Chlorambucil
Generic Name: chlorambucil (klor AM bue sil)Brand Names: Leukeran
What is chlorambucil?
Chlorambucil is a cancer medication that interferes with cancer cells and slows their growth and spread in the body.
Chlorambucil is used to treat several types of cancer, including Hodgkin's disease and certain types of leukemia or lymphoma.
Chlorambucil may also be used for other purposes not listed in this medication guide.
What is the most important information I should know about chlorambucil?
Do not use this medication without telling your doctor if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.Treatment with chlorambucil may increase your risk of developing other forms of cancer. This medication can also affect fertility (your ability to have children), whether you are a man or a woman. Talk to your doctor about your specific risks when using chlorambucil.
Chlorambucil can lower the blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. To be sure your blood cells do not get too low, your blood will need to be tested on a regular basis. Do not miss any scheduled visits to your doctor.
Do not receive a "live" vaccine while you are being treated with chlorambucil.
Stop using chlorambucil and call your doctor at once if you have a seizure, red or peeling skin rash, severe nausea or stomach pain, jaundice (yellowing of your skin or eyes), any unusual mass or lump, fever, chills, sore throat, cough, flu-like symptoms, pale skin, easy bruising or bleeding, unusual weakness, white patches or sores inside your mouth or on your lips, or missed menstrual periods.What should I discuss with my healthcare provider before taking chlorambucil?
You should not use this medication if you are allergic to chlorambucil, or if you have received this medication in the past without successful treatment of your condition.If you have received radiation treatment within the past 4 weeks, you may need a dose adjustment or special tests to safely take chlorambucil.
FDA pregnancy category D. This medication can cause harm to an unborn baby. Do not use chlorambucil without your doctor's consent if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.This medication can affect fertility (your ability to have children), whether you are a man or a woman.
It is not known whether chlorambucil passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.Treatment with chlorambucil may increase your risk of developing other forms of cancer. Talk to your doctor about your specific risk.
How should I take chlorambucil?
Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label. You should not take chlorambucil unless you remain under the care of a doctor.
Take this medicine with a full glass of water.Chlorambucil can lower the blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. To be sure your blood cells do not get too low, your blood will need to be tested on a regular basis. Do not miss any scheduled visits to your doctor.
Store chlorambucil in the refrigerator but do not allow it to freeze.See also: Chlorambucil dosage in more detail
What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine.Overdose symptoms may include agitation, loss of balance or coordination, or seizure (convulsions).
What should I avoid while taking chlorambucil?
Avoid being near people who have colds, the flu, or other contagious illnesses. Contact your doctor at once if you develop signs of infection.
Do not receive a "live" vaccine while you are being treated with chlorambucil.
Chlorambucil side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using chlorambucil and call your doctor at once if you have any of these serious side effects:seizure (convulsions);
fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;
nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
an unusual mass or lump;
fever, chills, body aches, flu symptoms, or ongoing cough;
pale skin, easy bruising or bleeding, unusual weakness;
white patches or sores inside your mouth or on your lips;
severe nausea, vomiting, or diarrhea; or
missed menstrual periods.
Less serious side effects:
upset stomach, mild nausea, diarrhea;
tremors or shaking; or
numbness or tingling.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Chlorambucil Dosing 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/dayNephrotic 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/dayHodgkin's Lymphoma: 0.2 mg/kg/day
What other drugs will affect chlorambucil?
There may be other drugs that can affect chlorambucil. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.
Where can I get more information?
- Your pharmacist can provide more information about chlorambucil.
- Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed
- Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. 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 drugs you are taking, check with your doctor, nurse or pharmacist.
- chlorambucil Advanced Consumer (Micromedex) - Includes Dosage Information
- Chlorambucil MedFacts Consumer Leaflet (Wolters Kluwer)
- Chlorambucil Professional Patient Advice (Wolters Kluwer)
- Leukeran Prescribing Information (FDA)