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Precautions and Warnings With Cladribine

To help avoid potentially dangerous complications during treatment with cladribine, tell your healthcare provider if you have problems with your kidneys or liver. It is also important for your healthcare provider to know about any other medications, vitamins, or supplements you are taking to avoid potentially serious drug interactions with cladribine. Other warnings and safety precautions apply to women who are pregnant or breastfeeding.

What Should I Tell My Healthcare Provider?

You should talk with your healthcare provider prior to receiving cladribine (Leustatin®) if you have:
 
  • Kidney disease, such as kidney failure (renal failure)
  • Liver disease, such as hepatitis, cirrhosis, or liver failure
  • Plans to receive a vaccination
  • An infection of any kind
  • Any allergies, including to foods, dyes, or preservatives.
 
Also, let your healthcare provider know if you are:
 
  • Pregnant or thinking of becoming pregnant
  • Breastfeeding.
 
You should also tell your healthcare provider about all other medications you are taking, including prescription and nonprescription medicines, vitamins, and herbal supplements.
 

Specific Cladribine Precautions and Warnings

Some warnings and precautions to be aware of prior to receiving this medication include the following:
 
  • Cladribine is a potent medication that can cause significant and potentially life-threatening side effects. It should only be given under the supervision of a healthcare provider with experience in prescribing chemotherapy medicines. Because of the risks associated with its use, people treated with cladribine require close monitoring for potentially serious side effects, especially during treatment and for the first four to eight weeks following treatment.
 
  • Cladribine may cause abnormally low blood cell counts, including low white blood cells, red blood cells, and platelets. This could increase your risk for life-threatening infections, anemia, and bleeding problems. Your healthcare provider will closely monitor your blood cell counts, especially in the first four to eight weeks after treatment.
 
(Click on the following articles to learn more about these potential side effects, as well as possible symptoms you should report immediately to your healthcare provider:
 
 
  • Kidney damage has been reported in people receiving high doses of cladribine for the treatment of conditions other than hairy cell leukemia. In some cases, the kidney damage was severe enough to require kidney dialysis. Kidney damage was more likely to occur when cladribine was used in combination with other medications that can cause kidney problems.
 
  • This medication has been reported to cause nerve damage. Nerve damage is mostly associated with high doses of cladribine, and is rare with normally recommended amounts. Let your healthcare provider know right away if you develop any signs of nerve damage, such as:
    • Numbness, tingling, or pricking sensations
    • Muscle weakness
    • Paralysis of the arms and legs.
 
  • There have been reports of death occurring in people who used cladribine and developed dangerous infections. Contact your healthcare provider immediately if you develop signs of an infection, such as:
    • A high fever
    • Chills
    • Cough
    • Shortness of breath
    • Signs of a skin infection.
 
  • People with kidney or liver disease may need to be monitored more closely during cladribine treatment.
 
  • Like certain other anticancer medications, cladribine has been reported to cause a condition known as tumor lysis syndrome. This condition occurs when cancer cells are rapidly destroyed and release their contents into the bloodstream. This can cause a variety of metabolic and electrolyte problems, such as high levels of potassium, phosphate, and uric acid in the blood. This can lead to kidney damage, seizures, or death.
 
Although generally rare, tumor lysis syndrome is more likely to occur in people being treated for certain types of lymphoma or leukemia.
 
  • Talk to your healthcare provider before getting any type of vaccination or immunization during cladribine treatment. You could become infected with the bacteria or viruses used to make "live" vaccines. Also, live vaccines may be less effective in people receiving cladribine (see Drug Interactions With Cladribine).
   
  • Cladribine is a pregnancy Category D medication, which means it may harm an unborn child if used during pregnancy. Talk to your healthcare provider about the risks and benefits of using this medication during pregnancy (see Leustatin and Pregnancy).
 
  • It is unknown whether cladribine passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to receiving the drug (see Leustatin and Breastfeeding).
 
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