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Cytarabine is a medication used in the management and treatment of leukemias and lymphomas. It belongs to the antimetabolic group of medications. This activity reviews the indications, action, and contraindications for cytarabine as a valuable agent in treating acute myeloid leukemia (and other leukemias). This activity will highlight the mechanism of action, adverse event profile, and other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions) pertinent for members of the healthcare team in the treatment of patients with leukemia and related conditions. Objectives: Identify the mechanism of action of cytarabine. Describe the potential adverse effects of cytarabine. Review the appropriate monitoring for patients receiving therapy with cytarabine. Summarize interprofessional team strategies for improving care coordination for patient safety in cases of cytarabine overdose and improve outcomes. Access free multiple choice questions on this topic.

Toxicity caused by cytarabine can classify into either low dose or high dose toxicity. The only noteworthy low-dose toxicity is myelosuppression, while corneal toxicity is frequent with high doses of cytarabine. Continuous infusion may prove more toxic than the typical intermittent dosage. Considerable cardiac toxicity has been observed only in the standard induction schedules.[11]

It is an observation that in delivering therapeutic drugs, incorrect doses of drugs are sometimes administered.[12] Lack of proper care during intrathecal administration of cytarabine in pediatric patients can lead to overdose. Previously cerebrospinal fluid exchange was recommended if such an incident occurred. Contrary to this belief, there have been recent reports that if there is prompt identification of such an error, then management via a cerebrospinal fluid exchange is not necessary.[13][14] In the above case reports, hydrocortisone was administered, and the patient received adequate supportive care. All patients were neurologically stable at the time of overdose. They did not show any signs of cytarabine toxicity or complications and quickly recovered. Given the critical nature of the illnesses for which cytarabine is given, an interprofessional, coordinated team approach to therapy and monitoring is absolutely essential. This team includes specialists, mid-level practitioners, family clinicians, oncology specialty-trained nurses, and pharmacists, preferably with oncology specialization. By working collaboratively and engaging in open information-sharing regarding the latest information on the patient's case, patient outcomes can be optimized, and adverse events minimized when utilizing cytarabine therapy. [Level 5]