Class: Nitrogen mustard
- Tablets 2 mg
Chlorambucil is a bifunctional alkylating agent of the nitrogen mustard type. A cell cycle nonspecific drug, chlorambucil interacts with cellular DNA to produce a cytotoxic cross-linkage.
Rapidly and completely absorbed. T max is within 1 h. C max is about 1 mcg/mL.
99% protein bound (albumin). Crosses the placenta.
Rapidly and extensively metabolized in the liver to phenylacetic acid mustard (active).
The t ½ is 1.5 h (chlorambucil) and 2.4 h (phenylacetic acid mustard). 15% to 60% is excreted in urine after 24 h (less than 1% as chlorambucil or phenylacetic acid mustard).
Indications and Usage
Chronic lymphatic leukemia; malignant lymphomas including lymphosarcoma, giant follicular lymphoma, and Hodgkin disease.
Ovarian and testicular carcinoma, non-Hodgkin lymphoma, Waldenström macroglobulinemia.
Prior resistance or hypersensitivity.
Dosage and AdministrationInitial Treatment
PO 0.1 to 0.2 mg/kg/day (4 to 10 mg/day) for 3 to 6 wk. Hodgkin disease usually requires 0.2 mg/kg/day, whereas lymphomas or chronic lymphocytic leukemia usually require 0.1 mg/kg/day.Maintenance
PO Doses should not exceed 0.1 mg/kg/day and may be as low as 0.03 mg/kg/day. Doses of 2 to 4 mg/day are typical.
- Diligently follow institutional and NIH procedures for handling, administration, and disposal of anticancer drugs.
- Prescribed dose may be given at one time.
- Administer without regard to meals but administer with food if GI upset occurs.
Store tablets in refrigerator (36° to 46°F).
None well documented.
Laboratory Test Interactions
None well documented.
Confusion; agitation; ataxia; hallucinations; tremors; muscular twitching; flaccid paresis; peripheral neuropathy; seizures; myoclonia.
Rash; urticaria; skin hypersensitivity (including rare reports of skin rash progressing to erythema multiforme, toxic epidermal necrolysis, and Stevens-Johnson syndrome).
Nausea; vomiting; diarrhea; oral ulceration; mucositis.
Sterile cystitis; reversible and permanent sterility.
Bone marrow suppression; leukemia.
Interstitial pneumonia; pulmonary fibrosis.
Acute myelogenous leukemia; drug fever; secondary malignancies.
WarningsBone marrow damage
Chlorambucil can severely suppress bone marrow function.Carcinogenesis
Because of its carcinogenic properties, do not give to patients with conditions other than chronic lymphatic leukemia or malignant lymphomas.Fertility
Chlorambucil has caused chromatid or chromosome damage in men. Reversible and permanent sterility have occurred in men and women.Mutagenicity and teratogenicity
Probable in humans.
Document total cumulative dose.Infection
Monitor patient for signs and symptoms of bacterial, viral, or fungal infection. Report to health care provider immediately if noted.WBC/Platelet count
Implement infection control measures if WBC drops; implement bleeding precautions if platelet count drops.
Category D .
Safety and efficacy not established.
Use with caution because of the greater frequency of decreased hepatic, renal, or cardiac function, and concomitant diseases or other drug therapy.
Chromosome or chromatid damage may occur.
Ensure women of childbearing potential are not pregnant when therapy is initiated and are using effective contraception during treatment.
Skin rash progressing to erythema multiforme, toxic epidermal necrolysis, or Stevens-Johnson syndrome may occur.
Hypoplastic bone marrow/Infiltration
Ensure that daily dose does not exceed 0.1 mg/kg in patient with confirmed hypoplastic bone marrow or bone marrow infiltration.
Radiation and chemotherapy
Do not give a full dosage before 4 wk after a full course of radiation therapy or chemotherapy because of the vulnerability of the bone marrow to damage under these conditions.
Rare, focal, or generalized seizures have occurred in adults and children at therapeutic daily doses, pulse dosing regimens, and in acute overdosage. Exercise caution when administering chlorambucil to patients with a history of seizure disorders, head trauma, or to patients receiving other potentially epileptogenic drugs.
Reversible pancytopenia, neurological toxicity ranging from agitated behavior and ataxia to multiple grand mal seizures.
- Explain name, action, and potential adverse reactions of the treatment regimen. Review the treatment regimen including dosing schedule, duration of treatment, and monitoring that will be required.
- Review benefits of therapy and risks, including potential infertility, leukemia, or secondary malignancies.
- Advise patient, family, or caregiver to immediately report any of the following to health care provider: skin rash; difficulty breathing; fever, chills, or other signs of infection; bleeding or unusual or bruising; seizures; yellow discoloration of skin or eyes; unusual lumps or masses.
- Advise patient, family, or caregiver to report any of the following to health care provider: persistent nausea, vomiting, or diarrhea; persistent cough; loss of menstruation.
- Caution women of childbearing potential to avoid becoming pregnant during therapy.
- Advise men that therapy may temporarily or permanently impair their fertility.
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