a chronic [90:<60 mL/minute, the AUC was increased by 140%. Use: Labeled Indications Acute lymphoblastic leukemia, relapsed or refractory: Treatment of relapsed or refractory acute lymphoblastic leukemia (ALL) in patients 1 to 21 years of age (after at least 2 prior regimens) Off Label Uses Acute lymphoblastic leukemia, refractory or relapsed (adults) Data from a phase II study in adults with refractory or relapsed acute leukemia supports the use of clofarabine as monotherapy in the treatment of patients with acute lymphoblastic leukemia [Kantarjian 2003] . Additional data may be necessary to further define the role of clofarabine in this condition. Acute myeloid leukemia, refractory (patients> <70 years of age) Data from a phase I/II clinical trial in patients 18 to 70 years of age with refractory acute myeloid leukemia (AML) supports the use of clofarabine (in combination with cytarabine and filgrastim) in the treatment of this condition [Becker 2011] . Additional data may be necessary to further define the role of clofarabine in this condition. Langerhans cell histiocytosis (refractory) (children) Data from a small retrospective review of children (ages 1 to 18 years) with histiocytic disorders supports the use of clofarabine in the management of Langerhans cell histiocytosis [Simko 2014] . Additional data may be necessary to further define the role of clofarabine in this condition. Contraindications There are no contraindications listed in the manufacturer s US labeling. Canadian labeling: Hypersensitivity to clofarabine or any component of the formulation; symptomatic CNS involvement; history of serious heart, liver, kidney, or pancreas disease; severe hepatic impairment (AST and/or ALT> 5 x ULN, and/or bilirubin >3 x ULN); severe renal impairment (CrCl <30 mL/minute) Dosing: Adult Note: Calculate body surface area (BSA) prior to each cycle, utilizing actual body weight. Premedications: Clofarabine is associated with a moderate emetic potential; antiemetics are recommended to prevent nausea and vomiting (Basch 2011; Roila 2016). Consider prophylactic corticosteroids (hydrocortisone 100 mg/m 2 on days 1 to 3) to prevent signs/symptoms of capillary leak syndrome or systemic inflammatory response syndrome (SIRS), and hydration and antihyperuricemic therapy (to reduce the risk of tumor lysis syndrome/hyperuricemia). Acute lymphoblastic leukemia (ALL), relapsed or refractory: Adults 21 years: IV: 52 mg/m 2 /day days 1 through 5; repeat every 2 to 6 weeks; subsequent cycles should begin no sooner than 14 days from day 1 of the previous cycle (subsequent cycles may be administered when ANC 750/mm 3 ) Off-label dosing: IV: 20 to 30 mg/m 2 once daily on days 1 through 5 (in combination with cyclophosphamide and etoposide [CLOVE regimen]) as a bridging regimen to hematopoietic stem cell transplant in patients with relapsed or very high risk disease (Gossai 2014) Acute lymphoblastic leukemia, relapsed/refractory (ALL; off-label population): IV: Induction: 40 mg/m 2 once daily for 5 days; may repeat induction cycle once in 3 to 6 weeks if needed (depending on marrow response and recovery) (Kantarjian 2003) Consolidation: 30 mg/m 2 once daily for 5 days (or last tolerated induction dose, whichever is lower); repeat every 4 weeks for up to a maximum of 6 consolidation cycles (Kantarjian 2003) Acute myeloid leukemia (AML), refractory (off-label use): Adults> <70 years: IV: Induction: 25 mg/m 2 /day for 5 days (in combination with cytarabine and filgrastim) may repeat one time after 21 days if needed (Becker 2011) Consolidation: 20 mg/m 2 /day for 5 days (in combination with cytarabine and filgrastim) for 1 or 2 cycles (Becker 2011) Dosing: Pediatric Note: Calculate body surface area (BSA) prior to each cycle, utilizing actual body weight. Premedications: Clofarabine is associated with a moderate emetic potential; antiemetics are recommended to prevent nausea and vomiting (Dupuis 2011). Consider prophylactic corticosteroids (hydrocortisone 100 mg/m 2 on days 1 to 3) to prevent signs/symptoms of capillary leak syndrome or systemic inflammatory response syndrome (SIRS), and hydration and antihyperuricemic therapy (to reduce the risk of tumor lysis syndrome/hyperuricemia). Acute lymphoblastic leukemia (ALL), relapsed