Drug General Information (ID: DDIPR4VL1E)
Drug Name			Cytarabine		Drug Info		Fludarabine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antineoplastics				Antineoplastics
Structure

Mechanism of Cytarabine-Fludarabine Interaction (Severity Level: Moderate)
Additive immunosuppressive effects Click to Show/Hide Mechanism Graph
Drug Name		Cytarabine				Fludarabine
Mechanism 1		Immunosuppressive effects				Immunosuppressive effects
Key Mechanism Factor 1
		Factor Name		Immunosuppressive effects
		Factor Description		Immunosuppression is when your immune system is not functioning as it should. The immune system is made up of cells, tissues and organs that help the body fight off infections. If the immune system is suppressed, an infection that your body was able to control may become serious or even fatal.
Mechanism Description		Additive immunosuppressive effects by the combination of Cytarabine and Fludarabine
Additive myelosuppressive effects Click to Show/Hide Mechanism Graph
Drug Name		Cytarabine				Fludarabine
Mechanism 2		Myelosuppressive effects				Myelosuppressive effects
Key Mechanism Factor 2
		Factor Name		Myelosuppressive effects
		Factor Description		Myelosuppression, also known as bone marrow suppression, is a decrease in bone marrow activity that leads to a decrease in the production of blood cells. Some blood cell disorders include: erythrocytopenia (anemia), leukopenia (neutropenia), and thrombocytopenia (thrombocytopenia).
Mechanism Description		Additive myelosuppressive effects by the combination of Cytarabine and Fludarabine

Recommended Action
Management		It has been suggested that cytarabine be given as a relatively short-term infusion (two to four hours) following fludarabine to minimize metabolic interference with the subsequent fludarabine dose and to maximize ara-CTP synthesis.

References
1	Gandhi V, Estey E, Keating MJ, Plunkett W "Fludarabine potentiates metabolism of cytarabine in patients with acute myelogenous leukemia during therapy." J Clin Oncol 11 (1993): 116-24. [PMID: 8418222]
2	Kemena A, Gandhi V, Shewach DS, Keating M, Plunkett W "Inhibition of fludarabine metabolism by arabinosylcytosine during therapy." Cancer Chemother Pharmacol 31 (1992): 193-9. [PMID: 1464155]