Generic Name: chlorambucil (klor AM bue sil)
Brand Names: Leukeran
What is chlorambucil?
Chlorambucil is a cancer medication that interferes with the growth and spread of cancer cells in the body.
Chlorambucil is used to treat several types of cancer, including Hodgkin's disease and certain types of leukemia or lymphoma.
Chlorambucil may also be used for purposes not listed in this medication guide.
What is the most important information I should know about chlorambucil?
Do not use chlorambucil if you are pregnant. It could harm the unborn baby.
Taking chlorambucil may increase your risk of developing other types of cancer. Chlorambucil may also affect fertility (your ability to have children), whether you are a man or a woman. Ask your doctor about your individual risk.
Chlorambucil can lower blood cells that help your body fight infections. Your blood may need to be tested often. Avoid being near people who are sick or have infections. Avoid activities that may increase your risk of bleeding injury. Tell your doctor at once if you develop signs of infection.
Do not receive a "live" vaccine while you are being treated with chlorambucil, and for at least 3 months after your treatment ends. The vaccine may not work as well during this time, and may not fully protect you from disease. Stop taking chlorambucil and call your doctor at once if you have a seizure, red or peeling skin rash, severe nausea or stomach pain, jaundice (yellowing of your skin or eyes), fever, chills, sore throat, ongoing cough, flu symptoms, mouth sores, easy bruising or bleeding, or any unusual mass or lump.
What should I discuss with my healthcare provider before taking chlorambucil?
You should not use this medication if you are allergic to chlorambucil, or if you have received this medication in the past without successful treatment of your condition.
To make sure you can safely take chlorambucil, tell your doctor if you have any of these other conditions:
kidney disease;
liver disease;
a history of seizures;
a history of head injury or brain tumor; or
if you have received radiation or chemotherapy within the past 4 weeks.
FDA pregnancy category D. Do not use chlorambucil if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment. This medication may affect fertility (your ability to have children), whether you are a man or a woman. It is not known whether chlorambucil passes into breast milk or if it could harm a nursing baby. You should not breast-feed while taking chlorambucil.
Taking chlorambucil may increase your risk of developing other types of cancer. Talk to your doctor about your specific risk.
How should I take chlorambucil?
You must remain under the care of a doctor while you are using chlorambucil.
Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.
Chlorambucil is usually taken for 3 to 6 weeks. Follow your doctor's instructions.
Your doctor may occasionally change your dose to make sure you get the best results.
Chlorambucil can lower blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. Your blood will need to be tested often. Your cancer treatments may be delayed based on the results of these tests. Visit your doctor regularly.
Store chlorambucil tablets in the refrigerator, do not freeze.
See also: Chlorambucil dosage (in more detail)
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Overdose symptoms may include agitation, loss of balance or coordination, or seizure (convulsions).
What should I avoid while taking chlorambucil?
Avoid being near people who are sick or have infections. Tell your doctor at once if you develop signs of infection.
Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth. Do not receive a "live" vaccine while you are being treated with chlorambucil, and for at least 3 months after your treatment ends. The vaccine may not work as well during this time, and may not fully protect you from disease. Live vaccines include measles, mumps, rubella (MMR), oral polio, rotavirus, typhoid, varicella (chickenpox), H1N1 influenza, and nasal flu vaccine.
Chlorambucil side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking chlorambucil and call your doctor at once if you have a serious side effect such as:
seizure (convulsions);
fever, chills, body aches, flu symptoms, sores in your mouth and throat, ongoing cough;
pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating;
easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;
fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;
nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
an unusual mass or lump;
chest discomfort, dry cough or hack;
feeling short of breath on exertion;
feeling weak or tired, loss of appetite, rapid weight loss;
severe nausea, vomiting, or diarrhea; or
missed menstrual periods.
Less serious side effects:
mild nausea, vomiting, or diarrhea;
tremors or shaking; or
numbness, burning, pain, or tingly feeling.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Chlorambucil Dosing Information
Usual Adult Dose for Hodgkin's Disease:
For initiation of therapy or for short courses of treatment:
Usual Dosage: 0.1 to 0.2 mg/kg orally daily for 3 to 6 weeks as required. (This usually amounts to 4 to 10 mg per day for the average patient.) The entire daily dose may be given at one time. The dosage must be carefully adjusted according to the response of the patient and must be reduced as soon as there is an abrupt fall in the white blood cell count. Patients with Hodgkin's disease usually require 0.2 mg/kg daily. Patients with other lymphomas or chronic lymphocytic leukemia usually require only 0.1 mg/kg daily. When lymphocytic infiltration of the bone marrow is present, or when the bone marrow is hypoplastic, the daily dose should not exceed 0.1 mg/kg (about 6 mg for the average patient).