or refractory: Children 1 year and Adolescents: IV: 52 mg/m 2 /day days 1 through 5; repeat every 2 to 6 weeks; subsequent cycles should begin no sooner than 14 days from day 1 of the previous cycle (subsequent cycles may be administered when ANC 750/mm 3 ) Off-label dosing: IV: 20 to 30 mg/m 2 once daily on days 1 through 5 (in combination with cyclophosphamide and etoposide [CLOVE regimen]) as a bridging regimen to hematopoietic stem cell transplant in patients with relapsed or very high risk disease (Gossai 2014) Langerhans cell histiocytosis, refractory (off-label use): Children 1 to 18 years: IV: 25 mg/m 2 /day days 1 through 5; repeat every 28 days for 2 to 8 cycles (Simko 2014). Additional data may be necessary to further define the role of clofarabine in this condition. Dosing: Renal Impairment Clofarabine undergoes renal elimination and exposure is increased as creatinine clearance decreases (Bonate 2011). Renal impairment at baseline: CrCl> 60 mL/minute: No dosage adjustment necessary. CrCl 30 to 60 mL/minute: Reduce dose to 50% of the usual dose CrCl <30 mL/minute: There are no dosage adjustments provided in the manufacturer's labeling; use with caution (has not been studied). Dialysis: There are no dosage adjustments provided in the manufacturer's labeling (has not been studied). Renal toxicity during treatment: Grade 3 or higher increase in serum creatinine: Discontinue clofarabine; may reinitiate with a 25% dose reduction after patient is stable and organ function recovers to baseline Dosing: Hepatic Impairment Hepatic impairment at baseline: There are no dosage adjustments provided in the manufacturer's labeling; use with caution (has not been studied). Hepatotoxicity during treatment: Grade 3 or higher increase in hepatic enzymes/bilirubin: Discontinue clofarabine; may reinitiate with a 25% dose reduction after patient is stable and organ function recovers to baseline. Dosing: Adjustment for Toxicity Hematologic toxicity: ANC> <500/mm 3 lasting 4 weeks: Reduce dose by 25% for next cycle Nonhematologic toxicity: Clinically significant infection: Withhold treatment until infection is under control, then restart at full dose Grade 3 toxicity excluding infection, nausea and vomiting controlled by antiemetics, or transient elevations in transaminases and bilirubin: Withhold treatment; may reinitiate with a 25% dose reduction with resolution or return to baseline Grade 4 toxicity (noninfectious): Discontinue clofarabine. Capillary leak or systemic inflammatory response syndrome (SIRS) early signs/symptoms (eg, hypotension, tachycardia, tachypnea, pulmonary edema): Discontinue clofarabine; institute supportive measures. May consider reinitiating with a 25% dose reduction after patient is stable and organ function recovers to baseline. Dermatologic toxicity: Exfoliative or bullous rash, or suspected Stevens-Johnson syndrome or toxic epidermal necrolysis: Discontinue clofarabine. Hypotension (during the 5 days of infusion): Discontinue clofarabine. Dosing: Obesity American Society for Blood and Marrow Transplantation (ASBMT) practice guideline committee position statement on chemotherapy dosing in obesity: Utilize actual body weight (full weight) for calculation of body surface area in clofarabine dosing for hematopoietic stem cell transplant conditioning regimens in pediatrics and adults (Bubalo, 2014). Reconstitution Clofarabine should be diluted with NS or D5W to a final concentration of 0.15 to 0.4 mg/mL. Manufacturer recommends the product be filtered through a 0.2 micron filter prior to dilution. Administration Clofarabine is associated with a moderate emetic potential; antiemetics are recommended to prevent nausea and vomiting (Basch 2011; Dupuis 2011; Roila 2016). IV infusion: Infuse over 2 hours for relapsed/refractory ALL. May be infused over 1 hour for some off-label protocols (Becker 2011; Kantarjian 2003). Continuous IV fluids are encouraged to decrease adverse events and tumor lysis effects. Hypotension may be a sign of capillary leak syndrome or systemic inflammatory response syndrome (SIRS). Discontinue if the patient becomes hypotensive during administration; may consider therapy reinitiation with a 25% dose reduction after return to baseline. Do not administer any other medications