Drug Detail:Clolar (Clofarabine [ kloe-far-a-been ])
Generic Name: CLOFARABINE 1mg in 1mL
Dosage Form: injection
Drug Class: Antimetabolites
Recommended Dosage
Administer the recommended pediatric dose of 52 mg/m2 as an intravenous infusion over 2 hours daily for 5 consecutive days.
- Repeat treatment cycles following recovery or return to baseline organ function, approximately every 2 to 6 weeks. Base dosage on the patient's body surface area (BSA), calculated using the actual height and weight before the start of each cycle. To prevent drug incompatibilities, do not administer other medications through the same intravenous line. Administer subsequent cycles no sooner than 14 days from the starting day of the previous cycle and provided the patient's ANC is ≥0.75 × 109/L.
- Provide supportive care, such as intravenous fluids, antihyperuricemic treatment, and alkalinize urine throughout the 5 days of Clolar administration to reduce the effects of tumor lysis and other adverse reactions.
- Discontinue Clolar if hypotension develops during the 5 days of administration.
- Monitor renal and hepatic function during the 5 days of Clolar administration [see Warnings and Precautions (5.7, 5.8)].
- Monitor patients taking medications known to affect blood pressure. Monitor cardiac function during administration of Clolar.
Recommended Dosage Reduction for Renal Impairment
- Reduce the dose by 50% in patients with creatinine clearance (CrCL) between 30 and 60 mL/min. There is insufficient information to make a dosage recommendation in patients with CrCL less than 30 mL/min [see Use in Specific Populations (8.6)].
Potential Concomitant Medications and Medications to Avoid
- Consider prophylactic antiemetic medications as Clolar is moderately emetogenic.
- Consider the use of prophylactic steroids to mitigate Systemic Inflammatory Response Syndrome (SIRS) or capillary leak syndrome (e.g., hypotension, tachycardia, tachypnea, and pulmonary edema).
- Minimize exposure to drugs with known renal toxicity during the 5 days of Clolar administration since the risk of renal toxicity may be increased.
- Avoid concomitant use of medications known to induce hepatic toxicity.
Dose Modifications and Reinitiation of Therapy after Adverse Reactions
Hematologic Toxicity
- If a patient experiences a Grade 4 neutropenia (ANC <0.5 × 109/L) lasting ≥4 weeks, reduce dose by 25% for the next cycle.
Non-hematologic Toxicity
- Withhold Clolar if a patient develops a clinically significant infection, until the infection is controlled, then restart at the full dose.
- Withhold Clolar for a Grade 3 non-infectious non-hematologic toxicity (excluding transient elevations in serum transaminases and/or serum bilirubin and/or nausea/vomiting controlled by antiemetic therapy). Re-institute Clolar administration at a 25% dose reduction when resolution or return to baseline.
- Discontinue Clolar administration for a Grade 4 non-infectious non-hematologic toxicity.
- Discontinue Clolar administration if a patient shows early signs or symptoms of SIRS or capillary leak syndrome (e.g., hypotension, tachycardia, tachypnea, and pulmonary edema) occur and provide appropriate supportive measures.
- Discontinue Clolar administration if Grade 3 or higher increases in creatinine or bilirubin are noted. Re-institute Clolar with a 25% dose reduction, when the patient is stable and organ function has returned to baseline. If hyperuricemia is anticipated (tumor lysis), initiate measures to control uric acid.
Reconstitution/Preparation
Filter Clolar through a sterile 0.2 micron syringe filter and then dilute with 5% Dextrose Injection, USP, or 0.9% Sodium Chloride Injection, USP, prior to intravenous infusion to a final concentration between 0.15 mg/mL and 0.4 mg/mL. Use within 24 hours of preparation. Parenteral drug products should be visually inspected for particulate matter and discoloration prior to administration, whenever solution and container permit. Store diluted Clolar at room temperature (15°C to 30°C).
Discard unused portion in vial.
