Chlorambucil Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Hodgkin's Disease

For initiation of therapy or for short courses of treatment:
Usual Dosage: 0.1 to 0.2 mg/kg orally daily for 3 to 6 weeks as required. (This usually amounts to 4 to 10 mg per day for the average patient.) The entire daily dose may be given at one time. The dosage must be carefully adjusted according to the response of the patient and must be reduced as soon as there is an abrupt fall in the white blood cell count. Patients with Hodgkin's disease usually require 0.2 mg/kg daily. Patients with other lymphomas or chronic lymphocytic leukemia usually require only 0.1 mg/kg daily. When lymphocytic infiltration of the bone marrow is present, or when the bone marrow is hypoplastic, the daily dose should not exceed 0.1 mg/kg (about 6 mg for the average patient).

Alternatively the initial dosage of chlorambucil for the treatment of Hodgkin's disease is 10 mg orally once a day for seven days out of twenty one. This regimen also includes vinblastine, procarbazine, prednisolone, etoposide, vincristine, and doxorubicin.

Alternate schedules for the treatment of chronic lymphocytic leukemia employing intermittent, biweekly, or once-monthly pulse doses of chlorambucil have been reported. Intermittent schedules of chlorambucil begin with an initial single dose of 0.4 mg/kg. Doses are generally increased by 0.1 mg/kg until control of lymphocytosis or toxicity is observed. Subsequent doses are modified to produce mild hematologic toxicity. It is felt that the response rate of chronic lymphocytic leukemia to the biweekly or once-monthly schedule of chlorambucil administration is similar or better to that previously reported with daily administration and that hematologic toxicity was less than or equal to that encountered in studies using daily chlorambucil.

Radiation and cytotoxic drugs render the bone marrow more vulnerable to damage, and chlorambucil should be used with particular caution within 4 weeks of a full course of radiation therapy or chemotherapy. However, small doses of palliative radiation over isolated foci remote from the bone marrow will not usually depress the neutrophil and platelet count. In these cases chlorambucil may be given in the customary dosage.

It is presently felt that short courses of treatment are safer than continuous maintenance therapy, although both methods have been effective. It must be recognized that continuous therapy may give the appearance of "maintenance" in patients who are actually in remission and have no immediate need for further drug. If maintenance dosage is used, it should not exceed 0.1 mg/kg daily and may well be as low as 0.03 mg/kg daily.

Typical maintenance dose is 2 mg to 4 mg daily, or less, depending on the status of the blood counts. It may, therefore, be desirable to withdraw the drug after maximal control has been achieved, since intermittent therapy reinstituted at time of relapse may be as effective as continuous treatment.

Usual Adult Dose for Chronic Lymphocytic Leukemia

For initiation of therapy or for short courses of treatment:
Usual Dosage: 0.1 to 0.2 mg/kg orally daily for 3 to 6 weeks as required. (This usually amounts to 4 to 10 mg per day for the average patient.) The entire daily dose may be given at one time. The dosage must be carefully adjusted according to the response of the patient and must be reduced as soon as there is an abrupt fall in the white blood cell count. Patients with Hodgkin's disease usually require 0.2 mg/kg daily. Patients with other lymphomas or chronic lymphocytic leukemia usually require only 0.1 mg/kg daily. When lymphocytic infiltration of the bone marrow is present, or when the bone marrow is hypoplastic, the daily dose should not exceed 0.1 mg/kg (about 6 mg for the average patient).

Alternatively the initial dosage of chlorambucil for the treatment of Hodgkin's disease is 10 mg orally once a day for seven days out of twenty one. This regimen also includes vinblastine, procarbazine, prednisolone, etoposide, vincristine, and doxorubicin.

Alternate schedules for the treatment of chronic lymphocytic leukemia employing intermittent, biweekly, or once-monthly pulse doses of chlorambucil have been reported. Intermittent schedules of chlorambucil begin with an initial single dose of 0.4 mg/kg. Doses are generally increased by 0.1 mg/kg until control of lymphocytosis or toxicity is observed. Subsequent doses are modified to produce mild hematologic toxicity. It is felt that the response rate of chronic lymphocytic leukemia to the biweekly or once-monthly schedule of chlorambucil administration is similar or better to that previously reported with daily administration and that hematologic toxicity was less than or equal to that encountered in studies using daily chlorambucil.

