Formulary
Cladribine: Indications, Dosing, Side Effects and Interactions
Cladribine is a nucleoside analogue that is cytotoxic particularly to lymphocytes and monocytes, inhibiting both DNA synthesis and repair.
MedNext Academy | 4 min read
Cladribine: Indications, Dosing, Side Effects and Interactions
Cladribine is a nucleoside analogue that is cytotoxic particularly to lymphocytes and monocytes, inhibiting both DNA synthesis and repair.
Drug action
Cladribine is a nucleoside analogue that is cytotoxic particularly to lymphocytes and monocytes, inhibiting both DNA synthesis and repair. Its effect on B- and T-lymphocytes is thought to interrupt the cascade of immune events central to multiple sclerosis.
Indications and dose
**Hairy cell leukaemia (specialist use only)**
- **Adult** (By Subcutaneous Injection, Or By Intravenous Infusion): Specialist indication - access specialist resources for dosing information.
**B-cell chronic lymphocytic leukaemia (specialist use only)**
- **Adult** (By Intravenous Infusion): Specialist indication - access specialist resources for dosing information.
**Multiple sclerosis (under expert supervision)**
- **Adult** (By Mouth): (consult product literature or local protocols).
Cautions
General cautions: Acute infection; use irradiated blood only (haematology consultation advised) Specific cautions: With intravenous use High tumour burden-consult product literature; symptomatic or severe bone marrow depression With oral use No prior exposure to varicella zoster virus; prior malignancy (consider if potential benefit outweighs risk) With subcutaneous use High tumour burden-consult product literature; symptomatic or severe bone marrow depression Cautions, further information Immunosuppressive effect of cladribine With intravenous use or subcutaneous use: Cladribine has potent and prolonged myelosuppressive and immunosuppressive effects. Patients treated with cladribine are more prone to serious bacterial, opportunistic fungal, and viral infections, and prophylactic therapy should be considered in those at risk. Acute infections should be treated before initiating cladribine. To prevent potentially fatal transfusion-related graft-versus-host reaction, only irradiated blood products should be administered. Prescribers should consult specialist literature when using highly immunosuppressive drugs. Varicella zoster virus With oral use: Manufacturer advises vaccination prior to initiation of therapy in patients who have no history of exposure to varicella zoster virus; delay treatment for 4-6 weeks after vaccination.
Contraindications
With oral use Active chronic hepatitis; active chronic tuberculosis; active malignancy; HIV infection; immunocompromised patients
Side effects
General side-effects: Common or very common Increased risk of infection Specific side-effects: Common or very common With intravenous use Anaemia; anxiety; appetite decreased; arrhythmias; arthritis; asthenia; chest pain; chills; confusion; conjunctivitis; constipation; cough; diarrhoea; dizziness; dyspnoea; febrile neutropenia; fever; flatulence; gastrointestinal discomfort; haemolytic anaemia; headache; hyperhidrosis; hypersensitivity; insomnia; interstitial lung disease; joint disorders; malaise; muscle weakness; myalgia; myocardial ischaemia; nausea; neoplasms; oedema; pain; pulmonary fibrosis; renal impairment; respiratory disorders; secondary malignancy; septic shock; skin reactions; thrombocytopenia; vomiting With oral use Alopecia; lymphopenia; rash With subcutaneous use Anaemia; anxiety; appetite decreased; arrhythmias; arthralgia; arthritis; asthenia; bone marrow disorders; chills; constipation; cough; diarrhoea; dizziness; dyspnoea; fever; gastrointestinal disorders; gastrointestinal pain; haemorrhage; headache; hyperhidrosis; hypotension; immunosuppression; insomnia; lymphopenia; malaise; mucositis; myalgia; myocardial ischaemia; nausea; neutropenia; oedema; pain; respiratory disorders; secondary malignancy; sepsis; skin reactions; thrombocytopenia; vomiting Uncommon With intravenous use Bone marrow disorders; hypereosinophilia; level of consciousness decreased; nerve disorders; neurotoxicity (with high doses); paralysis; paraparesis; Stevens-Johnson syndrome; tumour lysis syndrome With oral use Liver injury With subcutaneous use Ataxia; cachexia; confusion; drowsiness; eye inflammation; haemolytic anaemia; paraesthesia; polyneuropathy Rare or very rare With intravenous use Heart failure With subcutaneous use Amyloidosis; cholecystitis; depression; dysphagia; epilepsy; graft versus host disease; heart failure; hepatic failure; hypereosinophilia; pulmonary embolism; renal failure; severe cutaneous adverse reactions (SCARs); speech disorder; tumour lysis syndrome Frequency not known With oral use Malignancy
Interactions
**Other interactions (2):**
- Therefore, simultaneous administration of nucleoside analogues with cladribine is not advisable.
- Since interactions with medicinal products undergoing intracellular phosphorylation, such as antiviral agents, or with inhibitors of adenosine uptake (e.g.
Pregnancy
Manufacturer advises avoid-teratogenic in animal studies. See also Pregnancy and reproductive function in Cytotoxic drugs .
Breast feeding
With intravenous use or subcutaneous use: Manufacturer advises avoid during treatment and for 6 months after the last dose-no information available. With oral use: Manufacturer advises avoid during treatment and for 1 week after the last dose-no information available.
Hepatic impairment
With intravenous use: Manufacturer advises caution (limited information available). With subcutaneous use: Manufacturer advises caution in mild impairment; avoid in moderate to severe impairment (no information available). With oral use: Manufacturer advises avoid in moderate to severe impairment (no information available).
Renal impairment
With subcutaneous use: Manufacturer advises caution in mild impairment; avoid in moderate-to-severe impairment. With oral use: Manufacturer advises avoid in moderate-to-severe impairment-no information available. With intravenous use: Manufacturer advises caution-limited information available.
Medicinal forms
Tablet,Solution,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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