Article Contents ::

Details About Generic Salt ::  Mechlore

Main Medicine Class::    

(meh-klor-ETH-ah-meen)
Mustargen
Powder for injection
10 mg
Class: Alkylating agent
Nitrogen mustard

 Indications Hodgkin disease, lymphosarcoma, chronic myelocytic or lymphocytic leukemia, polycythemia vera, mycosis fungoides (topical), bronchogenic carcinoma; palliative treatment of malignant effusion (intrapleural, intraperitoneal, or intrapericardial use only).

 Contraindications Infectious disease; previous anaphylactic reactions to the drug.

 Route/Dosage

Lymphorsarcoma, Chronic Myelocytic or Lymphocytic Leukemia, Polycythemia Vera, Bronchogenic Carcinoma; Palliative Treatment of Malignant Effusion (Intrapleural, Intraperitoneal, or Intrapericardial Use Only)

ADULTS: IV Total dose of 0.4 mg/kg of body weight for each course (as single dose or divided doses of 0.1 to 0.2 mg/kg/day). Dose based on ideal dry body weight. May repeat courses at 3- to 6-wk intervals.

Advanced Hodgkin’s Disease

ADULTS: IV When used in MOPP regimen, dose is 6 mg/m2/day on days 1 and 8 of a 28-day cycle. The dose should be decreased 50% if leukocyte count is 3000 to 3999/mm3, and 75% if the count is between 1000 and 2999/mm3 or platelets between 50,000 and 100,000/mm3. On later cycles, do not administer if leukocyte count is less than 1000/mm3 or platelets are less than 50,000/mm3.

Mycosis Fungoides

ADULTS: Topical Apply compounded solutions or ointments to the entire body surface once daily for 6 to 12 mo. If the lesions do not reappear, continue to apply every 2 to 7 days for a total of 3 yr.

Interactions None well documented.

Lab Test Interferences None well documented.

 Adverse Reactions

CNS: Serious neurotoxicity including headache, hallucinations, seizures, and encephalopathy with high-dose bone marrow transplantation regimens. DERMATOLOGIC: Alopecia, hyperpigmentation, contact dermatitis with topical use. GI: Very high potential for nausea and vomiting; diarrhea, peptic ulcer, metallic taste just after drug administration. GU: Amenorrhea; sterility. HEMATOLOGIC: Bone marrow suppression, nadir at 7 to 14 days. HYPERSENSITIVITY: Anaphylactoid reaction with IV or topical administration. SPECIALSENSES: Vertigo, tinnitus; diminished hearing infrequently. OTHER: Actinic keratoses and squamous cell carcinomas with topical use; acute nonlymphocytic leukemia and non-Hodgkin lymphoma after MOPP therapy of Hodgkin disease.

 Precautions

Pregnancy: Category D. Lactation: Undetermined. Children: Safety and efficacy in children have not been established by well-controlled studies. Amyloidosis: Nitrogen mustard therapy may contribute to extensive and rapid development of amyloidosis; use only if foci or acute and chronic suppurative inflammation are absent. Carcinogenesis: Therapy with nitrogen mustard may be associated with an increased incidence of second malignant tumor. Chronic lymphatic leukemia: Drug toxicity, especially sensitivity to bone marrow failure, appears to be more common in chronic lymphatic leukemia than in other conditions; administer with great caution in this condition, if at all. Extravasation: Mechlorethamine is a vesicant; extravasation can cause severe local necrosis. Fertility impairment: Impaired spermatogenesis, azoospermia, and total germinal aplasia have occurred in men. GI: Nausea and vomiting usually begins 1 to 3 hr after use. Vomiting may persist for the first 8 hr, nausea for 24 hr. Hematologic: The usual course of treatment produces lymphocytopenia within 24 hr after the first injection; significant granulocytopenia occurs within 6 to 8 days and lasts for 10 days to 3 wk. Severe thrombocytopenia may lead to bleeding from the gums and GI tract, petechiae, and small SC hemorrhages. Erythrocyte and hemoglobin levels may decline, but rarely significantly, during the first 2 wk after therapy. Depression of the hematopoietic system may occur at least 50 days after starting therapy. Herpes zoster: Herpes zoster, common with lymphomas, may first appear after therapy is instituted and may be precipitated by treatment. Hypersensitivity reactions: Reactions, including anaphylaxis have occurred. Hyperuricemia: Urate precipitation may develop during therapy, particularly in the treatment of lymphomas. Intercavitary administration: Pain occurs rarely with intrapleural use; it is common with intraperitoneal injection and if often associated with nausea, vomiting, and diarrhea of 2 to 3 days duration. Transient cardiac irregularities may occur with intrapericardial injection. Tumors: Tumors of bone and nervous tissue respond poorly to therapy.

