Article Contents ::

Details About Generic Salt ::  Chloramb

Main Medicine Class::    

klor-AM-byoo-sill
Leukeran
Tablets
2 mg
Class: Alkylating agent
Nitrogen mustard

 Indications Chronic lymphocytic leukemia, lymphomas.

Ovarian and testicular carcinoma, polycythemia vera.

 Contraindications Standard considerations.

 Route/Dosage

Chronic Lymphocytic Leukemia Remission Induction

ADULTS: PO 0.1 to 0.2 mg/kg/day (4 to 10 mg/day) for 3 to 6 wk.

Chronic Lymphocytic Leukemia Maintenance

ADULTS: PO Doses should not exceed 0.1 mg/kg/day and may be as low as 0.03 mg/kg/day. Doses of 2 to 4 mg/day are typical.

Pulse Dosing for Chronic Lymphocytic Leukemia

ADULTS: PO Initial single dose of 0.4 mg/kg. Doses are then given at biweekly or monthly intervals, increasing by 0.1 mg/kg increments until lymphocytosis is controlled or toxicity occurs. Subsequent doses are modified to produce mild hematologic toxicity.

Dosage Reduction

ADULTS: PO Dosage reductions are required if the patient has received full-dose radiation or myelotoxic drugs within the last month or has a low leukocyte or platelet count. Do not exceed 0.1 mg/kg/day when lymphocytic infiltration of bone marrow is present, or bone marrow is hypoplastic.

Interactions None well documented.

Lab Test Interferences None well documented.

 Adverse Reactions

CNS: Confusion; agitation; ataxia; hallucinations; tremors; muscular twitching; flaccid paresis; peripheral neuropathy; seizures. DERMATOLOGIC: Rash; urticaria. GI: Nausea; vomiting; diarrhea; oral ulceration; mucositis. GU: Sterile cystitis; reversible and permanent sterility. HEMATOLOGIC: Bone marrow suppression. HYPERSENSITIVITY: Angioedema. OTHER: Acute myelogenous leukemia.

 Precautions

Pregnancy: Category D. Lactation: Undetermined. Children: Safety and efficacy not established. Bone marrow damage: Chlorambucil can severely suppress bone marrow function. Carcinogenesis: Because of its carcinogenic properties, do not give to patients with conditions other than chronic lymphatic leukemia or malignant lymphomas. Fertility impairment: Chlorambucil has caused chromatid or chromosome damage in men. Reversible and permanent sterility have occurred inmen and women. Radiation and chemotherapy: Do not give a full dosage before 4 wk after a full course of radiation therapy or chemotherapy because of the vulnerability of the bone marrow to damage under these conditions. Seizures: Rare, focal, or generalized seizures have occurred in adults and children at therapeutic daily doses, pulse dosing regimens and in acute overdosage. Exercise caution when administering chlorambucil to patients with a history of seizure disorders, head trauma, or to patients receiving other potentially epileptogenic drugs.

PATIENT CARE CONSIDERATIONS


 Administration/Storage

  • Store tablets at room temperature in a dry place.
  • Administer orally, once daily or in divided doses.
  • Shake the suspension well before using.

Extemporaneous oral suspension

  • For chlorambucil 2 mg/mL oral suspension, crush sixty 2 mg oral tablets completely and suspend in 30 mL of 1% methylcellulose. Dilute with sufficient syrup for a final total volume of 60 mL. Simple syrup or cherry syrup may be used. It is stable for days stored in amber glass bottles under refrigeration.

 Assessment/Interventions

  • Monitor CBCs 1 to 2 times/wk; reduce dose immediately if there is an abrupt fall in the WBC count.
  • Hyperuricemia may occur because of rapid cell lysis; monitor serum uric acid. Minimize effects of hyperuricemia with hydration, urinary alkalinization, and allopurinol.
  • Determine weekly hemoglobin levels, total and differential leukocyte counts and quantitative platelet counts. Also, during ther first 3 to 6 wk of therapy, perform white blood cell (WBC) counts 3 to 4 days after each of the weekly complete blood counts. It is dangerous to allow a patient to go > 2 wk without hematological and clinical examinations.
  • Follow procedures for proper handling and disposal of anticancer drugs. Wear gloves and avoid skin exposure and inhalation of fumes.
  • Observe patients carefully to avoid life-threatening damage to the bone marrow. A slowly progressive lymphopenia may develop during treatment. Most patients have some neutropenia after the third week of treatment which may continue for up to 10 days after the last dose. Severe neutropenia appears to be dose-related and usually occurs only in patients who have received a total dose of ³ 6.5 mg/kg in 1 course.
OVERDOSAGE: SIGNS & SYMPTOMS
  Reversible pancytopenia, neurological toxicity ranging from agitated behavior and ataxia to multiple grand mal seizures

 Patient/Family Education

  • Major toxicities of chlorambucil are related to hypersensitivity, drug fever, myelosuppression, hepatotoxicity, infertility, siezures, GI toxicity, and secondary malignancies.
  • Notify health care provider with any of the follow symptoms: unusual bleeding or bruising, fever, nausea, vomiting, skin rash, chills, sore throat, cough, shortness of breath, seizures, amenorrhea, unusual lumps or masses, flank or stomach pain, joint pain, sores in the mouth or on the lips, yellow discoloration of the skin or eyes.
  • Contraceptive measures are recommended during therapy.