Alternatively the initial dosage of chlorambucil for the treatment of Hodgkin's disease is 10 mg orally once a day for seven days out of twenty one. This regimen also includes vinblastine, procarbazine, prednisolone, etoposide, vincristine, and doxorubicin.
Alternate schedules for the treatment of chronic lymphocytic leukemia employing intermittent, biweekly, or once-monthly pulse doses of chlorambucil have been reported. Intermittent schedules of chlorambucil begin with an initial single dose of 0.4 mg/kg. Doses are generally increased by 0.1 mg/kg until control of lymphocytosis or toxicity is observed. Subsequent doses are modified to produce mild hematologic toxicity. It is felt that the response rate of chronic lymphocytic leukemia to the biweekly or once-monthly schedule of chlorambucil administration is similar or better to that previously reported with daily administration and that hematologic toxicity was less than or equal to that encountered in studies using daily chlorambucil.
Radiation and cytotoxic drugs render the bone marrow more vulnerable to damage, and chlorambucil should be used with particular caution within 4 weeks of a full course of radiation therapy or chemotherapy. However, small doses of palliative radiation over isolated foci remote from the bone marrow will not usually depress the neutrophil and platelet count. In these cases chlorambucil may be given in the customary dosage.
It is presently felt that short courses of treatment are safer than continuous maintenance therapy, although both methods have been effective. It must be recognized that continuous therapy may give the appearance of "maintenance" in patients who are actually in remission and have no immediate need for further drug. If maintenance dosage is used, it should not exceed 0.1 mg/kg daily and may well be as low as 0.03 mg/kg daily.
Typical maintenance dose is 2 mg to 4 mg daily, or less, depending on the status of the blood counts. It may, therefore, be desirable to withdraw the drug after maximal control has been achieved, since intermittent therapy reinstituted at time of relapse may be as effective as continuous treatment.
Usual Adult Dose for Chronic Lymphocytic Leukemia:
For initiation of therapy or for short courses of treatment:
Usual Dosage: 0.1 to 0.2 mg/kg orally daily for 3 to 6 weeks as required. (This usually amounts to 4 to 10 mg per day for the average patient.) The entire daily dose may be given at one time. The dosage must be carefully adjusted according to the response of the patient and must be reduced as soon as there is an abrupt fall in the white blood cell count. Patients with Hodgkin's disease usually require 0.2 mg/kg daily. Patients with other lymphomas or chronic lymphocytic leukemia usually require only 0.1 mg/kg daily. When lymphocytic infiltration of the bone marrow is present, or when the bone marrow is hypoplastic, the daily dose should not exceed 0.1 mg/kg (about 6 mg for the average patient).
Alternatively the initial dosage of chlorambucil for the treatment of Hodgkin's disease is 10 mg orally once a day for seven days out of twenty one. This regimen also includes vinblastine, procarbazine, prednisolone, etoposide, vincristine, and doxorubicin.
Alternate schedules for the treatment of chronic lymphocytic leukemia employing intermittent, biweekly, or once-monthly pulse doses of chlorambucil have been reported. Intermittent schedules of chlorambucil begin with an initial single dose of 0.4 mg/kg. Doses are generally increased by 0.1 mg/kg until control of lymphocytosis or toxicity is observed. Subsequent doses are modified to produce mild hematologic toxicity. It is felt that the response rate of chronic lymphocytic leukemia to the biweekly or once-monthly schedule of chlorambucil administration is similar or better to that previously reported with daily administration and that hematologic toxicity was less than or equal to that encountered in studies using daily chlorambucil.
Radiation and cytotoxic drugs render the bone marrow more vulnerable to damage, and chlorambucil should be used with particular caution within 4 weeks of a full course of radiation therapy or chemotherapy. However, small doses of palliative radiation over isolated foci remote from the bone marrow will not usually depress the neutrophil and platelet count. In these cases chlorambucil may be given in the customary dosage.
It is presently felt that short courses of treatment are safer than continuous maintenance therapy, although both methods have been effective. It must be recognized that continuous therapy may give the appearance of "maintenance" in patients who are actually in remission and have no immediate need for further drug. If maintenance dosage is used, it should not exceed 0.1 mg/kg daily and may well be as low as 0.03 mg/kg daily.
Typical maintenance dose is 2 mg to 4 mg daily, or less, depending on the status of the blood counts. It may, therefore, be desirable to withdraw the drug after maximal control has been achieved, since intermittent therapy reinstituted at time of relapse may be as effective as continuous treatment.
