Side effects of High Dose ARA-C

A.    Hematologic

    1.    Leukopenia, thrombocytopenia, anemia

    2.    Watch for decreased WBC count (and ANC), decreased platelet count, decreased H/H.

B.    Ocular

    1.    Excessive tearing, photophobia, pain, blurred vision, keratitis (inflammation of the cornea).

    2.    Symptoms resolve in a few days, but visual acuity problems may take weeks to resolve fully

    3.    Corticosteroid eye drops are ordered for prophylactic treatment of conjunctivitis.  Dose:  0.1% Decadron opthalmic 1-2 gtts Q4-6 hours while awake for seven days following Ara-C.  Install one drop at a time; drops feel "gritty" and cause burning sensation on installation

C.    Cerebral/Cerebellar

    1.    Nystagmus, dysarthria (stammering, stuttering), ataxia (loss of coordination of the muscles, especially of the extremities), slurring of speech, decreased level of consciousness, loss of balance, personality changes, memory loss.

    2.    Onset:  3-8 days after first dose.  Symptoms usually last between 3-10 days.  (However, 30% of patients will not recover normal cerebellar function.)  Ataxia and nystagmus are usually the first signs of cerebellar syndrome and may precede more severe symptoms by 24 hours.

    3.    Seizure activity is rare.

D.    Gastrointestinal

    1.    Diarrhea, nausea/vomiting, stomatitis (mild oral ulceration is fairly common), anorexia.

    2.    GI hemorrhage is rare.

E.    Hepatic

    1.    Hepatic dysfunction is evidenced by transient enzyme elevations.   

    2.    Watch for:  elevated SGOT/SGPT, lactic dehydrogenase, and bilirubin levels.

F.    Renal

    1.    Renal impairment may evolve as a result of hepatic dysfunction.

    2.    Watch for elevated BUN/CR.

G.    Pulmonary

    1.    Sudden respiratory distress is possible, rapidly progressing to pulmonary edema and cardiomegaly.  It is rare but onset is 22-27 days after cessation of therapy.

    2.    Clinical features:  tachypnea, hypoxemia, diffuse pulmonary infiltrates on x-ray.

H.    Skin

    1.    Rash is possible which starts on palms and soles and may progress to neck and chest or disseminate to the whole body.

    2.    There is no specific treatment for the rash but documentation of its progress is important.

I.    Other

    1.    Flu-like syndrome: malaise, bone pain, headache.

    2.    Hemorrhagic cystitis is rare.