PATIENT CARE CONSIDERATIONS


 Administration/Storage

  • Store at room temperature, colder than 40°C (104°F) and protect from light and humidity.
  • Mechlorethamine powder for injection should not be used if there are droplets of water in the vial before reconstitution.
  • Topical preparations must be prepared in a fume hood to prevent circulation of toxic vapors into room air.
  • Reconstituted solution should appear colorless. Do not use the solution if it is discolored.
  • Follow procedures for proper handling and disposal of anticancer drugs. Wear gloves and avoid skin exposure and inhalation of fumes.
  • Administer IV or topically.

IV

  • Dilute with 10 mL of sterile water for injection or 0.9% Sodium Chloride for a concentration of 1 mg/mL. After injecting diluent into vial, with needle still in rubber stopper, shake the vial to dissolve the drug.
  • IV solutions decompose rapidly; therefore, use reconstituted solutions immediately.
  • Give by IV push injection or IV sidearm into a running infusion.

Topical

  • Use rubber gloves to apply. Product should be used only in well-ventilated areas with chemotherapy spill kits in close proximity.
  • For a topical ointment, dissolve mechlorethamine in dehydrated alcohol, filter resulting solution, and add into a petrolatum or anhydrous ointment base.
  • For a topical solution, dissolve 10 mg of mechlorethamine in 50 to 60 mL of water.

 Assessment/Interventions

  • Hyperuricemia may occur because of rapid cell lysis; monitor serum uric acid. Minimize effects of hyperuricemia with hydration, urinary alkalinization, and allopurinol.
  • If mechlorethamine accidentally comes into contact with skin or mucous membranes, flush with copious amounts of water, then apply a 1/6 molar solution of sodium thiosulfate to neutralize any remaining mechlorethamine. To prepare a 16% molar solution of sodium thiosulfate, dilute 4 mL of a 10% solution of sodium thiosulfate with 6 mL of sterile water, or dilute 1.6 mL of a 25% solution of sodium thiosulfate with 8.4 mL of sterile water.
  • Many renal, hepatic, and bone marrow function abnormalities occur in patients with neoplastic disease who receive mechlorethamine. Check renal, hepatic, and bone marrow functions frequently.

 Patient/Family Education

  • Explain name, action, and potential side effects of drug.
  • Advise patient, family, or caregiver that medication will be prepared and administered by health care provider in a health care setting.
  • Advise patient, family, or caregiver that medication may be used in combination with other agents, including antiemetics, to achieve maximum benefit possible.
  • Review dosing schedule with patient, family, or caregiver.
  • Advise patient, family, or caregiver to immediately report any of the following to health care provider: rash; hives; difficulty breathing; fever, chills or other signs of infection; sores in mouth; unusual bleeding or bruising; pain, redness or swelling at injection site.
  • Advise patient, family, or caregiver to report any of the following to health care provider: persistent nausea, vomiting, diarrhea or appetite loss; persistent or worsening general body weakness.
  • Instruct patient to not take any prescription or otc medications or dietary supplements unless advised by health care provider.
  • Caution women of childbearing potential to avoid becoming pregnant during therapy.
  • Instruct women of childbearing potential to notify health care provider if they become pregnant, plan on becoming pregnant, or are breastfeeding.
  • Advise patient, family, or caregiver that following discharge frequent follow-up visits and laboratory tests will be required to monitor therapy and to be sure to keep appointments.

