What is cytarabine?

Cytarabine is used to treat acute myeloid leukaemia (AML). It may sometimes be used to treat other types of leukaemia and lymphomas. It is best to read this information with our general information about chemotherapy and the type of leukaemia or lymphoma you have.

Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

How cytarabine is given

You will be given cytarabine during a stay in hospital or in the chemotherapy day unit. A chemotherapy nurse will give it to you. Cytarabine can be given in combination with other cancer drugs.

During treatment you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.

Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that your blood cells are at a safe level to have chemotherapy.

You will see a doctor or nurse before you have chemotherapy. They will ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.

Your nurse usually gives you anti-sickness (anti-emetic) drugs and sometimes steroids before the cytarabine. Cytarabine can be given:

  • through a short thin tube the nurse puts into a vein in your arm or hand (cannula)
  • through a fine tube that goes under the skin of your chest and into a vein close by (central line)
  • through a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line)
  • as an injection under the skin (subcutaneous injection)
  • as an injection into the spinal fluid (intrathecal).

Your nurse can give you cytarabine as a slow injection or drip (infusion) into your cannula or line. They usually run the drip through a pump, which gives you the treatment over a set time.

Sometimes cytarabine is given as an injection under the skin. A trained nurse may give it to you as an outpatient or in your own home. In time they may teach you how to inject yourself.

Cytarabine can be given into the spinal fluid to allow the drug to reach the brain. This is called intrathecal chemotherapy. Your doctor will tell you about side effects when it is given this way.

Your cancer doctor or nurse will explain how your treatment will be given so you know what to expect.


Your course of chemotherapy

You may have a course of several cycles of treatment. Your nurse or doctor will discuss your treatment plan with you. The length of your treatment, the dose and the number of cycles you have depends on your individual situation.

About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.

If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Side effects while treatment is being given

Some people may have side effects while they are being given the chemotherapy or shortly after they have it:

Allergic reaction

Some people have an allergic reaction while having this treatment. Signs of a reaction can include:

  • feeling hot or flushed
  • a skin rash or itching
  • shivering
  • feeling dizzy
  • a headache
  • feeling breathless
  • swelling of your face or mouth, hands, feet or ankles
  • pain in your back, tummy or chest.

Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, it can be treated quickly.

Problems at the injection site

Cytarabine can be given as an injection under the skin (subcutaneous injection). Sometimes, it causes redness and swelling where it is given (injection site). This can be uncomfortable. Your nurse will inject into a different area of your skin each time you have an injection. This will help to reduce any irritation. They can also give you advice on how to relieve any discomfort.

Common side effects

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection.

If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.

If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:

  • your temperature goes over 37.5°C (99.5°F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection.

Symptoms of an infection include:

  • feeling shivery
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine often.

It is important to follow any specific advice your cancer treatment team gives you.

The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.

Bruising and bleeding

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. 

Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:

  • nosebleeds
  • bleeding gums
  • tiny red or purple spots on the skin that may look like a rash.

Some people may need a drip to give them extra platelets. This is called a platelet transfusion.

Anaemia (low number of red blood cells)

This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Cytarabine syndrome

Cytarabine may cause some symptoms 6 to 12 hours after it has been given. This is called cytarabine syndrome. Signs can include:

  • a high temperature or chills
  • a rash
  • pain in the eyes, bones, tummy or chest.

Tell your nurse or contact the hospital straight away if you have any of these symptoms.

Feeling sick

You may feel sick with this treatment. The nurses will give you anti-sickness drugs regularly. If you still feel sick, tell your nurse or doctor. They can change the anti-sickness drug to one that works better for you.

Loss of appetite

This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.

Diarrhoea

If you have diarrhoea, tell your nurse. Try to drink at least 2 litres (3½ pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Problems passing urine (peeing)

Some people find it difficult to pass urine (pee) after having cytarabine. Tell your doctor or nurse straight away if this is a problem for you.

Effects on the kidneys

This treatment can affect how your kidneys work. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your kidneys are working.

It is important to drink at least 2 litres (3½ pints) of fluids each day to help protect your kidneys.

Effects on the liver

This treatment can change the way your liver works. This usually goes back to normal after treatment finishes. Rarely, the drug may cause your skin and the whites of your eyes to turn yellow (jaundice). You will have regular blood tests to check how well your liver is working.

