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Chlorambucil

Class
DNA crosslinking agents
Subclass
Alkylating agents
Generic name
Chlorambucil
Brand names
Leukeran®
Common formulations
Film-coated tablet
Dosage and administration
Adults patients
Treatment
Hodgkin lymphoma
•
0.1-0.2 mg/kg PO daily for 3-6 weeks
Non-Hodgkin's lymphoma
•
0.1-0.2 mg/kg PO daily for 3-6 weeks
Eosinophilic granulomatosis with polyangiitis • Off-label
•
0.2 mg/kg PO daily
Nephrotic syndrome • Off-label
•
0.1-0.2 mg/kg PO daily for 8-12 weeks
Pneumonitis in patients with SLE • Off-label
•
0.1-0.2 mg/kg PO daily
Polyarteritis nodosa • Off-label
•
0.2 mg/kg PO daily
Systemic vasculitis syndromes • Off-label
•
0.2 mg/kg PO daily
Adjunctive treatment
Adjunctive treatment for chronic lymphocytic leukemia • Off-label
•
12 mg/m² PO daily once-daily doses on days 1-7 of 28-day cycles for a duration of up to 6 courses of therapy
Alternative
•
20 mg/m² PO daily once-daily doses on day 1 of 28-day cycles for a duration of up to 12 courses of therapy
Other off-label uses
•
Treatment of Behçet's syndrome
•
Treatment of dermatomyositis (refractory)
•
Treatment of immune thrombocytopenic purpura
•
Treatment of uveitis
Indications for use
Labeled indications
Adults
•
Treatment of Hodgkin lymphoma
•
Treatment of chronic lymphocytic leukemia
•
Treatment of non-Hodgkin's lymphoma
Off-label indications
Adults
•
Treatment of Behçet's syndrome
•
Treatment of dermatomyositis (refractory)
•
Treatment of eosinophilic granulomatosis with polyangiitis
•
Treatment of immune thrombocytopenic purpura
•
Treatment of nephrotic syndrome
•
Treatment of pneumonitis in patients with SLE
•
Treatment of polyarteritis nodosa
•
Treatment of systemic vasculitis syndromes
•
Treatment of uveitis
•
Adjunctive treatment for chronic lymphocytic leukemia
Safety risks
Boxed warnings
Hematologic disorder
•
Use extreme caution with risk factors for Bone marrow suppression.
Contraindications
Hypersensitivity to Chlorambucil
Warnings and precautions
Seizures
•
Use caution with nephrotic syndrome, receiving high-dose pulse therapy, receiving concomitant drugs that may also cause seizures, or who have a history of head trauma or seizure disorder.
Specific populations
Renal impairment
eGFR 20-50 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Monitor for myelosuppression.
eGFR 10-20 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Monitor for myelosuppression.
eGFR < 10 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Monitor for myelosuppression.
Renal replacement therapy
Continuous renal replacement
•
Use acceptable. No dose adjustment required. Monitor for myelosuppression.
Intermittent hemodialysis
•
Use acceptable. No dose adjustment required. Monitor for myelosuppression.
Peritoneal dialysis
•
Use acceptable. No dose adjustment required. Monitor for myelosuppression.
Hepatic impairment
Any severity
•
Reduce dose. Monitor for toxicity.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: D
•
Avoid use. Evidence of fetal harm in humans.
Breastfeeding
Little information available on breastfeeding safety.
•
Do not use during breastfeeding.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
↓ blood neutrophil count
Common 1-10%
•
Agitation, ataxia, erythema multiforme, limb paresis, myoclonus, oral ulcers, pancytopenia, confusion, diarrhea, hallucinations, nausea, seizure, skin rash, tremor, vomiting, Stevens-Johnson syndrome, toxic epidermal necrolysis
Unknown frequency
•
Anemia, angioedema, azoospermia, ↓ WBC count, ↓ blood lymphocyte count, ↓ platelet count, ↑ liver enzymes, jaundice, peripheral neuropathy, pneumonitis, pulmonary fibrosis, amenorrhea, fever, infertility, teratogenesis, urticaria
Interactions
Drug(s)
Check Interactions
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