cladribine
Mavenclad (cladribine) is an oral medication used to treat multiple sclerosis (MS) that flares up from time to time (relapsing forms of MS). It's not a first-choice medication because it can cause many serious side effects, but it might be an option for people who didn't have good results from other MS medications. You only have to take it a few days out of the year, but need to get regular lab work to check your health. It can be very expensive because it's brand only.
What is Mavenclad (cladribine)?
What is Mavenclad (cladribine) used for?
- Relapsing forms of multiple sclerosis (MS)
How Mavenclad (cladribine) works
Mavenclad (cladribine) is an antimetabolite. It's not fully known how Mavenclad (cladribine) works, but it's thought to treat MS by killing lymphocytes, a type of white blood cell (WBC). Normally, WBCs protect your body from infections. But in people with MS, they can attack your nerves and cause inflammation (swelling). So Mavenclad (cladribine) treats MS by killing these WBCs to protect your nerves.
Drug facts
Side effects of Mavenclad (cladribine)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Infections that affect the nose, throat, and upper airways (38%)
- Headache (25%)
- Low lymphocyte count (24%)
- Nausea (10%)
- Back pain (8%)
- Muscle and joint pain (7%)
- Trouble sleeping (6%)
Less Common Side Effects
- Infections in the lungs
- High blood pressure
- Fever
- Depression
Mavenclad (cladribine) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Cancer
- Serious infections: fever, feeling unwell, low appetite, muscle aches or pain, blistered rash or skin blotches, burning, tingling, itching in the skin, vision changes, thinking problems, confusion, problems with balance, weakness on one side of your body
- Blood problems: dizziness, tiredness, weakness, bruising more easily, bleeds that are difficult to stop
- Liver injury: nausea, vomiting, stomach pain, fatigue, low appetite, yellowing skin, dark urine
- Serious allergic reactions: rash, mouth ulcers, throat swelling, headache, double vision
- Heart failure: shortness of breath, fast heart beat, swelling or fluid buildup in your body
The following Mavenclad (cladribine) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Low red blood cell level—unusual weakness or fatigue, dizziness, headache, trouble breathing
- Pain, tingling, or numbness in the hands or feet, muscle weakness, change in vision, confusion or trouble speaking, loss of balance or coordination, trouble walking, seizures
- Unusual bruising or bleeding
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
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Pros and cons of Mavenclad (cladribine)
Pros
- Short treatment, only need to take it about 10 days per year
- Taken by mouth, so can be a good option for people who don't like needles
- Comes in a special weekly dosing pack with your exact dose, so convenient to take
Cons
- Not taken regularly, so might be difficult for some people to remember when to take it
- Need to get lab work and tests done before, during, and after treatment
- More likely to get sick during and after taking this medication
- Brand only, so can be expensive
Pharmacist tips for Mavenclad (cladribine)
- Remember when to go to your lab appointments and to take your Mavenclad (cladribine) at the right time. Use a calendar or other methods to remind you of these dates.
- Swallow Mavenclad (cladribine) whole with water. Don't chew this medication. You can take it with or without food.
- Don't take Mavenclad (cladribine) at the same time as other medications because it can affect how well other medications work. If you're on other medications, take them at least 3 hours before or after you take Mavenclad (cladribine).
- Mavenclad (cladribine) can cause cancer. Only take it out of the blister when you're ready to take it. If you leave the tablet out on a table or if broken pieces fall on the ground, you must clean the area right away with water to prevent children or pets from touching or eating the medication.
- Make sure your hands are dry before you take Mavenclad (cladribine) out of the blister. Swallow this medication immediately. Don't hold the tablet in your hands for too long.
- It might take 6 months or longer for your WBC count to recover after you stop Mavenclad (cladribine). During this time, you're still at a higher risk of getting sick so make sure to protect yourself by doing things such as washing your hands with soap and water, avoid touching your eyes or mouth with unwashed hands, and getting enough sleep. Let your provider know right away if you feel sick.
Common questions about Mavenclad (cladribine)
Before, during, and sometimes even after treatment with Mavenclad (cladribine), you'll need certain tests done to make sure this medication is safe for you. Your provider will check you for certain infections, liver damage, low white blood cell (WBC) count, pregnancy (if you're a woman of childbearing age), and cancer. This medication can cause serious side effects if used by people with certain conditions. You can look at the full list of tests here. Talk with your provider and make sure you have appointments scheduled for the tests you need.
Yes, you're more likely to get sick when you take Mavenclad (cladribine). This medication lowers your WBC levels, which puts you at higher risk for infections. You'll need to do blood work before, during, and after treatment with Mavenclad (cladribine) to track your WBCs. If it's too low, you might need to stop treatment until your WBC count goes up to the normal range. Let your provider know right away if you feel sick and experience symptoms, such as fever, fatigue, weakness, difficulty walking, stomach pain, joint pain, headaches, body aches, cough, runny nose, or sore throat.
It's best to get all the immunizations you need before starting Mavenclad (cladribine). Get live-attenuated vaccines at least 4 to 6 weeks before you start Mavenclad (cladribine). Because this medication weakens your immune system, you might get sick from vaccines made from live viruses. If you need to get live vaccines after Mavenclad (cladribine) treatment, you will need to get blood work to check that your WBCs are in the normal range first.
No, don't take Mavenclad (cladribine) if you're pregnant or breastfeeding. This medication can cause birth defects or death to unborn babies, and it passes into breastmilk. Females of childbearing age and men with female partners of childbearing age need to use effective birth control both during and for at least 6 months after Mavenclad (cladribine) treatment. If you're female and only using hormonal birth control, you and your partner should also consider using a barrier method of birth control, like condoms. If you become pregnant, stop this medication right away. Don't breastfeed during and for at least 10 days after your last dose of Mavenclad (cladribine).
