Adverse reactions caused by cytarabine, depend on the dosage, mode of administration and duration of therapy.
On the part of the hematopoiesis system: leukopenia, thrombocytopenia, anemia, megaloblastosis, reticulocytopenia. The decrease in the number of leukocytes is of a two-phase nature, with the first maximum decrease being achieved by 7-9 days. Then there is a short-term rise with a maximum of 12 days. At the second and deeper decline, the minimum number of leukocytes is observed in 15-24 days. In the next 10 days, the number of white blood cells increases rapidly. The decrease in the number of platelets becomes noticeable by day 5, the minimum occurs between 12-15 days.In the next 10 days there is a rapid increase in the number of platelets to the baseline level. The severity of these reactions depends on the dose and the scheme of administration.
From the gastrointestinal tract: nausea, vomiting, loss of appetite, abdominal pain, diarrhea, inflammation or ulceration of the gastrointestinal mucosa (oral and rectal cavity, less often - esophagus). Nausea and vomiting most often occur after a rapid intravenous injection. When using high doses (2-3 g / m2) ulceration of the gastrointestinal tract can be severe, it is possible to develop necrotic colitis, small intestine necrosis, cystic pneumatosis of the intestine, leading to peritonitis.
From the liver and pancreas: a violation of the liver, jaundice. With high-dosage therapy - a violation of liver function with hyperbilirubinemia, sepsis and liver abscess.
Individual cases of development of thrombosis of hepatic veins (Badd-Chiari syndrome), as well as pancreatitis in the treatment of high doses of cytarabine in combination with other drugs, have also been reported.
From the nervous system: neuritis, neurotoxicity, headache, dizziness.Disturbances from the central nervous system are mainly observed in high-dose therapy, with disorders of cerebral and cerebellar functions (nystagmus, dysarthria, ataxia, confusion), including personality changes, drowsiness, and coma. Disorders from the CNS are usually reversible. Also reported were cases of peripheral motor and sensory neuropathy and late progressive ascending paralysis. In some cases after the intrathecal administration of the drug, nausea, vomiting, dizziness and fever were noted. These complaints can also be caused by lumbar puncture. Cumulative neurotoxicity may also occur, especially with short intervals between dose administrations. Individual cases of necrotizing leukoencephalopathy, as well as paraplegia and blindness after intrathecal cytarabine injection were described.
From the side of the musculoskeletal system: when used in high doses, myalgias and / or arthralgias in the neck and lower extremities were observed. A case of rhabdomyolysis is also described.
From the sense organs: conjunctivitis (photophobia, burning sensation in the eyes, pronounced lachrymation), keratitis. In the treatment of high doses, reversible ulcerative keratitis and hemorrhagic conjunctivitis, visual disturbances may occur.
From the cardiovascular and respiratory systems: transient arrhythmia, cardiomyopathy (including fatal, when using cytarabine in high doses in combination with cyclophosphamide), pericarditis, sore throat, dyspnea, pneumonia, diffuse interstitial pneumonitis (medium doses - 1 g / m2), progressive respiratory distress syndrome, leading to pulmonary edema and cardiomegaly with possible fatal outcome (high doses of cytarabine).
From the side of the kidneys and urinary tract: impaired renal function, urinary retention, hyperuricemia, or urate nephropathy.
From the skin and skin appendages: itching, rash (patchy-papular and urticaria), the appearance of pigment spots on the skin, ulceration of the skin, alopecia. There are rare reports of severe skin rashes leading to desquamation. Local reactions: inflammation of subcutaneous fat at the injection site.
Infectious complications: viral, bacterial, fungal, parasitic or saprophytic infections of any localization (including sepsis), usually of mild or moderate severity, but can be severe and sometimes fatal (their development is caused by a decrease in immunity).
Cytarabine Syndrome: fever, muscle pain, bone pain, sometimes pain in the chest, spotty papular rash, conjunctivitis, malaise. These symptoms usually appear 6-12 hours after the administration of the drug.
It has been established that glucocorticosteroids are effective in treating or preventing the development of this syndrome.
Other: fever, thrombophlebitis, allergic reactions (including anaphylaxis, urticaria, edema), isolated cases of the syndrome of inadequate production of antidiuretic hormone.