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a nitrogen mustardalkylating agent used as an antineoplastic agent.



Pharmacologic class: Alkylating agent, nitrogen mustard

Therapeutic class: Antineoplastic, immunosuppressant

Pregnancy risk category D

FDA Box Warning

• Drug may suppress bone marrow function severely and is carcinogenic.

• Drug causes infertility and is probably mutagenic and teratogenic.


Interacts with cellular DNA to produce cytotoxic cross-linkage, which disrupts cell function. Cell-cycle-phase nonspecific.


Tablets: 2 mg

Indications and dosages

Chronic lymphocytic leukemia, malignant lymphoma, Hodgkin's disease

Adults: Initially, 0.1 to 0.2 mg/kg/day P.O. for 3 to 6 weeks as a single dose or in divided doses. Maintenance dosage is based on CBC but shouldn't exceed 0.1 mg/kg/day.

Off-label uses

• Idiopathic membranous nephropathy
• Meningoencephalitis associated with Behçet's disease
• Rheumatoid arthritis


• Hypersensitivity to drug or other alkylating agents
• Pregnancy or breastfeeding


Use cautiously in:
• hematopoietic depression, infection, other chronic debilitating diseases
• history of seizures or head trauma
• patients who have undergone radiation or other chemotherapy
• elderly patients
• females of childbearing age
• children (safety and efficacy not established).


• Before starting therapy, assess for history of seizures or head trauma.
• After full-course radiation or chemotherapy, wait 4 weeks before giving full doses (because of bone marrow vulnerability).
• To minimize GI effects, drug may be given at bedtime with antiemetic, especially if high dosage is prescribed.

Adverse reactions

CNS: peripheral neuropathy, tremor, confusion, agitation, ataxia, flaccid paresis, seizures

EENT: keratitis

GI: nausea, vomiting, diarrhea

GU: sterile cystitis, amenorrhea, sterility, decreased sperm count

Hematologic: anemia, leukopenia, thrombocytopenia, neutropenia, bone marrow depression

Hepatic: jaundice, hepatotoxicity

Metabolic: hyperuricemia

Musculoskeletal: muscle twitching

Respiratory: interstitial pneumonitis, pulmonary fibrosis

Skin: rash, erythema multiforme, epidermal necrolysis, Stevens-Johnson syndrome

Other: drug fever, allergic reaction, secondary malignancies


Drug-drug.Anticoagulants, aspirin: increased risk of bleeding

Immunosuppressants, myelosuppressants: additive bone marrow depression

Live-virus vaccines: decreased antibody response to vaccine, increased risk of adverse reactions

Drug-diagnostic tests.Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, uric acid: increased levels (may reflect hepatotoxicity)

Granulocytes, hemoglobin, neutrophils, platelets, red blood cells, white blood cells (WBCs): decreased counts

Drug-herbs.Astragalus, echinacea, melatonin: interference with immunosuppressant action

Patient monitoring

Monitor CBC with white cell differential and platelet count weekly.
• Monitor WBC count every 3 to 4 days.
• Assess liver function test results.

Patient teaching

• Instruct patient to immediately report unusual bleeding or bruising, fever, nausea, vomiting, rash, chills, sore throat, cough, shortness of breath, seizures, amenorrhea, unusual lumps or masses, flank or stomach pain, joint pain, lip or mouth sores, or yellowing of skin or sclera.
• Tell patient to take drug with full glass of water.
• Inform patient that drug may increase his risk for infection. Advise him to wash hands frequently, wear a mask in public places, and avoid people with infections.
• Instruct patient to contact prescriber before receiving vaccines.
• Advise female patient to use reliable contraception.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.


/chlor·am·bu·cil/ (klor-am´bu-sil) an alkylating agent from the nitrogen mustard group, used as an antineoplastic.


An anticancer drug that is a derivitive of nitrogen mustard and is used to depress the proliferation and maturation of lymphocytes in diseases such as leukemia.


an alkylating agent.
indications It is prescribed in the treatment of a variety of malignant neoplastic diseases, including chronic lymphocytic leukemia and Hodgkin's disease.
contraindications Bone marrow depression or known hypersensitivity to this drug prohibits its use. It is not given during pregnancy or within 28 days of chemotherapy or radiation therapy. Pregnancy should be avoided for 1 month after discontinuing use.
adverse effects Among the more serious adverse reactions are bone marrow depression, GI disturbance, skin rash, and hepatotoxicity.


Leukeran Oncology An alkylating chemotherapeutic of the nitrogen mustard family, used for lymphomas and other CAs Adverse effects BM suppression, leukemia, infertility, convulsions


A nitrogen-mustard drug used in the treatment of LEUKAEMIA and LYMPHOMAS including HODGKIN'S DISEASE. The drug is on the WHO official list. A brand name is Leukeran.


drug used to treat chronic lymphocytic leukaemia, non-Hodgkin's lymphoma and Hodgkin's disease; it may predispose to opportunistic infection, e.g. tinea pedis


Drugs that prevent or reduce the immune response. They are used in the treatment of a variety of severe inflammations such as uveitis, scleritis, keratoconjunctivitis sicca, Behçet's syndrome, sympathetic ophthalmia, and to prevent corneal graft rejection. They include the corticosteroids (e.g. prednisolone), ciclosporin (cyclosporine), tacrolimus, and cytotoxic agents (e.g. azathioprine, chlorambucil, cyclophosphamide, methotrexate). It must be noted that immunosuppressants render the patient more susceptible to infection because immunity is reduced.

chlorambucil (kloram´byəsil´),

n brand name: Leukeran;
drug class: antineoplastic alkylating agent;
action: inhibits enzymes that allow synthesis of amino acids in proteins;
uses: chronic lymphocytic leukemia, Hodgkin's disease, breast carcinoma, ovarian carcinoma.


a nitrogen mustard derivative used as an antineoplastic agent.
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5 times longer for ibrutinib compared with chlorambucil, with 87% of patients continuing on single-agent ibrutinib treatment.
2-5) 5 Chlorambucil (2 mg/kg PO twice weekly) was selected because it can be administered orally at a relatively low frequency.
They found that for patients with membranous nephropathy, six months' therapy with alternating monthly cycles of prednisolone and chlorambucil was the most effective option.
At that point the decision to treat with chlorambucil was taken, obtaining complete ulceration healing in few weeks, and a more slow reduction of the atypical lymphocytes count.
The trial compared Campath (alemtuzumab) with chlorambucil in previously untreated B-CLL patients.
The same study found that most plans covered the following drugs, with median copays ranging from $5-$40: lomustine, thioguanine, bexarotene, erlotinib, exemestane, anastrozole, megestrol acetate, tamoxifen, chlorambucil, procarbazine, altretamine, and others.
However, a number of immunosuppressant medications have been tried including alkylating agents such as cyclophosphamide 2 mg/kg/d or chlorambucil 0.
Other therapies for treating PV patients include myelosuppressive agents such as chlorambucil, radioactive phosphorus ([.
The patient was treated with chlorambucil and had an excellent response.
Steroid-refractory cases may require combinations of corticosteroids and cytotoxic drugs such as azathioprine, cyclophosphamide, or chlorambucil (18).
14) The pharmacist mistook chlorambucil, the generic drug prescribed by her physician, for alkeran, the generic name for Melphalen--a substantially more powerful prescription drug that requires more careful monitoring.