through the same intravenous line. Storage Store intact vials at 25 C (77 F); excursions permitted to 15 C to 30 C (59 F to 86 F). Solutions diluted for infusion in D 5 W or NS may be stored for up to 24 hours at room temperature (use within 24 hours of preparation). Drug Interactions Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. Consider therapy modification Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Monitor therapy Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy BCG (Intravesical): Immunosuppressants may diminish the therapeutic effect of BCG (Intravesical). Avoid combination BCG (Intravesical): Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical). Avoid combination Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Blood Pressure Lowering Agents: May enhance the hypotensive effect of Hypotension-Associated Agents. Monitor therapy Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy CloZAPine: Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased. Monitor therapy Coccidioides immitis Skin Test: Immunosuppressants may diminish the diagnostic effect of Coccidioides immitis Skin Test. Monitor therapy Deferiprone: Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone. Avoid combination Denosumab: May enhance the adverse/toxic effect of Immunosuppressants. Specifically, the risk for serious infections may be increased. Monitor therapy Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Dipyrone: May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased Avoid combination DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Monitor therapy Echinacea: May diminish the therapeutic effect of Immunosuppressants. Consider therapy modification Fingolimod: Immunosuppressants may enhance the immunosuppressive effect of Fingolimod. Management: Avoid the concomitant use of fingolimod and other immunosuppressants when possible. If combined, monitor patients closely for additive immunosuppressant effects (eg, infections). Consider therapy modification Herbs (Hypotensive Properties): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Monitor therapy Leflunomide: Immunosuppressants may enhance the adverse/toxic effect of Leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Management: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Patients receiving both leflunomide and another immunosuppressant should be monitored for bone marrow suppression at least monthly. Consider therapy modification Lenograstim: Antineoplastic Agents may diminish the therapeutic effect of Lenograstim. Management: Avoid the use of lenograstim 24 hours before until 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Consider therapy modification Levodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa. Monitor therapy Lipegfilgrastim: Antineoplastic Agents may diminish the therapeutic effect of Lipegfilgrastim. Management: Avoid concomitant use of lipegfilgrastim and myelosuppressive cytotoxic chemotherapy. Lipegfilgrastim should be administered at least 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Consider therapy modification Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Natalizumab: Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased. Avoid combination Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Monitor therapy Nivolumab: Immunosuppressants may diminish the therapeutic effect of Nivolumab. Consider therapy modification Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Consider therapy modification Ocrelizumab: May enhance the immunosuppressive effect of Immunosuppressants. Monitor therapy Palifermin: May enhance the adverse/toxic effect of Antineoplastic Agents. Specifically, the duration and severity of oral mucositis may be increased. Management: Do not administer palifermin within 24 hours before, during infusion of, or within 24 hours after administration of myelotoxic chemotherapy. Consider therapy modification Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Monitor therapy Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Pidotimod: Immunosuppressants may diminish the therapeutic effect of Pidotimod. Monitor therapy Pimecrolimus: May enhance the adverse/toxic effect of Immunosuppressants. Avoid combination Promazine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Monitor