MS- Mavenclad DI Flashcards
Mavenclad generic name
Cladribine
Cladribine indications
RRMS, active SPMS in adults who’ve failed other therapies for MS
NOT FOR CIS!
Cladribine MoA
Purine nucleoside analogue
Prodrug activated by phosphorylation and converted into Cd-ATP to incorporate it into DNA to result in the breakage of DNA strands and shutdowns DNA synthesis and repair
(the MoA in MS is unknown, that’s just how it works as an anticancer med)
Cladribine dosing
3.5mg/kg dose over 2 cycles, administered as 1.75mg/kg in each year
Max dose is 3.5mg/kg over 2 years, or 20mg/day
What to do with a missed dose of cladribine
Administer the missed dose the next day and extend the number of days in the treatment cycle
Ex: if you miss 2 consecutive doses, extend the cycle by 2 days
Warnings/precautions of cladribine
Bone marrow suppression, infection, PML, vaccines, graft-vs.-host disease, hepatotoxicity, cardiotoxicity
Cladribine ADEs
HA, nausea, lymphocytopenia, bone marrow depression, decreased Hg, thrombocytopenia, hypersensitivity reaction, infection, URI, fever, HTN, insomnia, depression, alopecia, oral herpes simplex infection, neutropenia, fungal infection, herpes infections, back pain, arthralgia, arthritis, bronchitis, malignant neoplasm of the ovary, coccidiodomycosis, pyelonephritis
Cladribine is a substrate of what?
BCRP, pGp
Cladribine DDIs
Myelosuppressive agents, immunosuppressants
Agents that undergo intracellular phosphorylation may diminish effect
BCRP inducers may decrease the serum concentration
BCRP inhibitors may increase the serum concentration
Echinacea can decrease the therapeutic effect
Cladribine may decrease effectiveness of OCs
Inhibitors of ENT1 and CNT3 may increase concentration of cladribine
pGp inducers may decrease the serum concentration of cladribine
Immunosuppressants may diminish therapeutic effect of inactivated vaccines
Immunosuppressants may enhance the adverse/toxic effect of live vaccines
Cladribine CIs
Malignancy, PREGNANCY, people who don’t use protection, hypersensitivity, HIV, active infections like hepatitis and TB, breastfeeding during treatment and 10 days after last dose
Cladribine BBWs
Malignancy, TERATOGENICITY
Cladribine monitoring
Lymphocytes, CBC with lymphocyte count, HIV, TB, HBV, HCV status, VZV antibody status, pregnancy test, LFTs, MRI, PML, standard cancer screening, signs/symptoms of acute infection
Special handling of cladribine
It’s a NIOSH drug; basically they recommend using as much caution and protection as possible when handling the drug