Effects on the eyes

This treatment may make your eyes feel sore, red and itchy (conjunctivitis). Your doctor may prescribe eye drops to help prevent this. It is important to use these as you are told to.

This treatment may also make your eyes more sensitive to light and cause blurred vision. If you have pain or notice any change in your vision, always tell your doctor or nurse.

Do not wear contact lenses if you are using eye drops or if your eyes are sore. Your doctor can tell you when you can wear them again.

Sore mouth

You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection.

Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth is sore:

  • tell your nurse or doctor – they can give you a mouthwash or medicines to help
  • try to drink plenty of fluids
  • avoid alcohol, tobacco, and foods that irritate your mouth.

Hair loss

Your hair will get thinner or you may lose all the hair from your head. You may also lose your eyelashes, eyebrows or other body hair.

Your nurse can talk to you about ways to cope with hair loss. There are ways to cover up hair loss if you want to. It is important to cover your head to protect your scalp when you are out in the sun.

Hair loss is almost always temporary and your hair will usually grow back after treatment ends.

Feeling tired

Feeling tired is a common side effect. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.

Skin changes

Cytarabine may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. Cytarabine can cause a rash, which may be itchy. It may also cause your skin to become red or blistered.

Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.

Muscle or joint pain

You may get pain in your muscles or joints for a few days after treatment. If this happens, tell your doctor so they can give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help.

Abdominal pain

Let your doctor know if you develop any pain in your tummy (abdomen). It can usually be controlled with mild painkillers.

Less common side effects

Soreness and redness of palms of hands and soles of feet

This is called palmar-plantar or hand-foot syndrome. It gets better when treatment ends. Your doctor or nurse may prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and to avoid tight-fitting socks, shoes and gloves.

Effects on the lungs

This treatment can cause changes to the lungs. Tell your doctor if you develop:

  • a cough
  • wheezing
  • a fever (high temperature)
  • breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

Effects on the nervous system

High doses of cytarabine can affect the nervous system. Tell your doctor or nurse straight away if you:

  • feel very drowsy, confused, dizzy or unsteady
  • have problems with coordination or speech
  • have flickering eye movements you cannot control.

They may make changes to your treatment. It is important not to drive or operate machinery if you notice these effects. Rarely, this treatment can cause seizures (fits).

Effects on the heart

Chemotherapy can affect the way the heart works. You may have tests to see how well your heart is working. These may be done before, during and sometimes after treatment. If the treatment is causing heart problems, your doctor can change the type of chemotherapy you are having.

Contact a doctor straight away if you:

  • have pain or tightness in your chest
  • feel breathless or dizzy
  • feel your heart is beating too fast or too slowly.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor.

Tumour lysis syndrome (TLS)

This treatment causes cancer cells to break down quickly. This releases uric acid (a waste product) into the blood. The kidneys usually get rid of uric acid, but they may not be able to cope with large amounts. This can cause chemical imbalances in the blood that may affect the kidneys and the heart. This is called tumour lysis syndrome (TLS). You will have regular blood tests to check the uric acid levels.

Your doctor may give you drugs to help prevent TLS. Drinking at least 2 litres (3½ pints) of fluid a day will also help.

Numb or tingling hands or feet (peripheral neuropathy)

High doses of cytarabine can affect the nerves. This can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.

Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.

Other information

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

  • pain, redness or swelling in a leg or arm
  • breathlessness
  • chest pain.

If you have any of these symptoms, contact a doctor straight away.

A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

Other medicines

Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:

  • medicines you have been prescribed
  • medicines you buy in a shop or chemist
  • vitamins, herbal drugs and complementary therapies.

Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.

You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant.

If you are a woman, your periods may become irregular or stop. This may be temporary, but for some women it is permanent. Your menopause may start sooner than it would have done.

There may be ways to preserve fertility for men and women. If you are worried about fertility, it is important to talk with your doctor before you start treatment.

Contraception

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.

Sex

If you have sex in the first few days after chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluids.

Breastfeeding

Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.

Vaccinations

Your doctor or nurse may talk to you about vaccinations. These help reduce your risk of getting infections.

Doctors usually recommend that you have a flu jab, which is an inactivated vaccination. People with weak immune systems can have this type of vaccination.

If your immune system is weak, you need to avoid live vaccinations such as shingles. Your cancer doctor or GP can tell you more about live vaccinations.

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