Chlorambucil

Chlorambucil is used in the treatment of some cancers of blood and lymphatic system. It may be also used to treat other kinds of cancer, as determined by the doctor. It is used alone or in combination with other cancer medicines. Chlorambucil should be taken empty stomach, or 1 hour before and 2 hours after a meal. But, try to have it at the same time every day for most benefits. This will depend on what you are being treated for and may change from time to time. You should take it exactly as your doctor has advised. Taking it in the wrong way or taking too much can cause very serious side effects. It may take several weeks or months for you to see or feel the benefits but do not stop taking it unless your doctor tells you to. The most common side effects of this medicine include anemia (low number of red blood cells), decreased blood cells (red cells, white cells, and platelets) decreased white blood cell count, infection, nausea and vomiting. If these bother you or appear serious, let your doctor know. There may be ways of reducing or preventing them. Inform your doctor if you have a medical history, of bleeding disorders, heart or liver disease, radiation treatment or any infection. Many other medicines can affect, or be affected by, this medicine so let your doctor know all medications you are using. This medicine is known to reduce the number of blood cells in your blood thereby, increasing the susceptibility to infections. Regular blood tests are required to check your blood cells along with kidney, liver and heart function during treatment with this medicine. The use of effective contraception by both males and females during treatment is important to avoid pregnancy.

Chlorambucil is an anti-cancer medication. It works by damaging the genetic material (DNA and RNA) of the cancer cells. This stops their growth and multiplication.

• Hodgkin's Disease
• Non-Hodgkin's Lymphoma
• Chronic Lymphocytic Leukemia
• Waldenstrom's Macroglobulinemia
• Blood cancer

Chlorambucil produces its anti-cancer effects by interfering with DNA replication and damaging the DNA in a cell. The DNA damage induces cell cycle arrest and cellular apoptosis via the accumulation of cytosolic p53 and subsequent activation of Bax, an apoptosis promoter.

Chlorambucil alkylates and cross-links DNA during all phases of the cell cycle, inducing DNA damage via three different methods of covalent adduct generation with double-helical DNA: attachment of alkyl groups to DNA bases, DNA damage via the formation of cross-links, and induction of mispairing of the nucleotides leading to mutations.

Chlorambucil interferes with DNA replication and RNA transcription by alkylation and cross-linking cellular DNA strands, thus leading to disruption of the nucleic acid function.

Adult Dose:

Hepatic Impairment: Primarily metabolized in liver; dose reduction may be required.

Renal Impairment: <1% (including metabolites) excreted in urine; no dose adjustment required.

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Chlorambucil is to be taken on an empty stomach. Take one hour before a meal or two hours after a meal. Ensure adequate hydration.

If you miss a dose of Chlorambucil, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.

Common Side Effects:

• Anemia (low red blood cell count)
• Decreased blood cells (red cells, white cells, and platelets)
• Decreased white blood cell count (neutrophils)
• Bone marrow suppression
• Nausea
• Vomiting
• Diarrhea
• Mouth ulcer

Rare: Irreversible bone marrow failure, allergic reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis, seizures, movement disorders, interstitial pulmonary fibrosis, interstitial pneumonia, hepatotoxicity, jaundice, sterile cystitis, drug fever.

• [CONSULT YOUR DOCTOR] It is not known whether Chlorambucil alters the ability to drive. Do not drive if you experience any symptoms that affect your ability to concentrate and react.
• Chlorambucil should be taken one hour before a meal or two hours after a meal.
• Monitor FBC closely. Bone marrow suppression is reversible only if withdrawn early enough.
• Should not be given to patients who have recently undergone radio- or chemotherapy.
• In lymphocytic infiltration of bone marrow or hypoplastic bone marrow, max daily dose is 0.1 mg/kg.
• Children with nephrotic syndrome, patients on high pulse dosing regimens, history of seizure disorders require caution.
• Ensure adequate contraceptive precautions.

• Hypersensitivity
• Pregnancy (1st trimester) and lactation
• Porphyria

Impairs immune response to vaccines, possible infection after administration of live vaccines.

[CONSULT YOUR DOCTOR] It is not known whether it is safe to consume alcohol with Chlorambucil. Please consult your doctor.

[CONSULT YOUR DOCTOR] Chlorambucil may be unsafe to use during pregnancy. Although there are limited studies in humans, animal studies have shown harmful effects on the developing baby. Your doctor will weigh the benefits and any potential risks before prescribing it to you. Please consult your doctor. Pregnancy Category D.

[UNSAFE] Chlorambucil is unsafe to use during breastfeeding. Data suggests that the drug may cause toxicity to the baby.

Safety and efficacy in children are not fully established. Seizures may occur in children with nephrotic syndrome.

Limited information is available regarding dose adjustment for elderly patients.

[CAUTION] Chlorambucil should be used with caution in patients with kidney disease. Dose adjustment of Chlorambucil may be needed. Please consult your doctor. Careful monitoring by a doctor is important as kidney disease patients are at an increased risk of bone marrow depression and inflammation and infections of urinary bladder while taking this medicine.

[CONSULT YOUR DOCTOR] There is limited information available on the use of Chlorambucil in patients with liver disease. Please consult your doctor.

Chlorambucil overdose may cause bone marrow suppression, seizures, nausea, vomiting, diarrhea, and gastrointestinal ulceration. In case of overdose, symptomatic and supportive treatment should be given.

Store in a cool and dry place, protected from light. Keep out of reach of children.

Chlorambucil