Cytarabine

Cytarabine is a chemotherapy drug used to treat acute myeloid leukaemia (AML). It may also 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 cancer you have.

Cytarabine is usually given into a vein, an injection under the skin (subcutaneous injection) or by injection into the spinal fluid (intrathecal injection). You usually have it as an outpatient or during a hospital stay. Your cancer doctor or nurse will tell you how often you will have it.

Like all chemotherapy drugs, cytarabine can cause side effects. Some of the side effects can be serious, so it is important to read the detailed information below.

Your healthcare team can give you advice on how to manage any side effects. Tell your doctor or nurse straight away if you:

  • have a temperature
  • feel unwell
  • have severe side effects, including any we do not mention here.

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

If you need medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

How cytarabine is given

You will have cytarabine in the chemotherapy day unit or during a stay in hospital. A chemotherapy nurse will give it to you.

During treatment you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse 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 it is okay for you to have chemotherapy.

You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are all right on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.

Your nurse gives you anti-sickness (anti-emetic) drugs and sometimes steroids before you start. Cytarabine is then given in one of the following ways:

  • as an injection under the skin (subcutaneous injection)
  • by injection into the spinal fluid (intrathecal)
  • through a short thin tube (cannula) that the nurse puts into a vein in your arm or hand
  • 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).

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 a trained nurse may give you your treatment at home and in time may teach you how to self-administer it.

When the chemotherapy is being given

Some people might have side effects while they are having the chemotherapy, including:

Problems at the injection site

Cytarabine is given as a subcutaneous injection into the fatty tissue under the skin. Sometimes, it causes redness and swelling where it’s given (injection site). This can be uncomfortable. To reduce the irritation, your nurse will change the injection site each time you have an injection. They can also give you advice on how to relieve any discomfort.

Your course of chemotherapy

Chemotherapy is usually given as a course of several sessions (cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer you're being treated for. Your nurse or doctor will discuss your treatment plan with you.

Cytarabine can be given into the spinal fluid to allow the drug to reach the spinal cord and brain. This is called intrathecal chemotherapy.

The doctor numbs an area of skin over your spine with local anaesthetic. They gently insert a needle between two of the spinal bones. This is called a lumbar puncture. They inject the chemotherapy drug through this needle into the spinal fluid. Your cancer doctor and nurse will explain everything in advance so you know what to expect.

You may get a headache after a lumbar puncture. To help prevent this, you need to lie flat for a few hours afterwards and drink plenty of fluids. Any other side effects may be different from those mentioned in this information. Your doctor or nurse will talk to you about this.


Possible side effects of cytarabine

We explain the most common side effects of cytarabine here. But we don’t include all the rare ones that are unlikely to affect you. 

You may get some of the side effects we mention, but you are very unlikely to get all of them. If you are taking other chemotherapy drugs as well, you may have some side effects that we don’t list here. Always tell your doctor or nurse about any side effects you have. 

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

Serious and life threatening side effects

Sometimes cancer drugs can result in very serious side effects, which rarely may be life threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.

Contact the hospital

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

More information about this drug

We’re not able to list every side effect for this treatment here, particularly the rarer ones. For more detailed information you can visit the electronic medicines compendium (eMC).


Common side effects of cytarabine

Risk of infection

Cytarabine can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia. This can start seven days after treatment. You are most likely to get an infection 10–14 days after treatment.

Contact the hospital straight away on the contact number you’ve been given if:

  • your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough or needing to pass urine often.

The number of white blood cells usually increases steadily and returns to normal before your next chemotherapy. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.

Bruising and bleeding

Cytarabine 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 you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.

Anaemia (low number of red blood cells)

Cytarabine 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 (blood transfusion).

Feeling sick

This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.

Loss of appetite

You may lose your appetite during your treatment. Try to eat small meals regularly. Don’t worry if you don’t eat much for a day or two.

If your appetite doesn’t improve after a few days, let your nurse or dietitian know. They can give you advice on getting more calories and protein in your diet. They may give you food supplements or meal replacement drinks to try. Your doctor can prescribe some of these and you can buy them from chemists.

Diarrhoea

Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluids every day.

Problems passing urine

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

Changes in the way the kidneys and liver work

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

Eye problems

Your eyes may become watery and feel sore. Your doctor can prescribe eye drops to help with this. If your eyes get red and inflamed (conjunctivitis) tell your doctor. You may need antibiotic eye drops.

Cytarabine may also make your eyes more sensitive to light and cause blurry vision and/or eye pain. Always tell your doctor or nurse if you have pain or notice any change in your vision.

Sore mouth

Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.

Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.

Hair loss

Your hair will thin and you may lose all the hair from your head. This usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. It is important to cover your head to protect your scalp when you are out in the sun. Your nurse can give you advice about coping with hair loss.

Tiredness

Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.

Skin changes

Chemotherapy 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.

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 and/or joint pain

You may get pain in your joints or muscles for a few days after chemotherapy. Tell your doctor if this happens so they can prescribe painkillers. Let them know if the pain does not get better. Try to get plenty of rest. Taking regular warm baths 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 of cytarabine

Effects on the lungs

Cytarabine can cause changes to the lungs. These are more common if you are treated with higher doses of chemotherapy. Always tell your doctor if you develop wheezing, a cough, or a fever, or if you feel breathless. You should also let them know if any existing breathing problems get worse. If necessary, they can arrange for you to have tests to check your lungs. 

Effects on the nervous system

High doses of cytarabine can affect the nervous system. You may feel drowsy, confused, dizzy or unsteady. Tell your doctor or nurse straight away if you notice any of these symptoms. They may make some changes to your treatment if the symptoms become a problem for you. It’s important not to drive or operate machinery if you notice these effects. Rarely, this treatment can cause seizures (fits).


Other information about cytarabine

Blood clot risk

Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.

Cytarabine may cause a reaction 6–12 hours after it’s been given. Signs of a reaction can include:

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

Tell your nurse straight away if you have any of these symptoms.

Other medicines

Some other medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Cytarabine interacts with digoxin and some other drugs. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.

Fertility

Cytarabine may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.

Contraception

Your doctor will advise you not to become pregnant or father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.

Sex

If you have sex within the first couple of days of having chemotherapy you need to use a condom. This is to protect your partner in case there is any chemotherapy in your semen or vaginal fluid.

Changes to your periods

Chemotherapy can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women, this is temporary, but for others it is permanent and they start the menopause.

Breastfeeding

Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.

Medical and dental treatment

If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them contact details for your cancer doctor. 

Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.