Radiation and cytotoxic drugs render the bone marrow more vulnerable to damage, and chlorambucil should be used with particular caution within 4 weeks of a full course of radiation therapy or chemotherapy. However, small doses of palliative radiation over isolated foci remote from the bone marrow will not usually depress the neutrophil and platelet count. In these cases chlorambucil may be given in the customary dosage.

It is presently felt that short courses of treatment are safer than continuous maintenance therapy, although both methods have been effective. It must be recognized that continuous therapy may give the appearance of "maintenance" in patients who are actually in remission and have no immediate need for further drug. If maintenance dosage is used, it should not exceed 0.1 mg/kg daily and may well be as low as 0.03 mg/kg daily.

Typical maintenance dose is 2 mg to 4 mg daily, or less, depending on the status of the blood counts. It may, therefore, be desirable to withdraw the drug after maximal control has been achieved, since intermittent therapy reinstituted at time of relapse may be as effective as continuous treatment.

Usual Adult Dose for Lymphoma

For initiation of therapy or for short courses of treatment:
Usual Dosage: 0.1 to 0.2 mg/kg orally daily for 3 to 6 weeks as required. (This usually amounts to 4 to 10 mg per day for the average patient.) The entire daily dose may be given at one time. The dosage must be carefully adjusted according to the response of the patient and must be reduced as soon as there is an abrupt fall in the white blood cell count. Patients with Hodgkin's disease usually require 0.2 mg/kg daily. Patients with other lymphomas or chronic lymphocytic leukemia usually require only 0.1 mg/kg daily. When lymphocytic infiltration of the bone marrow is present, or when the bone marrow is hypoplastic, the daily dose should not exceed 0.1 mg/kg (about 6 mg for the average patient).

Alternatively the initial dosage of chlorambucil for the treatment of Hodgkin's disease is 10 mg orally once a day for seven days out of twenty one. This regimen also includes vinblastine, procarbazine, prednisolone, etoposide, vincristine, and doxorubicin.

Alternate schedules for the treatment of chronic lymphocytic leukemia employing intermittent, biweekly, or once-monthly pulse doses of chlorambucil have been reported. Intermittent schedules of chlorambucil begin with an initial single dose of 0.4 mg/kg. Doses are generally increased by 0.1 mg/kg until control of lymphocytosis or toxicity is observed. Subsequent doses are modified to produce mild hematologic toxicity. It is felt that the response rate of chronic lymphocytic leukemia to the biweekly or once-monthly schedule of chlorambucil administration is similar or better to that previously reported with daily administration and that hematologic toxicity was less than or equal to that encountered in studies using daily chlorambucil.

Radiation and cytotoxic drugs render the bone marrow more vulnerable to damage, and chlorambucil should be used with particular caution within 4 weeks of a full course of radiation therapy or chemotherapy. However, small doses of palliative radiation over isolated foci remote from the bone marrow will not usually depress the neutrophil and platelet count. In these cases chlorambucil may be given in the customary dosage.

It is presently felt that short courses of treatment are safer than continuous maintenance therapy, although both methods have been effective. It must be recognized that continuous therapy may give the appearance of "maintenance" in patients who are actually in remission and have no immediate need for further drug. If maintenance dosage is used, it should not exceed 0.1 mg/kg daily and may well be as low as 0.03 mg/kg daily.

Typical maintenance dose is 2 mg to 4 mg daily, or less, depending on the status of the blood counts. It may, therefore, be desirable to withdraw the drug after maximal control has been achieved, since intermittent therapy reinstituted at time of relapse may be as effective as continuous treatment.

Usual Pediatric Dose for Malignant Disease

Remission Induction: 0.1 to 0.2 mg/kg/day or 4.5 mg/m2/day once daily for 3 to 6 weeks
Maintenance Therapy: 0.03 to 0.1 mg/kg/day

Nephrotic Syndrome: 0.1 to 0.2 mg/kg/day every day for 5 to 12 weeks with low dose prednisone.

Chronic Lymphocytic Leukemia:
Initial Dose: 0.4 mg/kg every 2 weeks. Increase dose by 0.1 mg/kg every 2 weeks until a response occurs and/or myelosuppression occurs.
Alternate Initial Dose: 0.4 mg/kg every 4 weeks. Increase dose by 0.2 mg/kg every 2 weeks until a response occurs and/or myelosuppression occurs.

Non-Hodgkin's Lymphoma: 0.1 mg/kg/day

Hodgkin's Lymphoma: 0.2 mg/kg/day

Dose Adjustments

In general, dose selection for elderly patients should be cautious and start on the low end of the dosing range.

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