When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to nelarabine or if you are pregnant.

How to Use This Medicine:
Injectable

• Medicines used to treat cancer are very strong and can have many side effects. Before receiving this medicine, make sure you understand all the risks and benefits. It is important for you to work closely with your doctor during your treatment.
• You will receive this medicine while you are in a hospital or cancer treatment center. A nurse or other trained health professional will give you this medicine.
• Your doctor will prescribe your dose and schedule. This medicine is given through a needle placed in a vein.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Tell your doctor if you have ever been treated with cancer drugs in the past.
• This medicine may interfere with vaccines. Ask your doctor before you get a flu shot or any other vaccines.

Warnings While Using This Medicine:

• Make sure your doctor knows if you are pregnant or breast-feeding, or if you have nervous system problems, or kidney problems.
• It is not safe to take this medicine during pregnancy. It could harm an unborn baby. Tell your doctor right away if you become pregnant.
• This medicine may make you drowsy. Avoid driving, using machines, or doing anything else that could be dangerous if you are not alert.
• This medicine may make you bleed, bruise, or get infections more easily. Take precautions to prevent illness and injury. Wash your hands often.
• Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.
• Cancer medicine can cause nausea or vomiting, sometimes even after you receive medicine to prevent these effects. Ask your doctor or nurse about other ways to control any nausea or vomiting that might happen.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Extreme sleepiness.
• Numbness and tingling in the hands, fingers, feet, or toes.
• Problems with balance or walking.
• Problems with fine motor skills such as buttoning clothes.
• Seizures.
• Weakness and paralysis.

If you notice these less serious side effects, talk with your doctor:

• Body aches, muscle cramps or joint pains.
• Diarrhea, or constipation.
• Dry mouth and increased thirst.
• Fever, chills, cough, and sore throat.
• Headache, sleepiness, and blurry eyesight.
• Lightheadedness or fainting.
• Sores or white patches on your lips, mouth, or throat.
• Swelling in your hands, ankles, or feet.
• Tiredness and trouble breathing.
• Unusual bleeding or bruising.

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088