Formulary
Hydroxycarbamide: Indications, Dosing, Side Effects and Interactions
Hydroxycarbamide clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Hydroxycarbamide: Indications, Dosing, Side Effects and Interactions
Hydroxycarbamide clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Polycythaemia vera (specialist use only),Essential thrombocythaemia (specialist use only),Chronic myeloid leukaemia (specialist use only)**
- **Adult** (By Mouth): Specialist indication - access specialist resources for dosing information.
**Chronic myeloid leukaemia (specialist use only),Cancer of the cervix (specialist use only)**
- **Adult** (By Mouth): Specialist indication - access specialist resources for dosing information.
**Sickle-cell disease [prevention of recurrent vaso-occlusive crises] (initiated by a specialist)**
- **Adult** (By Mouth): Initially 15 mg/kg daily, increased in steps of 2.5-5 mg/kg daily, dose to be increased every 12 weeks according to response; usual dose 15-30 mg/kg daily; maximum 35 mg/kg per day.
**Sickle-cell disease [prevention of vaso-occlusive complications] (under expert supervision)**
- **Adult** (By Mouth): Initially 15 mg/kg daily, increased in steps of 5 mg/kg daily, dose to be increased every 8 weeks according to response; usual maintenance 20-25 mg/kg daily; maximum 35 mg/kg per day.
**Sickle-cell disease [prevention of recurrent vaso-occlusive crises] (initiated by a specialist) for Siklos**
- **Child 2-17 years** (By mouth): Initially 10-15 mg/kg once daily, increased in steps of 2.5-5 mg/kg daily, dose to be increased every 12 weeks according to response; usual dose 15-30 mg/kg daily; maximum 35 mg/kg per day.
**Sickle-cell disease [prevention of vaso-occlusive complications] (under expert supervision) for Xromi**
- **Child 2-17 years** (By mouth): Initially 15 mg/kg daily, increased in steps of 5 mg/kg daily, dose to be increased every 8 weeks according to response; usual maintenance 20-25 mg/kg daily; maximum 35 mg/kg per day.
Cautions
Leg ulcers (review treatment if cutaneous vasculitic ulcerations develop)
Side effects
Common or very common Alopecia; anaemia; appetite decreased; asthenia; bone marrow disorders; chills; constipation; cutaneous vasculitis; dermatomyositis; diarrhoea; disorientation; dizziness; drowsiness; dyspnoea; dysuria; fever; gastrointestinal discomfort; haemorrhage; hallucination; headache; hepatic disorders; leucopenia; lung infiltration; malaise; mucositis; nail discolouration; nail disorder; nausea; neoplasms; neutropenia; oral disorders; pancreatitis; peripheral neuropathy; pulmonary fibrosis; pulmonary oedema; red blood cell abnormalities; seizure; skin reactions; skin ulcers; sperm abnormalities; thrombocytopenia; vomiting Rare or very rare Cutaneous lupus erythematosus; gangrene; systemic lupus erythematosus (SLE) Frequency not known Amenorrhoea; gastrointestinal disorders; hypomagnesaemia; Parvovirus B19 infection; vitamin D deficiency; weight increased
Interactions
**Severe interactions:**
- Fatal and non-fatal pancreatitis has occurred in HIV-infected patients during therapy with hydroxycarbamide and didanosine, with or without stavudine.
- Fatal hepatic events were reported most often in patients treated with the combination of hydroxycarbamide, didanosine and stavudine.
- Peripheral neuropathy, which was severe in some cases, has been reported in HIV-infected patients receiving hydroxycarbamide in combination with antiretroviral agents, including didanosine, with or...
**Other interactions (5):**
- Hepatotoxicity and hepatic failure resulting in death were reported during post-marketing surveillance in HIV-infected patients treated with hydroxycarbamide and other antiretroviral agents.
- Studies have shown that there is an analytical interference of hydroxycarbamide with the enzymes (urease, uricase, and lactic dehydrogenase) used in the determination of urea, uric acid and lactic...
- Interference with Continuous Glucose Monitoring Systems Hydroxyurea may falsely elevate sensor glucose results from certain continuous glucose monitoring (CGM) systems.
- This may lead to missed hypoglycaemic episodes and can also cause hypoglycaemia if sensor glucose results are relied upon to dose insulin.
- If a patient using a CGM is to be prescribed hydroxyurea, consult with the CGM prescriber about appropriate glucose monitoring methods.
Pregnancy
Avoid (teratogenic in animal studies). See also Pregnancy and reproductive function in Cytotoxic drugs .
Breast feeding
Discontinue breast-feeding.
Hepatic impairment
Manufacturer advises caution in mild to moderate impairment; avoid in severe impairment (unless used for malignant conditions).
Renal impairment
In sickle-cell disease, avoid if eGFR less than 30 mL/minute/1.73 m 2 . Use with caution in malignant disease. Dose adjustments In sickle-cell disease, reduce initial dose by 50% if eGFR less than 60 mL/minute/1.73 m 2 .
Medicinal forms
Capsule,Tablet,Capsule,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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