Cytarabine (Ara C, cytosine arabinoside)

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Cytarabine (Ara C, cytosine arabinoside)
Cancer Research UK

Last updated 06 February 2009

What cytarabine is
Cytarabine is used to treat acute leukaemias, some types of head and neck cancer and non Hodgkin’s lymphoma (NHL). This drug is one of a group of chemotherapy drugs called anti-metabolites. Anti-metabolites are similar to normal body molecules but they are slightly different in structure. They stop cancer cells making and repairing DNA that they need to grow and multiply.

How you have treatment
Cytarabine is a clear liquid. You can have it

* Through a drip into a vein (intravenous infusion)
* Into the fluid surrounding the spinal cord (intrathecally)
* Or by an injection just under the skin (subcutaneously)

Cytarabine through a drip can take from 10 minutes to 2 hours, depending on the dose you have.

You usually have cytarabine chemotherapy as a course of several cycles of treatment. The treatment plan depends on which type of cancer you have. There is more about planning chemotherapy in the chemotherapy section of CancerHelp UK.

The side effects associated with cytarabine are listed below. You can use the links (underlined) to find out more about each side effect. Where there is no link please look at our chemotherapy side effects section or use the search box at the top of the page.

Common side effects

Many people experience a temporary drop in the number of blood cells made by your bone marrow, leading to the following side effects

* Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery. Infections can sometimes be life threatening. You should contact your treatment centre straight away if you think you have an infection
* Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
* Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia). You should contact your treatment centre if you have any of these effects.

Other common side effects include

* Fatigue during and after treatment – most people find their energy levels are back to normal after 6 months to a year
* Feeling or being sick is usually mild to moderate unless you are having high dose treatment
* Diarrhoea – if you are going to get this side effect, it usually happens about a week after your treatment
* Sore mouth or mouth ulcers – if you are going to get this side effect, it usually happens about a week after your treatment
* Loss of appetite is likely if you have sickness, diarrhoea, or a sore mouth
* Women may stop having periods (amenorrhoea) but this may only be temporary
* Cytarabine may have a harmful effect on a developing baby – do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant
* Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if this is important to you
* High uric acid levels in your blood due to cancer cells being broken down by the body – you will have regular blood tests and will be asked to drink plenty of fluids to flush out the uric acid. You may also have a drug called allopurinol.

Occasional side effects

Some people have the following side effects

* Hair loss or thinning
* Aching muscles (myalgia) and bones

High dose side effects

Treatment with high doses of cytarabine can cause the following side effects

* Sore, red eyes (conjunctivitis) because some of the drug is removed from your body (excreted) in your tears – your doctor may prescribe steroid eye drops to prevent sore eyes
* Sore, red skin, particularly on the hands and feet
* Drowsiness and confusion can affecting up to 1 in 10 people (10%) having high dose treatment – this is usually mild and gets better on its own. It is more likely if you are over 40, or have liver or kidney problems.

Important points to remember
The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

* How many times you've had the drug before
* Your general health
* The amount of the drug you have (the dose)
* Other drugs you are having

Some side effects are inconvenient or upsetting but not damaging to your health.

Some side effects are serious medical conditions and need treating. Where we have urged you to contact your doctor, this is because

* Your side effect may need treating
* Your drug dose may need reducing to try to prevent the side effect

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will have given you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Immunisations and chemotherapy
You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy.

It is perfectly safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but no one in the UK is given an oral vaccine now. So there is no problem in being with any baby or child who has recently had any vaccination in the UK. If you live abroad, you might need to make sure that you aren't in contact with anyone who has had oral polio or oral typhoid vaccination recently.

CancerHelp UK is not designed to provide medical advice or professional services and is intended to be for educational use only. The information provided through CancerHelp UK is not a substitute for professional care and should not be used for diagnosing or treating a health problem or a disease. If you have, or suspect you may have, a health problem you should consult your doctor.

Copyright Cancer Research UK 2002