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QuickView for Cladribine (compound)


PubChem
Name: Cladribine
PubChem Compound ID: 1546
Description: An antineoplastic agent used in the treatment of lymphoproliferative diseases including hairy-cell leukemia.
Molecular formula: C10H12ClN5O3
Molecular weight: 285.687 g/mol
Synonyms:
NCIOpen2_007300; ADENOSINE, 2-CHLORO-2'-DEOXY-; NCI60_000122; NCIOpen2_007340; Adenosine, 2-chloro-2'-deoxy; 5542-92-7; Cladribine; AIDS-022294; 4291-63-8; AIDS022294.
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DrugBank
Identification
Name: Cladribine
Name (isomeric): DB00242
Drug Type: small molecule
Description: An antineoplastic agent used in the treatment of lymphoproliferative diseases including hairy-cell leukemia.
Synonyms:
2-CdA; 2-Chloro-2'-deoxyadenosine; Chlorodeoxyadenosine; 2-Chlorodeoxyadenosine; 2-Chloro-2'-deoxy-beta-adenosine
Brand: Leustatin, Mylinax
Category: Antineoplastic Agents, Immunosuppressive Agents
CAS number: 4291-63-8
Pharmacology
Indication: For the treatment of active hairy cell leukemia (leukemic reticuloendotheliosis) as defined by clinically significant anemia, neutropenia, thrombocytopenia, or disease-related symptoms. Also used as an alternative agent for the treatment of chronic lymphocytic leukemia (CLL), low-grade non-Hodgkin's lymphoma, and cutaneous T-cell lymphoma.
Pharmacology:
Cladribine is a synthetic purine nucleoside that acts as an antineoplastic agent with immunosuppressive effects. Cladribine differs structurally from deoxyadenosine only by the presence of a chlorine atom at position 2 of the purine ring, which results in resistance to enzymatic degradation by adenosine deaminase. Due to this resistance, cladribine...
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Mechanism of Action:
Cladribine is structurally related to fludarabine and pentostatin but has a different mechanism of action. Although the exact mechanism of action has not been fully determined, evidence shows that cladribine is phosphorylated by deoxycytidine kinase to the nucleotidecladribine triphosphate (CdATP; 2-chloro-2′-deoxyadenosine 5′-triphosphate), which ...
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Absorption: Oral bioavailability is 34 to 48%.
Protein binding: 20%
Biotransformation: Metabolized in all cells with deoxycytidine kinase activity to 2-chloro-2'-deoxyadenosine-5'-triphosphate
Half Life: 5.4 hours
Clearance: 978 +/- 422 mL/h/kg
Toxicity: Symptoms of overdose include irreversible neurologic toxicity (paraparesis/quadriparesis), acute nephrotoxicity, and severe bone marrow suppression resulting in neutropenia, anemia and thrombocytopenia.
Affected organisms: Humans and other mammals
Interactions
Food interaction:
Echinacea should be used with caution, if at all, in patients receiving therapeutic immunosuppressants. Monitor for reduced efficacy of the immunosuppressant during concomitant use.
Drug interaction:
NatalizumabImmunosuppressants such as cladribine may enhance the adverse/toxic effect of natalizumab. Specifically, the risk of concurrent infection may be increased. Patients receiving natalizumab should not use concurrent immunosuppressants, and patients receiving chronic corticosteroids prior to natalizumab should be tapered off of steroids prior to starting natalizumab.
TrastuzumabTrastuzumab may increase the risk of neutropenia and anemia. Monitor closely for signs and symptoms of adverse events.
PimecrolimusPimecrolimus may enhance the adverse/toxic effect of immunosuppressants such as cladribine. Avoid use of pimecrolimus cream in patients receiving immunosuppressants.
TacrolimusTacrolimus (Topical) may enhance the adverse/toxic effect of immunosuppressants such as tacrolimus. Avoid use of tacrolimus ointment in patients receiving immunosuppressants.
RoflumilastRoflumilast may enhance the immunosuppressive effect of immunosuppressants such as cladribine. The Canadian roflumilast product monograph recommends avoiding concurrent use of roflumilast with any immunosuppressant medications due to the antiinflammatory/immune altering effects of roflumilast and the lack of relevant clinical experience with such use. Of note, this recommendation to avoid concurrent use does not apply to either inhaled corticosteroids (which have much more limited systemic immune-suppressing actions) or short-term systemic corticosteroid use. U.S. prescribing information does not contain this warning; but it appears prudent to avoid this combination when possible.
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