Cladribine is a disease‑modifying therapy (DMT) used to treat relapsing forms of multiple sclerosis (MS).

In Australia, cladribine tablets are available under the brand names Mavenclad® and CLADRITAB®. It is used to reduce the frequency of relapses and delay the progression of physical disability.

Cladribine is administered in two treatment courses over two years. Each treatment course consists of two treatment weeks at the start of a 1 year period. For a treatment week, you will be prescribed to take one or two tablets, once a day for 4-5 days. The second treatment week will usually start 4 weeks after the start date of the first. There is no Mavenclad® treatment between the two courses.

Dosage of cladribine is dependent on your weight. Your doctor will decide the number of tablets per day (1 or 2) and number of treatment days (4 or 5) depending on your body weight. You may need to take the same number of tablets each day or some days you might take two tablets and then only one tablet on the following days.

No further cladribine treatment is required in years 3 and 4. Re-initiation of therapy after 4 years has not been studied.

Cladribine helps most people with MS, but may have side effects in some people. All medications have side effects. It is important to notify your health professional if you experience any side effects or are feeling unwell.

A very common side effect of cladribine is a reduction in the number of a type of white blood cell known as lymphocytes. Reduced lymphocytes may increase your risk of getting an infection, particularly viral infections.

Other common side effects include cold sores, shingles, skin rashes and a reduced neutrophil count (a common type of white blood cell important to fighting off infections). Symptoms of shingles include a ‘band’ of severe pain and blistering rash, typically on one side of the upper body or the face, burning, tingling, numbness or itchiness of the skin in the affected area and feeling generally unwell or fever in the early stages of infection. Tell your doctor immediately if you get symptoms of shingles.

Your neurologist will assist you to assess the risks and the expected benefit of treatment with cladribine prior to starting therapy and over the course of treatment. Your health professional can provide comprehensive information on the use of cladribine, including precautions and side effects.

Cladribine interferes with DNA synthesis and suspected to cause or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. Pregnancy should be avoided during treatment and for at least 6 months after the last dose.

Both men and women must use a proven method of birth control while taking cladribine and for at least 6 months after your last dose of cladribine.

If you are currently pregnant or trying to become pregnant, please discuss your individual circumstances and treatment options with your neurologist or healthcare team.

It is not known if cladribine is excreted in human milk. Because many medications are excreted in human milk and there is no published experience with cladribine during breastfeeding, it should be avoided during breastfeeding and for at least 1 week after the last dose.

If you are currently breastfeeding, please discuss your individual circumstances and treatment options with your neurologist or healthcare team.