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Chlorambucil

(klor-am-byoo-sill)

Trade/other name(s): Leukeran

Why would this drug be used?

Chlorambucil is used to treat chronic lymphocytic leukemia, Hodgkin and non-Hodgkin lymphoma, and other conditions.

How does this drug work?

Chlorambucil is in the general group of chemotherapy drugs known as alkylating agents. It

slows or stops the growth of cancer cells, causing the cells to die.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have ever had seizures or a severe head injury. This drug can cause or worsen seizures in some people.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine.
  • If you think you might want to have children in the future. This drug can cause temporary or permanent sterility in some people. Talk with your doctor about the possible risk with this drug and options that may preserve your ability to have children.
  • If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it could harm the baby.
  • If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with chlorambucil. These include:

  • vitamin E
  • non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others
  • warfarin (Coumadin)
  • ticlopidine (Ticlid)
  • clopidogrel (Plavix)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren't sure what's in the medicines you take.

Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Chlorambucil is a pill that is given by mouth once a day. The length of time it is taken depends on the type of cancer being treated. Try to take the pill at about the same time every day. Take an anti-nausea pill an hour before taking the medicine if the pill makes you sick to your stomach. Drink lots of water during the day to keep your kidneys flushed out. The dose depends on the type of cancer being treated, your size, and your blood counts.

Take your medicine as you are directed and be sure to keep all your appointments. Talk with your doctor or nurse if you have any questions. Store the medicine in a tightly closed container away from heat and moisture and away from children and pets.

Precautions

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. Chlorambucil may affect your immune system. This could make vaccinations ineffective, or could even lead to serious infections if you get a live virus vaccine during or soon after treatment. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

Your doctor will probably test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it completely. Be sure to keep all your appointments for lab and doctor visits.

This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Stop the drug and tell your doctor or nurse right away if you develop signs of an allergic reaction such as rash, hives (itchy welts), fever and chills, or red blotches on your skin. If you have trouble breathing, if you have swelling or itching in your throat, lips, or mouth, or if you have other serious symptoms, stop the drug and get emergency help.

While taking this medicine, and for a few days afterward, there is a slight chance of a serious skin reaction. Symptoms often start as a skin rash with redness or blistering in the mouth, nose, or eyes, along with fever and body aches. If this happens, stop the drug and get emergency help.

Because of the way this drug acts on cells in the body, it may increase your long-term risk of getting a second type of cancer, such as leukemia. This is rare, but if it does occur it would likely be years after the drug is used. If you are getting this drug, your doctor feels this risk is outweighed by the risk of what might happen if you do not get this drug. You may want to discuss these risks with your doctor.

Avoid conceiving a child while on this drug and for some time afterward. The drug can harm a growing fetus. Check with your doctor about this.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • low white blood cell count with increased risk of infection*
  • low platelet count with increased risk of bleeding*
  • stopping of menstrual periods in women
  • reduced sperm production in men

Less common

  • loss of appetite
  • decreased weight
  • anemia (low red blood cell counts) which can cause weakness, paleness, trouble breathing, and other symptoms
  • dry, darkened skin
  • sterility (inability to have children)

Rare

  • nausea
  • vomiting
  • liver damage
  • scarring of lung tissue*
  • visual disturbances
  • second cancer or leukemia*
  • skin rash which can result in severe blistering*
  • confusion
  • seizures
  • allergic reaction*
  • death due to bone marrow damage, or other causes

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved before 1984 (FDA cannot verify dates of drugs approved before 1984.)

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.

Last Medical Review: 01/12/2010
Last Revised: 01/12/2010