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Chlorambucil Side Effects

For the Consumer

Applies to chlorambucil: oral tablet

Along with its needed effects, chlorambucil may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking chlorambucil:

More common
  • Black, tarry stools
  • bleeding gums
  • blood in the urine or stools
  • chest pain
  • cough or hoarseness, accompanied by fever or chills
  • fever or chills
  • lower back or side pain, accompanied by fever or chills
  • painful or difficult urination, accompanied by fever or chills
  • pinpoint red spots on the skin
  • shortness of breath
  • sores, ulcers, or white spots on the lips or in the mouth
  • swollen glands
  • troubled breathing with exertion
  • unusual bleeding or bruising
  • unusual tiredness or weakness
Less common
  • Blistering, peeling, or loosening of the skin
  • diarrhea
  • muscle pain
  • muscle twitching
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • seizures
  • shakiness and unsteady walk
  • shakiness in the legs, arms, hands, or feet
  • sore throat
  • sudden jerky movements of the body
  • unsteadiness, trembling, or other problems with muscle control or coordination
Incidence not known
  • Abdominal or stomach pain or tenderness
  • bone pain
  • clay colored stools
  • dark urine
  • decreased appetite
  • difficult breathing
  • headache
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • loss of appetite
  • trouble getting pregnant
  • troubled or quick, shallow breathing
  • yellow eyes or skin

Some side effects of chlorambucil may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common Rare
  • Anxiety
  • confusion
  • dry mouth
  • hyperventilation
  • irregular heartbeats
  • irritability
  • no muscle tone or movement
  • restlessness
  • seeing, hearing, or feeling things that are not there
  • trouble sleeping
Incidence not known

For Healthcare Professionals

Applies to chlorambucil: compounding powder, oral tablet


Bone marrow suppression has been reported to usually be reversible if chlorambucil is withdrawn early enough. However, irreversible bone marrow failure has been reported.[Ref]

Hematologic side effects including bone marrow suppression have been the most commonly reported with the use of chlorambucil. Anemia, leukopenia, neutropenia, thrombocytopenia, and pancytopenia have also been reported.[Ref]

Nervous system

Most nervous system effects have been reported to resolve upon discontinuation of the drug.

The manufacturer has noted that children with nephrotic syndrome and patients receiving high pulse doses of chlorambucil may have an increased risk of seizures.[Ref]

Nervous system side effects including coma, tremors, muscular twitching, confusion, agitation, ataxia, flaccid paresis, hallucinations, and focal and/or generalized seizures have been reported rarely. Peripheral neuropathy has also been reported.[Ref]


Dermatologic side effects have included skin hypersensitivity with rare reports of skin rash progressing to erythema multiforme, toxic epidermal necrolysis, and Stevens-Johnson syndrome.[Ref]


Gastrointestinal side effects including nausea, vomiting, diarrhea, and oral ulceration have been reported infrequently. Jaundice has also been reported.[Ref]


Respiratory side effects including pulmonary fibrosis and interstitial pneumonia have been reported.[Ref]


Hepatic side effects including hepatotoxicity have been reported. A case of chlorambucil-induced acute hepatic failure has been reported in a patient with membranous nephropathy.[Ref]


Genitourinary side effects including sterile cystitis and infertility have been reported.[Ref]


Oncologic side effects including leukemia and secondary malignancies have been reported.[Ref]


General side effects including drug fever have been reported.[Ref]


Ocular side effects including one case of visual failure and optic atrophy have been reported.[Ref]


Psychiatric side effects including lethargy and stupor have been reported.[Ref]


1. Rudd P, Fries JF, Epstein WV "Irreversible bone marrow failure with chlorambucil." J Rheumatol 2 (1975): 421-9

2. "Product Information. Leukeran Tablets (chlorambucil)." Glaxo Welcome, Research Triangle Pk, NC.

3. Williams SA, Makker SP, Grupe WE "Seizures: a significant side effect of chlorambucil therapy in children." J Pediatr 93 (1978): 516-8

4. Giles FJ, Smith MP, Goldstone AH "Chlorambucil lung toxicity." Acta Haematol 83 (1990): 156-8

5. Crestani B, Jaccard A, Israel-Biet D, Couderc LJ, Frija J, Clauvel JP "Chlorambucil-associated pneumonitis." Chest 105 (1994): 634-6

6. Patel SP, Nast CC, Adler SG "Chlorambucil-induced acute hepatic failure in a patient with membranous nephropathy." Am J Kidney Dis 36 (2000): 401-4

7. Palmer RG, Denman AM "Malignancies induced by chlorambucil." Cancer Treat Rev 11 (1984): 121-9

8. Yiannakis PH, Larner AJ "Visual failure and optic atrophy associated with chlorambucil therapy." BMJ 306 (1993): 109

Some side effects of chlorambucil may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.