therapy Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Roflumilast: May enhance the immunosuppressive effect of Immunosuppressants. Consider therapy modification Sipuleucel-T: Immunosuppressants may diminish the therapeutic effect of Sipuleucel-T. Monitor therapy Tacrolimus (Topical): May enhance the adverse/toxic effect of Immunosuppressants. Avoid combination Tertomotide: Immunosuppressants may diminish the therapeutic effect of Tertomotide. Monitor therapy Tofacitinib: Immunosuppressants may enhance the immunosuppressive effect of Tofacitinib. Management: Concurrent use with antirheumatic doses of methotrexate or nonbiologic disease modifying antirheumatic drugs (DMARDs) is permitted, and this warning seems particularly focused on more potent immunosuppressants. Consider therapy modification Trastuzumab: May enhance the neutropenic effect of Immunosuppressants. Monitor therapy Vaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting an immunosuppressant. If vaccinated during immunosuppressant therapy, revaccinate at least 3 months after immunosuppressant discontinuation. Consider therapy modification Vaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of Vaccines (Live). Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live organism vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants. Avoid combination Adverse Reactions Incidences include off-label use in the treatment of AML.> 10%: Cardiovascular: Tachycardia (35%), hypotension (29%), flushing (19%), hypertension (13%), edema (12%) Central nervous system: Headache (43%), chills (34%), fatigue (34%), anxiety (21%), pain (15%) Dermatologic: Pruritus (43%), skin rash (38%), palmar-plantar erythrodysesthesia (16%), erythema (11%) Gastrointestinal: Vomiting (78%), nausea (73%), diarrhea (56%), abdominal pain (35%), anorexia (30%), gingival bleeding (17%), mucosal inflammation (16%), oral candidiasis (11%) Genitourinary: Hematuria (13%) Hematologic & oncologic: Leukopenia (88%; grades 3/4: 88%), anemia (83%; grades 3/4: 75%), lymphocytopenia (82%; grades 3/4: 82%), thrombocytopenia (81%; grades 3/4: 80%), neutropenia (10% to 64%; grades 3/4: 64%; grade 4: 7%), febrile neutropenia (55%; grade 3: 51%; grade 4: 3%), petechia (26%; grade 3: 6%) Hepatic: Increased serum ALT (81%), increased serum AST (74%), increased bilirubin (45%) Infection: Infection (83%; includes bacterial, fungal, and viral), sepsis (including septic shock; 17%) Local: Catheter infection (12%) Neuromuscular & skeletal: Limb pain (30%), myalgia (14%) Renal: Increased serum creatinine (50%) Respiratory: Epistaxis (27%), dyspnea (13%), pleural effusion (12%) Miscellaneous: Fever (39%) 1% to 10%: Cardiovascular: Pericardial effusion (8%), capillary leak syndrome (4%) Central nervous system: Drowsiness (10%), irritability (10%), lethargy (10%), agitation (5%), mental status changes (1% to 4%) Dermatologic: Cellulitis (8%), pruritic rash (8%) Gastrointestinal: Rectal pain (8%), upper abdominal pain (8%), pseudomembranous colitis (7%), stomatitis (7%), pancreatitis (1% to 4%), typhlitis (1% to 4%) Hematologic & oncologic: Tumor lysis syndrome (6%; grade 3: 6%), oral mucosal petechiae (5%; grade 3: 4%) Hepatic: Jaundice (8%), hyperbilirubinemia (1% to 4%), hepatic sinusoidal obstruction syndrome (formerly known as hepatic veno-occlusive disease: 2%) Hypersensitivity: Hypersensitivity (1% to 4%) Infection: Herpes simplex infection (10%), bacteremia (9%), candidiasis (7%), herpes zoster (7%), staphylococcal bacteremia (6%), staphylococcal sepsis (5%), influenza (1% to 4%), sepsis syndrome (2%) Neuromuscular & skeletal: Back pain (10%), ostealgia (10%), weakness (10%), arthralgia (9%) Renal: Acute renal failure Respiratory: Pneumonia (10%), respiratory distress (10%), tachypnea (9%), upper respiratory tract infection (5%), pulmonary edema (1% to 4%), sinusitis (1% to 4%) <1%, postmarketing, and/or case reports: Enterocolitis (occurs more frequently within 30 days of treatment and with combination chemotherapy), exfoliative dermatitis, gastrointestinal hemorrhage, hallucination (Jeha 2006), hepatic failure, hepatitis, hepatomegaly (Jeha 2006), hypokalemia (Jeha 2006), hyponatremia, hypophosphatemia, increased right ventricular pressure (Jeha 2006), left