See pack age insert for further information. Dosage Modification Rules Patients with renal impairment dosing: CrCl > 70 ml/min: No dosage adjustment required. CrCl 30 -70 ml/min: Reduce dose by 20%. CrCl < 30 ml/min: Fludarabine should not be administered intravenously to these patients. Toxicity Toxicity from fludarabine includes the following: (a) hematologic -myelosuppression with anemia, neutropenia and thrombocytopenia; (b) nervous system-weakness, pain, malaise, paresthesias, visual and hearing disturbances, encephalopathy; (c) gastrointestinal-nausea, vomiting, GI bleeding, mucositis, and anorexia; (d) integumentary-rash, and pruritis; (e) other -interstitial pneumonitis, cough, fever, myalgia, tumor lysis, and elevated LFTs. Re-MATC H Protocol Page 77 of 106 Version: 20180628 19.