential alterations in cladribine exposure)
Curated Content: Needs Vetting Before Put to Clinical Use