Chlorambucil (Oral)

Chlorambucil is used to treat certain variations of cancer (such as lymphoma and leukemia). It belongs to the class of drugs named alkylating agents and works by stopping or slowing the growth of cancerous cells.

Overview

Chlorambucil belongs to a group of medicines which are called alkylating agents. It's used in the treatment of a variety of different cancer types of the blood and lymph system. Some of these include Hodgkin's disease, chronic lymphocytic leukaemia and other variations of lymphoma.

Chlorambucil works by interfering with the growth of cancer cells, which are eventually destroyed. Other effects may occur since the growth of normal cells may also be affected by the use of chlorambucil. These could be serious and must be reported to your doctor or physician.

Before commencing treatment with chlorambucil, you should discuss with your doctor the various risks and benefits associated with consumption and decide if it is the right choice for you.

This medication is only available via prescription from your doctor and is available in the dosage form of a tablet taken orally.

Condition(s) treated?

  • Follicular Lymphoma
  • Chronic lymphoid leukemia
  • Hodgkin's lymphoma
  • Minimal Change Glomerulonephritis
  • Cutaneous T-cell lymphoma
  • Mycosis fungoides
  • Waldenstrom's Macroglobulinemia

Type of medicine?

  • Oral tablet
  • Alkylating agent

Side Effects

As with all medicines, there can be a variety of side effects associated with the consumption of Chlorambucil. Some of these will be severe and need urgent medical attention and some will be more common and should disappear over time as your body adjusts to the medication. The following side effects are listed below in terms of more common, less common and rare. Remember you can report all side effects regardless of severity to the FDA on 1-800-FDA-1088.

Inform your doctor or a healthcare professional immediately if you suffer from any of the following side effects:

More common

  • Bleeding gums
  • Black, tarry stools
  • Chest pain
  • Blood in the stools or urine
  • Hoarseness or a cough which is accompanied by chills or fever
  • Side pain or lower back which is accompanied by chills or fever
  • Fever or chills
  • Difficult or painful urination, accompanied by chills or fever
  • Shortness of breath
  • Pinpoint red spots on the skin
  • Ulcers, sores, or white spots in the mouth or on the lips
  • Troubled breathing with exertion
  • Unusual bruising or bleeding
  • Swollen glands
  • Unusual weakness or tiredness

Less common

  • Joint pain
  • Itching
  • Swollen and large hives
  • Swelling of the lower legs or feet
  • Rash on your skin

Rare

  • Peeling, blistering or loosening of the skin
  • Diarrhea
  • Muscle pain
  • Muscle twitching
  • Red skin lesions, often with a purple center
  • Irritated, red eyes
  • Seizures
  • Unsteady walk and shakiness
  • Shakiness in the arms, legs, feet or hands
  • Sore throat
  • Sudden, jerky movements of the body
  • Trembling, unsteadiness or other problems with coordination and muscle control

Incidence not known

  • Stomach or abdominal or tenderness
  • Bone pain
  • Clay-colored stools
  • Dark urine
  • Decreased appetite
  • Difficult breathing
  • Headache
  • Large, hive-like swelling on the eyelids, face, tongue, lips, throat, hands, legs, sex organs or feet
  • Loss of appetite
  • Difficulty falling pregnant
  • Quick or troubled shallow breathing
  • Yellow skin or eyes

If you suffer from the following side effects, it's unlikely you will need urgent medical attention. These side effects usually ease or disappear during treatment as your body begins to adjust to the medication. However, if you are finding them problematic, contact your doctor or a health care professional for ways to reduce or prevent some of the side effects.

Less common

  • Vomiting and nausea
  • Changes in menstrual period

Rare

  • Anxiety
  • Confusion
  • Dry mouth
  • Hyperventilation
  • Irregular heartbeats
  • Irritability
  • No muscle movement or tone
  • Restlessness
  • Hearing, seeing, or feeling things that aren't there
  • Difficulty sleeping

Incidence not known

  • Welts or hives

Dosage

Your final dosage given of chlorambucil will depend on a number of factors, including your age, height and weight, the condition that is being treated, other medical conditions you may have, how severe your condition is and how you react to the first dose.

