How it is administered

Cytarabine is administered as a sterile solution for intravenous (IV), subcutaneous (under the skin), or intrathecal (into the spinal fluid) injection. It is not effective when taken orally. The medication is available in various strengths and formulations, including single-dose and multi-dose vials, with or without preservatives, depending on the intended route of administration. For intrathecal use (directly into the spinal fluid), only preservative-free preparations should be used.

How it works

Cytarabine is a type of chemotherapy medication known as an antimetabolite. It works by interfering with the growth of cancer cells, specifically targeting cells that are actively dividing. Cytarabine is incorporated into the DNA of rapidly dividing cells, which blocks the action of an enzyme called DNA polymerase. This prevents the cells from making new DNA and stops them from multiplying.

Cytarabine is especially effective against blood cancers like leukemia because these diseases involve cells that divide quickly. By blocking DNA synthesis, cytarabine causes the cancer cells to die. The medication is most active during the S-phase of the cell cycle, which is when DNA is being replicated. This phase-specific action means cytarabine is particularly effective when given in cycles that match the timing of cell division in leukemia cells.

Who Should take it

Cytarabine is indicated for use in combination with other approved anti-cancer drugs for the induction of remission in acute non-lymphocytic leukemia (which includes acute myeloid leukemia) in both adults and children. It is also used in the treatment of acute lymphocytic leukemia and the blast phase of chronic myelocytic leukemia. Additionally, cytarabine can be administered intrathecally for the prevention and treatment of meningeal leukemia (leukemia involving the central nervous system).

While cytarabine is not specifically approved for Juvenile Myelomonocytic Leukemia (JMML), it may be used as part of a broader chemotherapy regimen for blood cancers in pediatric patients, as determined by a healthcare provider.

Who should not take it

Cytarabine should not be used in patients who are hypersensitive to the drug or any of its components. It must be used with extreme caution in patients with pre-existing bone marrow suppression, as it can further decrease blood cell counts and increase the risk of infection and bleeding.

Patients with significant liver or kidney impairment may require dose adjustments or closer monitoring, as these conditions can increase the risk of toxicity. Cytarabine can cause fetal harm, so it should not be used during pregnancy unless clearly needed, and effective contraception is recommended for patients of childbearing potential. Nursing mothers should avoid breastfeeding while receiving cytarabine due to the risk of serious adverse reactions in infants.

Commonly used with

Cytarabine is commonly used in combination with other chemotherapy drugs to increase its effectiveness. It is often paired with anthracyclines such as daunorubicin or idarubicin in standard induction regimens for acute myeloid leukemia. It may also be used with medications like cyclophosphamide, vincristine, prednisone, and asparaginase, depending on the specific type of leukemia being treated.

When used for central nervous system involvement, cytarabine may be combined with methotrexate and hydrocortisone for intrathecal therapy.

Commonly tested with

Cytarabine is frequently tested in clinical trials and treatment protocols alongside other chemotherapy agents such as daunorubicin, idarubicin, etoposide, and asparaginase. It is also studied in combination with newer targeted therapies and immunotherapies for blood cancers.

In the context of central nervous system leukemia, cytarabine may be tested with methotrexate and corticosteroids for intrathecal administration.