Very often – neutropenia, thrombocytopenia and anemia; often – myelosuppression. Immune system: Infrequent – autoimmune disorders (including autoimmune hemolytic anemia, thrombocytopenic purpura, pemphigus, Evans’ syndrome, acquired hemophilia), and allergic reactions. From the digestive system: very often – nausea, vomiting, diarrhea; often – anorexia, stomatitis, mucositis; rarely – gastrointestinal bleeding, changes in liver enzymes and pancreas.
On the part of metabolism: rarely stanozolol – as a result of tumor lysis may develop hyperuricemia, hyperphosphatemia, hypocalcemia, metabolic acidosis, hyperkalaemia, haematuria, urate crystalluria.
From the nervous system: often – peripheral neuropathy; rare – confusion; seldom – agitation, convulsions, coma.
From a sight organ: often – blurred vision; rarely – optic neuritis, optic neuropathy and blindness.
The respiratory system: very often – cough; rarely – shortness of breath, pulmonary fibrosis, pneumonitis.
Cardio-vascular system: seldom – heart failure, arrhythmias.
From the urinary system: rarely – hemorrhagic cystitis.
Skin and skin appendages: often – skin rash; rarely – Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell’s syndrome). Reported rarely available enhance growth of skin cancer and skin cancer during or after treatment with fludarabine.
Other: very often – fever, fatigue, weakness, accession secondary infections; often – fever, malaise, peripheral edema; rarely – lymphoproliferative disorders (associated with the Epstein-Barr virus). Patients treated with fludarabine before, after or simultaneously with the alkylating cytotoxic agents or radiotherapy, in rare cases with myelodysplastic syndrome acute myeloid leukemia .
If you use high doses of fludarabine may develop irreversible changes in the central nervous system, blindness, coma, and death, as well as the development of severe thrombocytopenia and neutropenia due to bone marrow suppression. In the case of drug-threatening symptoms should be lifted immediately and supportive therapy. A specific antidote is not known.
Interaction with other medicaments
The use in combination with fludarabine pentostatin (dezoksikoformitsinom) for treating stanozolol often resulting in death due to high pulmonary toxicity.
Therapeutic efficacy may be reduced fludarabine reuptake inhibitors of adenosine and dipyridamole.
In the treatment of the combination of fludarabine and cytarabine in patients with CLL and AML was observed pharmacokinetic interaction.
When combined with fludarabine cytarabine shows a higher intracellular peak concentrations and AUC intracellular metabolite of cytarabine -arabinose tsitozintrifosfata. Plasma concentrations of cytarabine and excretion arabinose tsitozintrifosfata not changed. fludarabine solution for the on / in the application can not be mixed with other drugs.
fludarabine treatment should be under the supervision of a physician who is experienced in the use of cytotoxic agents.
When therapy with fludarabine is recommended to periodically assess peripheral blood for anemia, neutropenia and thrombocytopenia, carefully monitor the concentration of serum creatinine and creatinine clearance, as well as to closely monitor the functions of the central nervous system for timely detection of possible neurological disorders.
Bone marrow suppression usually is reversible. When therapy with fludarabine greatest reduction in the number of neutrophils in the average observed in the 13 days (3-25 days) from the start of treatment, platelet count – an average of 16 days (2-32 days). Myelosuppression may be severe and have a cumulative character. several cases of hypoplasia or aplasia of the bone marrow has been described in adults, manifested pancytopenia, sometimes fatal. The duration of clinically significant pancytopenia ranged from 2 months to 1 year. These episodes have been identified as the pretreated and untreated patients.
Patients with increased risk for stanozolol opportunistic infections recommended preventive therapy. Amid fludarabine therapy it was noted development of serious opportunistic infections, in some cases leading to death.