Cytarabine is a chemotherapy drug. It is a treatment for some types of lymphoma (cancer of the lymph glands) and leukaemia. You might also have it as a prevention in case cancer cells get into the spinal fluid.
How it works
This drug is a type of chemotherapy drug called an anti metabolite.
Anti metabolites are similar to normal body molecules but they are slightly different in structure. They kill cancer cells by stopping them making and repairing DNA that they need to grow and multiply.
How you have it
Cytarabine is a clear liquid. An experienced cancer doctor injects it into the fluid around the spinal cord during a lumbar puncture. This treatment is also called intrathecal cytarabine.
You have an intrathecal injection of cytarabine the same way you have a lumbar puncture. You lie on your side. Your doctor gives you a small injection to numb an area in your back. They then inject the cytarabine between 2 of your spinal bones into the spinal fluid. It takes from 1 to 5 minutes. Afterwards you need to lie flat for an hour.
When you have it
The number of treatments may vary. Your doctor will tell you how often you need treatment.
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.
When to contact your team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.
Some of the side effects listed are more likely to happen if you are having cytarabine as a drip or injection into a vein than if you are having it in the spinal fluid.
Common side effects
Common side effects happen in more than 10 in 100 people (more than 10%). At the time of this review, there have been no reports of common side effects for this treatment.
Occasional side effects
These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:
Breathlessness and looking pale
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
Increased risk of bruising and bleeding
This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).
Loss of appetite
You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.
Changes to being aware of your surroundings
You might feel sleepy, unable to stay awake or be unaware of surroundings (a low level of consciousness).
You might find that you are not able to speak or have some difficulty speaking.
You might have eye problems including blurred vision, sore, red, itchy, dry eyes (conjunctivitis) or an infection. Tell your doctor or nurse if you have this. They can give you eye drops or other medication to help.
You might also have abnormal eye movemants and your eyes might be more sensitive to light.
Sore inflammed blood vessels
Your blood vessels might get inflamed and sore. Symptoms include red spots on the skin, lumps or sores. Your legs and arms might aso feel weak and numb. Contact your advice line or tell your doctor or nurse if you have any of these symptoms.
High temperature (fever)
If you get a high temperature, let your health care team know straight away. Ask them if you can take paracetamol to help lower your temperature.
Inflammation at the site of injection
You might have small blood clots where you had the injection. This can cause swelling, redness and discomfort. Tell your healthcare team if this happens.
Feeling or being sick
Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.
Tummy (abdomen) pain
Tell your treatment team if you have this. They can check the cause and give you medicine to help.
Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids, avoid acidic foods such as oranges, lemons and grapefruits, and chew gum to keep the mouth moist. Tell your doctor or nurse if you have ulcers.
Sore back passage (anus)
You might also get sores (ulcers) around your back passage. Contact the advice line or tell your doctor or nurse if this happens.
Tell your doctor or nurse if you have headaches. They can give you some painkillers
You might have back pain. Speak to your doctor if this is a problem for you. They can prescribe medicine to help.
Rare side effects
These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:
- whole body infection (sepsis) causing fever, being sick, confusion, dizziness and chills
- brown or black spots on the skin (lentigo)
- numbness, weakness or pain in lower arms or legs
- loss of ability to move (paralysis of) legs and lower body
- inflammation of the sac surrounding the heart
- lung infection (pneumonia)
- shortness of breath
- sore throat, inflammation and or ulcers of the food pipe (oesophagus)
- cysts in the bowel, severe inflammation of the bowel causing damage symptoms include bloating, blood in the poo, diarrhoea, being sick and loss of appetite
- infection of the tissue lining the abdomen (peritonitis)
- ulcers on the skin
- pain, burning, reddening and blistering of the palms of the hands and soles of the feet
- muscle and joint pain
- inflammation at the site of injection
- increased levels of uric acid in the blood
- changes to how the liver works
- rash, dry itchy skin
- hair loss
- changes to how the kidneys work
Coping with side effects
We have more information about side effects and tips on how to cope with them.
What else do I need to know?
Other medicines, foods and drinks
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
Loss of fertility
It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Contraception and pregnancy
This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.
You can have:
- other vaccines, but they might not give you as much protection as usual
- the flu vaccine (as an injection)
- the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment
Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your
Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
More information about this treatment
For further information about this treatment go to the electronic Medicines Compendium (eMC) website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.