ventricular systolic dysfunction (Jeha 2006), major hemorrhage (including cerebral and pulmonary; majority of cases associated with thrombocytopenia), Stevens-Johnson syndrome, toxic epidermal necrolysis Warnings/Precautions Concerns related to adverse effects: Bone marrow suppression: Dose-dependent, reversible myelosuppression (neutropenia, thrombocytopenia, and anemia) is common; may be severe and prolonged. Monitor blood counts and platelets. May be at increased risk for infection due to neutropenia. Monitor for signs and symptoms of infection and treat promptly if infection develops; may require discontinuation. Capillary leak syndrome/systemic inflammatory response syndrome (SIRS): Cytokine release syndrome (eg, tachypnea, tachycardia, hypotension, pulmonary edema) may develop into capillary leak syndrome/SIRS, and organ dysfunction; immediately discontinue with signs/symptoms of SIRS or capillary leak syndrome (rapid-onset respiratory distress, hypotension, pleural/pericardial effusion, and multiorgan failure) and manage appropriately. Consider supportive treatment with diuretics, corticosteroids, and/or albumin. Prophylactic corticosteroids may prevent or diminish the signs/symptoms of cytokine release. May require dosage reduction. Dermatologic reactions: Serious and fatal cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been reported. Discontinue clofarabine for exfoliative or bullous rash, or if SJS or TEN are suspected. Gastrointestinal toxicity: Clofarabine is associated with a moderate emetic potential; antiemetics are recommended to prevent nausea and vomiting (Basch 2011; Dupuis 2011; Roila 2016). Serious and fatal enterocolitis (including neutropenic colitis, cecitis, and C. difficile colitis) has been reported, usually occurring within 30 days of treatment, and when used in combination with other chemotherapy. May lead to necrosis, perforation, hemorrhage or sepsis complications. Monitor for signs/symptoms of enterocolitis and manage promptly. Hemorrhage: Serious and fatal hemorrhages (including cerebral, gastrointestinal, and pulmonary hemorrhage) have occurred, usually associated with thrombocytopenia. Monitor and manage coagulation parameters. Hepatotoxicity: Transaminases and bilirubin may be increased during treatment; hepatitis and hepatic failure have been reported. Transaminase elevations generally occur within 10 days of administration and persist for 15 days. In some cases, hepatotoxicity was severe and fatal. The risk for hepatotoxicity, including hepatic sinusoidal obstruction syndrome (SOS; formerly called veno-occlusive disease [VOD]), is increased in patients who have previously undergone a hematopoietic stem cell transplant; discontinue if SOS is suspected. Avoid the concomitant use of drugs that may cause hepatotoxicity. Monitor liver function closely; discontinue immediately for grade 3 elevations in hepatic enzymes and/or bilirubin. Hypotension: Monitor blood pressure during 5 days of treatment; discontinue if hypotension develops. Monitor if on concurrent medications known to affect blood pressure. Infection: The risk for infections, including opportunistic infection or sepsis (may be severe or fatal), is increased due to prolonged neutropenia and immunocompromised state. Monitor for signs and symptoms of infection and treat promptly if infection develops; may require therapy discontinuation. Renal toxicity: Elevated creatinine, acute renal failure, and hematuria were observed in clinical studies. Infection, sepsis, or tumor lysis syndrome may cause an increased risk of renal toxicity in patients receiving clofarabine. Monitor renal function closely; may require dosage reduction or therapy discontinuation. Tumor lysis syndrome/hyperuricemia: Tumor lysis syndrome may occur as a consequence of leukemia treatment, including treatment with clofarabine, usually occurring in the first treatment cycle. May lead to life-threatening acute renal failure; adequate hydration and prophylactic antihyperuricemic therapy throughout treatment will reduce the risk/effects of tumor lysis syndrome; monitor closely. Disease-related concerns: Renal impairment: A pharmacokinetic study demonstrated that systemic exposure increases as creatinine clearance decreases (CrCl> <60 mL/minute) (Bonate 