This serves only as a guide and other dosage recommendations may not be listed here. This dosage suggestion is relevant for Leukeran.

Dosage for chronic lymphocytic leukemia

An oral tablet with a strength of 2mg.

Adult dosage (ages 18–64 years)

The typical dosage is once per day for three to six weeks. Your doctor will base the specific dosage on your condition and body weight. However, for most, the dosage will range from around 4 to 10 mg of chlorambucil per day. Your dosage may change during the period, however, your doctor will monitor and adjust as necessary. Be sure to take your dose exactly as directed by your doctor.

Child dosage (ages 0–17 years)

It has not been confirmed if chlorambucil is effective and safe for use in those who are younger than 18 years of age.

Child dosage (less than a month old)

Chlorambucil has not been studied in children younger than 1 month old, so it should not be used.

Senior dosage (65 years old and above)

It is possible that the liver of older adults may not work as well as it previously has done which can cause drugs to process more slowly within your system. This can result in a higher amount of a drug in your system for a longer time period, which in turn raises your risk of having unwanted or dangerous side effects.

Your doctor may begin by starting you on a very low dose and then will consider other conditions you may have when finalising your final dosage.

Dosage for malignant lymphoma (Non-Hodgkin and Hodgkin lymphomas)

Adult dosage (ages 18–64 years)

You will take chlorambucil once a day for around three to six weeks. The exact dosage will be based on your condition and body weight, however, for most people, the dose will range between 4 to 10 mg of chlorambucil per day. Your doctor will monitor you closely whilst taking this drug and may adjust if necessary. Ensure you take your dose exactly as your doctor has directed.

Child dosage (ages 0–17 years)

It has not been confirmed if chlorambucil is effective or safe for use in those who are younger than 18 years old.

Senior dosage (ages 65 years and older)

It is possible that the liver of older adults may not work as well as it previously has done which can cause drugs to process more slowly within your system. This can result in a higher amount of a drug in your system for a longer time period, which in turn raises your risk of having unwanted or dangerous side effects.

Your doctor may begin by giving you the lowest dosage and then consider other conditions you may have when finalising your specific dose.

What to do if you miss a dose

If you miss a dose, you should take your dose as soon as you remember. However, if your next scheduled dose is only a few hours away when you remember, you should only take one dose. Don't attempt to catch up by taking two doses at one time as this could result in dangerous side effects or overdose.

Overdose

If you think you have taken too much of this drug, you need to seek urgent medical attention. You may have dangerous levels of chlorambucil in your body. Symptoms of an overdose of chlorambucil include:

  • Seizures
  • Severe decreases in your blood cell counts which can result in infections, anemia and bleeding.
  • Problems with muscle control or coordination
  • Agitation
  • Do not take this drug with food. It needs to be taken on an empty stomach
  • Take this drug at the time(s) that has been set by your doctor
  • You can crush or cut the tablet to make it easier to take.

Interactions

Chlorambucil can interact with other medications and drugs. An interaction can change the way in which the drug works. This can prevent the drug from working well and be harmful to you. To prevent the risk of interactions, it's important that you inform your doctor of all the medications you are currently taking, including vitamins and herbal remedies. You should also list any previous medical conditions you have or medical conditions that run in the family, including bleeding/blood problems, gout or liver disease.

Severe Interactions of chlorambucil tablet

These medications are not usually in combination with chlorambucil. You should inform your healthcare professional for more information.