Medicscientist Drug Facts

 

Drugs Class ::

klor-AM-byoo-sill
Leukeran
Tablets
2 mg
Class: Alkylating agent
Nitrogen mustard

Indications for Drugs ::

 Indications Chronic lymphocytic leukemia, lymphomas.

Ovarian and testicular carcinoma, polycythemia vera.

Drug Dose ::

 Route/Dosage

Chronic Lymphocytic Leukemia Remission Induction

ADULTS: PO 0.1 to 0.2 mg/kg/day (4 to 10 mg/day) for 3 to 6 wk.

Chronic Lymphocytic Leukemia Maintenance

ADULTS: PO Doses should not exceed 0.1 mg/kg/day and may be as low as 0.03 mg/kg/day. Doses of 2 to 4 mg/day are typical.

Pulse Dosing for Chronic Lymphocytic Leukemia

ADULTS: PO Initial single dose of 0.4 mg/kg. Doses are then given at biweekly or monthly intervals, increasing by 0.1 mg/kg increments until lymphocytosis is controlled or toxicity occurs. Subsequent doses are modified to produce mild hematologic toxicity.

Dosage Reduction

ADULTS: PO Dosage reductions are required if the patient has received full-dose radiation or myelotoxic drugs within the last month or has a low leukocyte or platelet count. Do not exceed 0.1 mg/kg/day when lymphocytic infiltration of bone marrow is present, or bone marrow is hypoplastic.

Contraindication ::

 Contraindications Standard considerations.

Drug Precautions ::

 Precautions

Pregnancy: Category D. Lactation: Undetermined. Children: Safety and efficacy not established. Bone marrow damage: Chlorambucil can severely suppress bone marrow function. Carcinogenesis: Because of its carcinogenic properties, do not give to patients with conditions other than chronic lymphatic leukemia or malignant lymphomas. Fertility impairment: Chlorambucil has caused chromatid or chromosome damage in men. Reversible and permanent sterility have occurred inmen and women. Radiation and chemotherapy: Do not give a full dosage before 4 wk after a full course of radiation therapy or chemotherapy because of the vulnerability of the bone marrow to damage under these conditions. Seizures: Rare, focal, or generalized seizures have occurred in adults and children at therapeutic daily doses, pulse dosing regimens and in acute overdosage. Exercise caution when administering chlorambucil to patients with a history of seizure disorders, head trauma, or to patients receiving other potentially epileptogenic drugs.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CNS: Confusion; agitation; ataxia; hallucinations; tremors; muscular twitching; flaccid paresis; peripheral neuropathy; seizures. DERMATOLOGIC: Rash; urticaria. GI: Nausea; vomiting; diarrhea; oral ulceration; mucositis. GU: Sterile cystitis; reversible and permanent sterility. HEMATOLOGIC: Bone marrow suppression. HYPERSENSITIVITY: Angioedema. OTHER: Acute myelogenous leukemia.

Drug Mode of Action ::  

klor-AM-byoo-sill
Leukeran
Tablets
2 mg
Class: Alkylating agent
Nitrogen mustard

Drug Interactions ::

Interactions None well documented.

Drug Assesment ::

 Assessment/Interventions

  • Monitor CBCs 1 to 2 times/wk; reduce dose immediately if there is an abrupt fall in the WBC count.
  • Hyperuricemia may occur because of rapid cell lysis; monitor serum uric acid. Minimize effects of hyperuricemia with hydration, urinary alkalinization, and allopurinol.
  • Determine weekly hemoglobin levels, total and differential leukocyte counts and quantitative platelet counts. Also, during ther first 3 to 6 wk of therapy, perform white blood cell (WBC) counts 3 to 4 days after each of the weekly complete blood counts. It is dangerous to allow a patient to go > 2 wk without hematological and clinical examinations.
  • Follow procedures for proper handling and disposal of anticancer drugs. Wear gloves and avoid skin exposure and inhalation of fumes.
  • Observe patients carefully to avoid life-threatening damage to the bone marrow. A slowly progressive lymphopenia may develop during treatment. Most patients have some neutropenia after the third week of treatment which may continue for up to 10 days after the last dose. Severe neutropenia appears to be dose-related and usually occurs only in patients who have received a total dose of ³ 6.5 mg/kg in 1 course.
OVERDOSAGE: SIGNS & SYMPTOMS
  Reversible pancytopenia, neurological toxicity ranging from agitated behavior and ataxia to multiple grand mal seizures

Drug Storage/Management ::

 Administration/Storage

  • Store tablets at room temperature in a dry place.
  • Administer orally, once daily or in divided doses.
  • Shake the suspension well before using.

Extemporaneous oral suspension

  • For chlorambucil 2 mg/mL oral suspension, crush sixty 2 mg oral tablets completely and suspend in 30 mL of 1% methylcellulose. Dilute with sufficient syrup for a final total volume of 60 mL. Simple syrup or cherry syrup may be used. It is stable for days stored in amber glass bottles under refrigeration.

Drug Notes ::

 Patient/Family Education

  • Major toxicities of chlorambucil are related to hypersensitivity, drug fever, myelosuppression, hepatotoxicity, infertility, siezures, GI toxicity, and secondary malignancies.
  • Notify health care provider with any of the follow symptoms: unusual bleeding or bruising, fever, nausea, vomiting, skin rash, chills, sore throat, cough, shortness of breath, seizures, amenorrhea, unusual lumps or masses, flank or stomach pain, joint pain, sores in the mouth or on the lips, yellow discoloration of the skin or eyes.
  • Contraceptive measures are recommended during therapy.

Medicscientist Drug Facts

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