Medicscientist Drug Facts

 

Drugs Class ::

(meh-klor-ETH-ah-meen)
Mustargen
Powder for injection
10 mg
Class: Alkylating agent
Nitrogen mustard

Indications for Drugs ::

 Indications Hodgkin disease, lymphosarcoma, chronic myelocytic or lymphocytic leukemia, polycythemia vera, mycosis fungoides (topical), bronchogenic carcinoma; palliative treatment of malignant effusion (intrapleural, intraperitoneal, or intrapericardial use only).

Drug Dose ::

 Route/Dosage

Lymphorsarcoma, Chronic Myelocytic or Lymphocytic Leukemia, Polycythemia Vera, Bronchogenic Carcinoma; Palliative Treatment of Malignant Effusion (Intrapleural, Intraperitoneal, or Intrapericardial Use Only)

ADULTS: IV Total dose of 0.4 mg/kg of body weight for each course (as single dose or divided doses of 0.1 to 0.2 mg/kg/day). Dose based on ideal dry body weight. May repeat courses at 3- to 6-wk intervals.

Advanced Hodgkin’s Disease

ADULTS: IV When used in MOPP regimen, dose is 6 mg/m2/day on days 1 and 8 of a 28-day cycle. The dose should be decreased 50% if leukocyte count is 3000 to 3999/mm3, and 75% if the count is between 1000 and 2999/mm3 or platelets between 50,000 and 100,000/mm3. On later cycles, do not administer if leukocyte count is less than 1000/mm3 or platelets are less than 50,000/mm3.

Mycosis Fungoides

ADULTS: Topical Apply compounded solutions or ointments to the entire body surface once daily for 6 to 12 mo. If the lesions do not reappear, continue to apply every 2 to 7 days for a total of 3 yr.

Contraindication ::

 Contraindications Infectious disease; previous anaphylactic reactions to the drug.

Drug Precautions ::

 Precautions

Pregnancy: Category D. Lactation: Undetermined. Children: Safety and efficacy in children have not been established by well-controlled studies. Amyloidosis: Nitrogen mustard therapy may contribute to extensive and rapid development of amyloidosis; use only if foci or acute and chronic suppurative inflammation are absent. Carcinogenesis: Therapy with nitrogen mustard may be associated with an increased incidence of second malignant tumor. Chronic lymphatic leukemia: Drug toxicity, especially sensitivity to bone marrow failure, appears to be more common in chronic lymphatic leukemia than in other conditions; administer with great caution in this condition, if at all. Extravasation: Mechlorethamine is a vesicant; extravasation can cause severe local necrosis. Fertility impairment: Impaired spermatogenesis, azoospermia, and total germinal aplasia have occurred in men. GI: Nausea and vomiting usually begins 1 to 3 hr after use. Vomiting may persist for the first 8 hr, nausea for 24 hr. Hematologic: The usual course of treatment produces lymphocytopenia within 24 hr after the first injection; significant granulocytopenia occurs within 6 to 8 days and lasts for 10 days to 3 wk. Severe thrombocytopenia may lead to bleeding from the gums and GI tract, petechiae, and small SC hemorrhages. Erythrocyte and hemoglobin levels may decline, but rarely significantly, during the first 2 wk after therapy. Depression of the hematopoietic system may occur at least 50 days after starting therapy. Herpes zoster: Herpes zoster, common with lymphomas, may first appear after therapy is instituted and may be precipitated by treatment. Hypersensitivity reactions: Reactions, including anaphylaxis have occurred. Hyperuricemia: Urate precipitation may develop during therapy, particularly in the treatment of lymphomas. Intercavitary administration: Pain occurs rarely with intrapleural use; it is common with intraperitoneal injection and if often associated with nausea, vomiting, and diarrhea of 2 to 3 days duration. Transient cardiac irregularities may occur with intrapericardial injection. Tumors: Tumors of bone and nervous tissue respond poorly to therapy.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CNS: Serious neurotoxicity including headache, hallucinations, seizures, and encephalopathy with high-dose bone marrow transplantation regimens. DERMATOLOGIC: Alopecia, hyperpigmentation, contact dermatitis with topical use. GI: Very high potential for nausea and vomiting; diarrhea, peptic ulcer, metallic taste just after drug administration. GU: Amenorrhea; sterility. HEMATOLOGIC: Bone marrow suppression, nadir at 7 to 14 days. HYPERSENSITIVITY: Anaphylactoid reaction with IV or topical administration. SPECIALSENSES: Vertigo, tinnitus; diminished hearing infrequently. OTHER: Actinic keratoses and squamous cell carcinomas with topical use; acute nonlymphocytic leukemia and non-Hodgkin lymphoma after MOPP therapy of Hodgkin disease.