  • Bcg
  • Certolizumab
  • Adalimumab
  • Deferiprone
  • Clozapine
  • Etanercept
  • Fingolimod
  • Live influenza virus vaccine, trivalent
  • Golimuma- Infliximab
  • Leflunomide
  • Live influenza virus vaccine, h1n1
  • Measles virus vaccine
  • Varicella virus vaccine
  • Rubella virus vaccine
  • Natalizumab
  • Mumps virus vaccine
  • Nalidixic acid
  • Talimogene laherparepvec
  • Live poliovirus vaccine, trivalent
  • Thiotepa
  • Teriflunomide
  • Thalidomide
  • Rotavirus vaccine
  • Typhoid vaccine
  • Tofacitinib
  • Zoster vaccine live
  • Yellow fever vaccine

Moderate Interactions of chlorambucil tablet

The following medications may interact and cause very harmful effects. Consult your doctor for further information.

  • Alefacept
  • Alemtuzumab
  • Anakinra
  • Adenovirus vaccine
  • Amphotericin b
  • Amphotericin b lipid complex
  • Amphotericin b liposomal
  • Amphotericin b cholesteryl sulfate
  • Azathioprine
  • Anthrax vaccine adsorbed
  • Candida albicans extract
  • Cholera vaccine/live
  • Canakinumab
  • Coccidioidin skin test
  • Denosumab
  • Cladribine
  • Tetanus toxoid/ diphtheria toxoid / pertussis, acellular
  • Efalizumab
  • Tetanus and diphtheria oxoids / acellular, pertussis
  • Ganciclovir
  • Fludarabine
  • Hepatitis a pediatric vaccine
  • Filgrastim
  • Human papillomavirus vaccine
  • Hepatitis b pediatric vaccine
  • Hepatitis b adult vaccine
  • Histoplasmin
  • Hepatitis a & b adult vaccine combined
  • Hepatitis a adult vaccine
  • Hepatitis b adult vaccine
  • Hepatitis a pediatric vaccine
  • Hepatitis b pediatric vaccine
  • Haemophilus b conjugate (hboc) vaccine
  • Inactivated influenza virus vaccine, h1n1
  • Haemophilus b conjugate (prp-omp) vaccine
  • Inactivated influenza virus vaccine
  • Influenza virus vaccine, h5n1
  • Inactivated japanese enceph vacc sa14-14-2
  • Japanese encephalitis virus vaccine nakayama
  • Meningococcal conjugate vaccine
  • Lyme disease vaccine
  • Meningococcal polysaccharide vaccine
  • Meningococcal group B vaccine
  • Mixed respiratory vaccine
  • Niraparib
  • Mumps skin test antigen
  • Ocrelizumab
  • Olaparib
  • Palifermin
  • Omacetaxine
  • Pefilgrastim
  • Plague vaccine
  • Pentostatin
  • Pneumococcal 13-valent vaccine
  • Pneumococcal 7-valent vaccine
  • Pneumococcal 23-polyvalent vaccine
  • Inactivated poliovirus vaccine
  • Rabies vaccine, human diploid cell
  • Radium 223 dichloride
  • Rabies vaccine, purified chick embryo cell
  • Rilonacept
  • Sargramostim
  • Roflumilast
  • Sipuleucel-T
  • Skin test antigens
  • Staphage lysate (spl)
  • Sodium phosphate p32
  • Strontium-89 chloride
  • Tetanus toxoid
  • Tbo-filgrastim
  • Topotecan
  • Tuberculin purified protein derivative
  • Trichophyton skin test
  • Inactivated typhoid vaccine
  • Ustekinumab
  • Valganciclovir
  • Ubiquinone
  • Vitamin e

Warnings

This drug comes with several warnings and precautions that are outlined below.

Allergy warning

The use of chlorambucil can cause a severe allergic reaction.

Symptoms include:

  • Skin peeling
  • Widespread rash and redness on your skin
  • Blisters
  • Itching
  • Painful sores
  • Skin welts or hives
  • Swelling of your throat or tongue
  • Fever
  • Difficulty breathing

If you develop any of the above symptoms, you need to seek medical attention urgently. Do not under any circumstances take this drug if you've ever previously had an allergic reaction to it. Repeating the action could be fatal and cause death.

Contact with drug warning

This medication can harm other people if they touch it. You need to ask your pharmacist or doctor how it's best to handle this drug and its conditions.