If you missed your dose of Mavenclad (cladribine) on your scheduled day, don't take extra tablets to make up for the missed dose. Instead, just take your missed dose the next day. Be aware that this will extend your treatment cycle, so make a note on your calendar. For example, if you missed your Mavenclad (cladribine) dose 2 days in a row, your treatment cycle will be extended by 2 days to make up for these doses.
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Risks and warnings for Mavenclad (cladribine)
Mavenclad (cladribine) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Cancer
- Risk factors: Cancer | History of cancer | Having other conditions that put you at higher risk for cancer | Multiple rounds of Mavenclad (cladribine) treatment less than 2 years apart
Mavenclad (cladribine) can raise your risk of cancer. Your risk is higher if you have certain conditions, such obesity, or if you're taking certain medications, such as hormone therapy. You'll need to get a cancer screening before you start Mavenclad (cladribine). Don't take this medication if you have cancer. Let your provider know if you have a family history of cancer, you might need to switch to a different medication.
Harm to unborn babies
- Risk factors: Childbearing age and not using effective birth control | Currently pregnant
Mavenclad (cladribine) can cause birth defects in babies born to mothers who take this medication during pregnancy. Take a pregnancy test before starting this medication. Don't take Mavenclad (cladribine) if you're pregnant. If you're of childbearing age or if you have a female partner who is of childbearing age, you and your partner should use effective birth control during and for 6 months after your Mavenclad (cladribine) treatment. If you become pregnant, stop this medication and talk with your provider about other options for your MS.
Serious infections
- Risk factors: Multiple treatment courses of Mavenclad (cladribine) | Currently or history of taking other medications that can lower your immune system
Mavenclad (cladribine) can put you at risk for serious infections. It weakens your immune system by lowering your white blood cells (WBCs). You'll need to get blood work before, during, and after treatment with Mavenclad (cladribine) to track your WBCs. If it's too low, you might need to stop treatment until your WBC count goes up to a normal range.
Before starting this medication, you'll also need to check if you have certain infections because some infections might not show noticeable symptoms. Ask your provider for the full list of tests you need to do. Don't take this medication if you have HIV, active tuberculosis (TB), or active hepatitis. Tell your provider if you feel sick before you start or during treatment with Mavenclad (cladribine), you might need to wait until you're fully recovered before starting or continuing this medication.
Blood problems
Mavenclad (cladribine) can lower your counts of red blood cells (RBCs), WBCs, and platelets. You'll need to get blood tests before, during, and after treatment with this medication to monitor your blood cell counts. Let your provider know right away if you experience symptoms of blood problems, such as dizziness, tiredness, weakness, bruising more easily, bleeds that are difficult to stop.
If you ever need a blood transfusion, make sure your provider knows that you're taking or have taken Mavenclad (cladribine). The donated blood might need to be treated with radiation to prevent a serious complication called transfusion-associated graft-versus-host disease. This is a condition where parts of the transfused blood attack your organs.
Liver injury
Mavenclad (cladribine) can cause liver injuries. This can happen as early as weeks after starting this medication. Tell your provider if you experience symptoms of liver problems, such as nausea, vomiting, stomach pain, fatigue, low appetite, or have yellowing skin and dark urine, you might need to stop Mavenclad (cladribine).
Mavenclad (cladribine) dosage
Box| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 4 tablets of 10mg | 1 box | $12,639.85 | $12,639.85 |
| 6 tablets of 10mg | 1 box | $18,956.65 | $18,956.65 |
| 7 tablets of 10mg | 1 box | $22,115.05 | $22,115.05 |
| 8 tablets of 10mg | 1 box | $25,273.45 | $25,273.45 |
| 10 tablets of 10mg | 1 box | $31,590.25 | $31,590.25 |
Typical dosage for Mavenclad (cladribine)
Mavenclad (cladribine) is taken by mouth. Your total dose depends on your weight (3.5 mg/kg). This total dose isn't taken all at once, but divided in half and each half taken about 1 year apart. You take the first half of the total dose during the first treatment course. Then, you take the other half of the dose about 1 year later during the second treatment course. Each treatment course is divided into two treatment cycles, about 1 month apart.
The schedule for the total dose of Mavenclad (cladribine) typically looks like this:
First treatment course (1st half of the total dose)
- First cycle: Start any time.
- Second cycle: Start 23 to 27 days after you finish the first cycle in the first treatment course.
Second treatment course (2nd half of the total dose)
- First cycle: Start at least 10 months (43 weeks) after you finish the first treatment course.
- Second cycle: Start 23 to 27 days after you finish the first cycle in the second treatment course.
For each cycle, you'll receive your exact dose of Mavenclad (cladribine) in a special package. Typically in each cycle, you take 10 mg to 20 mg by mouth daily for 4 to 5 days. Don't take more than 20 mg per day.
After you finish both treatment courses of Mavenclad (cladribine), don't take this medication for at least 2 years.
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Mavenclad (cladribine) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Mavenclad (cladribine) will not be safe for you to take.
- Cancer
- Human immunodeficiency virus (HIV)
- Active long-term infections, such as hepatitis or tuberculosis
- Currently pregnant
- Child-bearing age (age when you're able to have children) and not planning to use effective birth control during and for 6 months after Mavenclad (cladribine) treatment
- Breastfeeding during and for 10 days after the last dose of Mavenclad (cladribine) treatment
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