Usual Adult Dose for Lymphoma:
For initiation of therapy or for short courses of treatment:
Usual Dosage: 0.1 to 0.2 mg/kg orally daily for 3 to 6 weeks as required. (This usually amounts to 4 to 10 mg per day for the average patient.) The entire daily dose may be given at one time. The dosage must be carefully adjusted according to the response of the patient and must be reduced as soon as there is an abrupt fall in the white blood cell count. Patients with Hodgkin's disease usually require 0.2 mg/kg daily. Patients with other lymphomas or chronic lymphocytic leukemia usually require only 0.1 mg/kg daily. When lymphocytic infiltration of the bone marrow is present, or when the bone marrow is hypoplastic, the daily dose should not exceed 0.1 mg/kg (about 6 mg for the average patient).
Alternatively the initial dosage of chlorambucil for the treatment of Hodgkin's disease is 10 mg orally once a day for seven days out of twenty one. This regimen also includes vinblastine, procarbazine, prednisolone, etoposide, vincristine, and doxorubicin.
Alternate schedules for the treatment of chronic lymphocytic leukemia employing intermittent, biweekly, or once-monthly pulse doses of chlorambucil have been reported. Intermittent schedules of chlorambucil begin with an initial single dose of 0.4 mg/kg. Doses are generally increased by 0.1 mg/kg until control of lymphocytosis or toxicity is observed. Subsequent doses are modified to produce mild hematologic toxicity. It is felt that the response rate of chronic lymphocytic leukemia to the biweekly or once-monthly schedule of chlorambucil administration is similar or better to that previously reported with daily administration and that hematologic toxicity was less than or equal to that encountered in studies using daily chlorambucil.
Radiation and cytotoxic drugs render the bone marrow more vulnerable to damage, and chlorambucil should be used with particular caution within 4 weeks of a full course of radiation therapy or chemotherapy. However, small doses of palliative radiation over isolated foci remote from the bone marrow will not usually depress the neutrophil and platelet count. In these cases chlorambucil may be given in the customary dosage.
It is presently felt that short courses of treatment are safer than continuous maintenance therapy, although both methods have been effective. It must be recognized that continuous therapy may give the appearance of "maintenance" in patients who are actually in remission and have no immediate need for further drug. If maintenance dosage is used, it should not exceed 0.1 mg/kg daily and may well be as low as 0.03 mg/kg daily.
Typical maintenance dose is 2 mg to 4 mg daily, or less, depending on the status of the blood counts. It may, therefore, be desirable to withdraw the drug after maximal control has been achieved, since intermittent therapy reinstituted at time of relapse may be as effective as continuous treatment.
Usual Pediatric Dose for Malignant Disease:
Remission Induction: 0.1 to 0.2 mg/kg/day or 4.5 mg/m2/day once daily for 3 to 6 weeks
Maintenance Therapy: 0.03 to 0.1 mg/kg/day
Nephrotic Syndrome: 0.1 to 0.2 mg/kg/day every day for 5 to 12 weeks with low dose prednisone.
Chronic Lymphocytic Leukemia:
Initial Dose: 0.4 mg/kg every 2 weeks. Increase dose by 0.1 mg/kg every 2 weeks until a response occurs and/or myelosuppression occurs.
Alternate Initial Dose: 0.4 mg/kg every 4 weeks. Increase dose by 0.2 mg/kg every 2 weeks until a response occurs and/or myelosuppression occurs.
Non-Hodgkin's Lymphoma: 0.1 mg/kg/day
Hodgkin's Lymphoma: 0.2 mg/kg/day
What other drugs will affect chlorambucil?
There may be other drugs that can interact with chlorambucil. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
More chlorambucil resources
- Chlorambucil Side Effects (in more detail)
- Chlorambucil Dosage
- Chlorambucil Use in Pregnancy & Breastfeeding
- Chlorambucil Drug Interactions
- Chlorambucil Support Group
- 2 Reviews for Chlorambucil - Add your own review/rating
- chlorambucil Advanced Consumer (Micromedex) - Includes Dosage Information
- Chlorambucil Professional Patient Advice (Wolters Kluwer)
- Chlorambucil Monograph (AHFS DI)
- Chlorambucil MedFacts Consumer Leaflet (Wolters Kluwer)
- Leukeran Prescribing Information (FDA)
Compare chlorambucil with other medications
- Cancer
- Chronic Lymphocytic Leukemia
- Hodgkin's Lymphoma
- Lymphoma
Where can I get more information?
- Your doctor or pharmacist can provide more information about chlorambucil.
See also: chlorambucil side effects (in more detail)
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