Chlorambucil (Leukeran)

Trade name: Leukeran    

Generic name:Chlorambucil  

Therapeutic Class: alkylating agents  

Manufacturer/Distributor: GlaxoSmithKline (GSK) 

Availability: Chlorambucil is available by prescription only 

Dosage form: Chlorambucil comes in coated tablet form to be taken by mouth 

Indications: Chlorambucil is used in the treatment of many cancers, principally: 

·         Hodgkin's disease 

·         non-Hodgkin’s lymphoma 

·         breast cancer 

·         ovarian cancer  

·         testicular cancer 

·         chronic lymphocytic leukemia (CLL) 

·         choriocarcinoma, an aggressive form of cancer that occurs in a woman's uterus 

·         Thrombocythemia, a blood disorder in which the body produces too many platelets (thrombocytes).  

Chlorambucil may be used to treat other medical conditions not listed in this article; talk to your doctor or pharmacist for more information.  

Storage: Keep Chlorambucil tightly closed and out of reach of children. Keep the medication in a dry place at room temperature and away from excess heat and humidity. It is not recommended to keep Chlorambucil in the bathroom. For more information, talk to your physician or pharmacist.  

Dosage: Your oncologist will base on many criteria to prescribe you an appropriate dosage: your weight, health in general, taking other drugs, and more specifically the type of cancer you have. For example, if you have chronic lymphocytic leukemia, your doctor can recommend you to take 0.15 mg chlorambucil per kilogram of body weight per day for four to eight weeks. Usually, the drug is recommended to be taken 1 hour before or 2 hours after meal. In some cases, Chlorambucil can be taken in combination with other anticancer drugs to increase the chances of surviving.  

Depending on your condition or the reaction of your body to the medication, your oncologist can adjust the dosage. Whatever the dose recommended, it is important to take Chlorambucil as indicated. In the absence of complications, treatment should be continued to the end. 

It is important to drink plenty of fluids while taking chlorambucil to help your body rid itself of the toxic effects of the drug. Drinking abundantly distilled water and fresh juice helps prevent kidney problems and other adverse effects of Chlorambucil.  

Overdose: It is very important to avoid Chlorambucil overdose. As all chemotherapy drugs, chlorambucil can cause serious health problems including the development of other types of cancers. If you think you have taken an overdose of the drug, you should immediately contact your doctor or the poison control center nearest you. A health care provider can give you an antidote, symptomatic treatment or blood transfusion to slow or stop the toxic effects of the medication. 

Missing dose: Chlorambucil can be taken one or several times per day. If you have been recommended to take the drug once a day and you miss a dose until the next day, do not double the dose. If you have been recommended to take medication several times a day and forgotten until the next dose, skip the missed dose; do not double the dose. Don’t ever take less or more of the prescribed dose.  

Contraindication s: Chlorambucil should not be given to patients who have or fall into any of these categories: 

Pregnant women

women who are breastfeeding

blood disorders: bleeding disorders, platelet disorders, hemophilia and anemia

head injury

recent or ongoing radiation therapy

seizures

certain viral infections: chickenpox, cold sores, herpes, etc.

Unusual or allergic reaction to Chlorambucil or any of its components.

Mechanism of action (MOA): Chlorambucil acts by modifying the structure of the constituents of the cancer cells (DNA), thus slowing or stopping their proliferation. 

Interactions: certain drugs may interact with Chlorambucil; do not take prescription or non-prescription medications along with Chlorambucil without first contacting your health care provider. the following medications can interact with Chlorambucil: 

vaccines 

  nalidixic acid, an antibiotic indicated for the treatment of gram-positive UTI 

  cyclosporin, an immunosuppressive agent  

All medications that increase blood cells levels:filgrastim, pegfilgrastim, sargramostim. 

In addition, talk to your doctor before taking vitamin supplements, St. John wort, acetaminophen, ketoprofen, aspirin, ibuprofen, Naproxen .

Side effects: In addition to causing death of cancer cells, Chlorambucil tends to interfere with healthy cells that multiply quickly, and cause adverse effects; the most common chlorambucil side effects of include:  fatigue,  hair loss, dry skin, mouth blistering, decreased appetite, constipation or diarrhea. Some pateitns can also experience skin disorders: rash, itching; and taste changes or metallic food taste.

Although rare, Chlorambucil can cause serious side effects which require immediate medical attention; contact your doctor immediately if you experience persistent fever, sore throat, red urine, dizziness,  confusion,  congestion,  shortness of breath or breathing discomfort, fainting (temporary loss of consciousness), unusual bruising or bleeding; Infection, which can be indicated by fever or sore throat.