Drug Mode of Action ::  

(meh-klor-ETH-ah-meen)
Mustargen
Powder for injection
10 mg
Class: Alkylating agent
Nitrogen mustard

Drug Interactions ::

Interactions None well documented.

Drug Assesment ::

 Assessment/Interventions

  • Hyperuricemia may occur because of rapid cell lysis; monitor serum uric acid. Minimize effects of hyperuricemia with hydration, urinary alkalinization, and allopurinol.
  • If mechlorethamine accidentally comes into contact with skin or mucous membranes, flush with copious amounts of water, then apply a 1/6 molar solution of sodium thiosulfate to neutralize any remaining mechlorethamine. To prepare a 16% molar solution of sodium thiosulfate, dilute 4 mL of a 10% solution of sodium thiosulfate with 6 mL of sterile water, or dilute 1.6 mL of a 25% solution of sodium thiosulfate with 8.4 mL of sterile water.
  • Many renal, hepatic, and bone marrow function abnormalities occur in patients with neoplastic disease who receive mechlorethamine. Check renal, hepatic, and bone marrow functions frequently.

Drug Storage/Management ::

 Administration/Storage

  • Store at room temperature, colder than 40°C (104°F) and protect from light and humidity.
  • Mechlorethamine powder for injection should not be used if there are droplets of water in the vial before reconstitution.
  • Topical preparations must be prepared in a fume hood to prevent circulation of toxic vapors into room air.
  • Reconstituted solution should appear colorless. Do not use the solution if it is discolored.
  • Follow procedures for proper handling and disposal of anticancer drugs. Wear gloves and avoid skin exposure and inhalation of fumes.
  • Administer IV or topically.

IV

  • Dilute with 10 mL of sterile water for injection or 0.9% Sodium Chloride for a concentration of 1 mg/mL. After injecting diluent into vial, with needle still in rubber stopper, shake the vial to dissolve the drug.
  • IV solutions decompose rapidly; therefore, use reconstituted solutions immediately.
  • Give by IV push injection or IV sidearm into a running infusion.

Topical

  • Use rubber gloves to apply. Product should be used only in well-ventilated areas with chemotherapy spill kits in close proximity.
  • For a topical ointment, dissolve mechlorethamine in dehydrated alcohol, filter resulting solution, and add into a petrolatum or anhydrous ointment base.
  • For a topical solution, dissolve 10 mg of mechlorethamine in 50 to 60 mL of water.

Drug Notes ::

 Patient/Family Education

  • Explain name, action, and potential side effects of drug.
  • Advise patient, family, or caregiver that medication will be prepared and administered by health care provider in a health care setting.
  • Advise patient, family, or caregiver that medication may be used in combination with other agents, including antiemetics, to achieve maximum benefit possible.
  • Review dosing schedule with patient, family, or caregiver.
  • Advise patient, family, or caregiver to immediately report any of the following to health care provider: rash; hives; difficulty breathing; fever, chills or other signs of infection; sores in mouth; unusual bleeding or bruising; pain, redness or swelling at injection site.
  • Advise patient, family, or caregiver to report any of the following to health care provider: persistent nausea, vomiting, diarrhea or appetite loss; persistent or worsening general body weakness.
  • Instruct patient to not take any prescription or otc medications or dietary supplements unless advised by health care provider.
  • Caution women of childbearing potential to avoid becoming pregnant during therapy.
  • Instruct women of childbearing potential to notify health care provider if they become pregnant, plan on becoming pregnant, or are breastfeeding.
  • Advise patient, family, or caregiver that following discharge frequent follow-up visits and laboratory tests will be required to monitor therapy and to be sure to keep appointments.

Medicscientist Drug Facts

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