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Mechlorethamine

(meh-klor-eth-uh-meen)

Trade/other name(s): Mustargen, nitrogen mustard

Why would this drug be used?

Mechlorethamine in intravenous (IV) form is used to treat Hodgkin disease, certain types of non-Hodgkin lymphomas and leukemias, and other cancers. It is sometimes used for non-cancer illnesses. The drug is also available in a gel or ointment (topical) form that is used on the skin to help control mycosis fungoides, a type of lymphoma of the skin. The gel form is discussed in a separate document.

The information below applies only to intravenous (IV) use.

How does this drug work?

Mechlorethamine is a member of a group of chemotherapy drugs known as alkylating agents. It works by binding to the DNA inside of cells. This results in DNA damage when a cell tries to divide to make new cells, which often leads to the death of the cell. Cancer cells divide more often than normal cells and have more trouble repairing damaged DNA, so they are more likely to be affected by this drug.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, kidney stones, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.
  • 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 man or woman 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 are breastfeeding. The drug may pass into breast milk and harm the baby.
  • If you think you might want to have children in the future. This drug might affect fertility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • 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 mechlorethamine. These include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn) and many others
  • Warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), or other blood thinners, including any type of heparin injections
  • Anti-platelet drugs such as clopidogrel (Plavix) or prasugrel (Effient)
  • Vitamin E

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?

Mechlorethamine is most often given as an injection in a vein (intravenously, or IV) over a period of about 20 minutes. If you feel any pain, burning, or discomfort in the vein when mechlorethamine is injected, tell your nurse right away.

Your dose and how often you get it depends on your weight, your blood counts, how well your liver is working, and the type of cancer being treated. Your doctor will test your blood counts before each treatment. If they are too low, your treatment will likely be delayed.

Since this drug causes nausea and vomiting, you should be given anti-nausea medicine before and after the mechlorethamine.

Precautions

This drug can cause allergic reactions in some people while the drug is being given. More serious reactions happen rarely, but can be dangerous. Symptoms can include feeling lightheaded or dizzy (due to low blood pressure), fever or chills, hives, nausea, itching, headache, coughing, shortness of breath, or swelling of the face, tongue, or throat. Tell your doctor or nurse right away if you notice any of these symptoms as you are getting the drug.

This drug is given into the vein (IV). If the drug leaks out of the vein and under the skin, it may damage the skin and nearby tissue around the IV site, causing pain, ulceration, and scarring. Tell the nurse right away if you notice redness, pain, swelling or other symptoms at or near the IV.

Your doctor will likely 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 altogether.

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.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor’s OK. Mechlorethamine may affect your immune system. This could make vaccinations ineffective, or 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.

You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor may give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor.

This drug can raise the blood level of uric acid (hyperuricemia), which can worsen gout and cause serious kidney damage. If your doctor feels you might be at risk, he or she will give you medicines and/or fluids during treatment to help prevent this.

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. 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.

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

  • Decreased white blood cell count with increased risk of infection*
  • Decreased platelet count with increased risk of bleeding*
  • Anemia (low red blood cell count) with symptoms like tiredness, paleness, or trouble catching your breath
  • Nausea*
  • Vomiting*
  • Taste changes
  • Decreased appetite
  • Hair thinning or loss, including hair on the face and body
  • Fetal changes if pregnancy occurs while taking mechlorethamine
  • Short-term or long-term infertility (inability to have children)

Less common

  • Hardening and darkening of vein used for injection
  • Chills
  • Fever
  • Diarrhea
  • Drowsiness
  • Headache
  • Rash

Rare

  • Ringing in ears, hearing loss
  • Severe allergic reaction, with itching, dizziness, wheezing, shortness of breath
  • Weakness
  • Confusion

*See “Precautions” section for more detailed information.

There are some 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: 09/18/2009
Last Revised: 09/09/2013