2011). Dosage reduction required for CrCl 30 to 60 mL/minute; use with caution in patients with CrCl> <30 mL/minute (has not been studied). Minimize the use of drugs known to cause renal toxicity during the 5-day treatment period. Concurrent drug therapy issues: Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Monitoring Parameters CBC with differential and platelets (daily during treatment, then 1 to 2 times weekly or as necessary); liver and kidney function (during 5 days of clofarabine administration); coagulation parameters, blood pressure, cardiac function, and respiratory status during infusion; signs and symptoms of tumor lysis syndrome, infection, hepatic sinusoidal obstruction syndrome, enterocolitis, and cytokine release syndrome (tachypnea, tachycardia, hypotension, pulmonary edema); hydration status Pregnancy Risk Factor D Pregnancy Considerations Adverse events were observed in animal reproduction studies. May cause fetal harm if administered to a pregnant woman. Women of childbearing potential should avoid becoming pregnant during therapy. All patients should use effective contraception to prevent pregnancy during treatment. Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Patient may experience fatigue, nausea, vomiting, diarrhea, flushing, lack of appetite, skin irritation, itching, anxiety, bone pain, muscle pain, joint pain, back pain, painful extremities, mouth irritation, or mouth sores. Have patient report immediately to prescriber signs of infection, signs of liver problems (dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or jaundice), signs of bowel problems (black, tarry, or bloody stools; fever; mucus in stools; vomiting; vomiting blood; severe abdominal pain; constipation; or diarrhea), signs of kidney problems (urinary retention, hematuria, change in amount of urine passed, or weight gain), signs of bleeding (vomiting blood or vomit that looks like coffee grounds; coughing up blood; hematuria; black, red, or tarry stools; bleeding from the gums; abnormal vaginal bleeding; bruises without a reason or that get bigger; or any severe or persistent bleeding); signs of severe cerebrovascular disease (change in strength on one side is greater than the other, difficulty speaking or thinking, change in balance, or vision changes); shortness of breath, fast breathing, angina, tachycardia, severe dizziness, passing out, confusion, severe loss of strength and energy, severe headache, vision changes, mood changes, pale skin, redness or irritation of palms or soles of feet, severe abdominal pain, signs of tumor lysis syndrome (tachycardia or abnormal heartbeat; any passing out; urinary retention; muscle weakness or cramps; nausea, vomiting, diarrhea or lack of appetite; or feeling sluggish), or signs of Stevens-Johnson syndrome/toxic epidermal necrolysis (red, swollen, blistered, or peeling skin [with or without fever]; red or irritated eyes; or sores in mouth, throat, nose, or eyes) (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients. Next Interactions Print this page Add to My Med List More about clofarabine Side Effects During Pregnancy Dosage Information Drug Interactions Support Group Pricing & Coupons En Español 0 Reviews Add your own review/rating Drug class: antimetabolites Consumer resources Clofarabine Clofarabine Intravenous (Advanced Reading) Professional resources Clofarabine (AHFS Monograph) Clofarabine Injection (FDA) Other brands: Clolar Related treatment guides Acute Lymphoblastic Leukemia> ]} Drug Status Rx Availability Prescription only D Pregnancy Category Positive evidence of risk N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Clofarabine Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first! Drug Class Antimetabolites Related Drugs antimetabolites methotrexate , fluorouracil , hydroxyurea , Xeloda , capecitabine , Hydrea Acute Lymphoblastic Leukemia methotrexate , Gleevec , mercaptopurine , imatinib , Adriamycin , doxorubicin , Sprycel , Trexall , dasatinib , Purinethol , Kymriah , Besponsa , Iclusig , Blincyto , ponatinib , Purixan , Oncaspar , Xatmep , Marqibo , pegaspargase , tisagenlecleucel , teniposide , asparaginase erwinia chrysanthemi , blinatumomab , More...} } seeking
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