The use of fludarabine should be carried out under the supervision of a qualified physician who has experience of antitumor therapy.
During the period of treatment, periodic monitoring of the picture of peripheral blood, uric acid level in the blood plasma, laboratory indicators of kidney function is necessary. In the case of hemolysis, therapy is discontinued. Patients at risk of developing tumor lysis syndrome require systematic monitoring of the physician, especially during the first week of treatment.
In elderly patients, a dose reduction may be required (age-related renal impairment is more likely). Fludarabine caution should be exercised after careful assessment of the risk / benefit ratio for patients in a weakened state, patients with a marked decrease in bone marrow function, immunodeficiency, opportunistic infections, children and patients with hepatic insufficiency (efficacy and safety in children, as well as in patients with hepatic impairment not studied ).
Patients who receive or receive fludarabine, requiring hemotransfusion, only irradiated blood should be transfused to avoid the "graft versus host" reaction.
Be wary appoint patients who had previously received cytotoxic drugs or radiation therapy.
Care must be taken when signs of bone marrow depression appear. Special precautions should be observed in case of thrombocytopenia (rejection of intramuscular injections, urine, feces and secretions for occult blood, refusal to take acetylsalicylic acid, caution when using toothbrushes, threads or toothpicks).Transfusion of platelet mass may be required.
Care is needed to avoid accidental cuts with sharp objects (including a safety razor, scissors). You should avoid contact sports or other situations in which there may be a hemorrhage or injury.
Appearance of signs of oppression of bone marrow function, unusual bleeding or hemorrhages, black tarry stools, blood in urine or feces or spot red spots on the skin requires immediate consultation of a doctor. When leukopenia should be carefully monitored for the development of infections. In patients with neutropenia with increasing body temperature, the use of antibiotics must begin empirically.
To prevent hyperuricemia during treatment, it is important to consume enough fluids and then increase diuresis to ensure the excretion of uric acid, in some cases, the appointment of allopurinol.
During the period of treatment, vaccination with live viral vaccines is not recommended. Use of live viral vaccines in patients with leukemia in remission should not occur within 3 months after the last course of chemotherapy.Immunization with oral polio vaccine for people in close contact with such a patient, especially family members, should be postponed.
During treatment with the drug, and also within 6 months after its termination, contraceptives should be used to avoid pregnancy.
The necessary rules for the use and destruction of the drug should be observed. Dilution of fludarabine should be carried out by trained personnel in a specially equipped place (in special cabinets with extraction), using protective clothing (disposable gloves, goggles, masks), with precautionary measures when preparing injection solutions and destroying needles, syringes, ampoules and unused residue preparation.
The scattered or remaining product is burned. In case of accidental ingestion of the drug solution on the skin, the affected area should be washed immediately with soap and water, and after contact with eyes, rinse thoroughly with plenty of water. Avoid inhalation of the drug. During pregnancy, nurses are not allowed to work.
Avoid accidental intravascular drug exposure.
Impact on the ability to drive vehicles and manage mechanisms.
Some of the side effects of the drug, such as increased fatigue, weakness, visual impairment, can adversely affect the ability to drive and perform potentially dangerous activities requiring increased concentration and speed of psychomotor reactions. When these undesirable phenomena appear, one should refrain from performing these activities.