Warnings for people with certain health conditions

If you have a history of liver disease or have ever suffered from liver problems, your body may struggle to clear this drug well. This can increase the level of chlorambucil inside your body and put you at risk of severe or unwanted side effects. If you have liver problems, your doctor may begin with you taking the lowest dosage possible and monitor you closely for any related side effects that may occur. Chlorambucil also has the potential to cause liver damage which means it could aggravate your liver disease, making it worse.

Pregnancy and breastfeeding

For those who are pregnant, chlorambucil is a category D pregnancy drug.

Research conducted in humans has shown adverse effects to the fetus when the mother takes chlorambucil. Therefore, this drug should only ever be used during pregnancy when it is absolutely necessary in serious cases to treat a dangerous condition in the mother.

You need to speak with your doctor if you are planning to become pregnant or are currently pregnant. Request information about the specific harm that could be done to your pregnancy as a result of taking this drug. Chlorambucil should be only used if the potential risk is acceptable given the drug’s potential benefit.

Call your doctor right immediately if you fall pregnant whilst taking chlorambucil.

For males, this drug can significantly reduce your sperm count and damage your sperm. This effect has the potential to be permanent.

Breastfeeding women

For those who are breastfeeding, it is not known if chlorambucil is passed into breast milk via feeding. If it does, it has the potential to cause serious side effects to the child who is receiving the milk. You should discuss with your doctor if you breastfeed your baby. You may need to decide whether it's best to stop breastfeeding or stop taking the drug altogether.

Use in older people

The liver of older patients may not work as well as it previously has done. This can, therefore, result in your body processing drugs more slowly. Because of this, a higher amount of medication will stay in your body for a longer period of time. This will increase your risk of unwanted and severe side effects.

The use in children

This drug hasn’t been tested or studied in children under the age of 18, so it should not be used.

  • Chlorambucil can increase your risk of contracting infections or can worsen current infections. You should, therefore, avoid contact with those who have infections that could spread to others, such as flu, measles, chicken pox etc. Speak to your doctor if you have ever been exposed to an infectious disease.
  • Don't have vaccinations/immunizations without the consent of your doctor and avoid contact with those who have recently received live vaccines.
  • To minimize your chances of getting bruised, cut, or injured, exercise caution with sharp objects like nail cutters, razors and avoid activities such as contact sports.
  • Be careful when using dental floss, a regular toothbrush or toothpick. Your dentist, doctor or other healthcare professional may suggest other ways to clean your gums and teeth. Consult with your doctor before you commence any dental work.
  • Don't touch the inside of your nose or your eyes unless you have just cleaned your hands and have not previously touched anything else in the meantime.

To make sure chlorambucil is safe for you, inform your doctor if you have:

  • Liver disease
  • Kidney disease
  • History of brain tumor or head injury
  • History of seizures
  • If you have received chemotherapy or radiation within the past 4 weeks.

Taking this medication could increase your risk of developing other variations of cancer. You should discuss with your doctor or health care professional about your specific risks.

Storage

Ensure you store chlorambucil in a refrigerator and keep it at a temperature that is between 36°F and 46°F (2°C and 8°C).

Do not store this medication in damp or moist areas, such as a bathroom.

Summary

When taken correctly, chlorambucil can be successful in treating various types of cancer such as lymphoma and leukemia. It should be used with caution in pregnancy and during breastfeeding. It is vital that you inform your doctor of all the medications you are currently taking, including vitamins and herbal remedies. This is because this drug can interact with a variety of other drugs and cause adverse and severe side effects.

Those with liver problems should also exercise caution when taking this drug. You should inform your doctor of previous medical issues including bleeding and liver problems. This drug cannot be used in children. To tell if the drug is working, your cancer symptoms should begin to improve over time. Your doctor will keep a close eye on you and do various tests to check your dosage requirements have not changed. They will monitor your white blood cell count during the first 3-6 weeks of treatment to ensure this is improving.