Home Drug Guide Chlorambucil

Drug Guide

Generic Name

Chlorambucil

Brand Names Leukeran

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Alkylating agent (Nitrogen mustard derivative)

FDA Approved Indications

  • Chronic lymphocytic leukemia (CLL)
  • Hodgkin's lymphoma (occasionally)
  • Other lymphoid malignancies

Mechanism of Action

Chlorambucil crosslinks DNA strands, leading to apoptosis of rapidly dividing cells. It alkylates RNA and DNA, disrupting nucleic acid synthesis and function.

Dosage and Administration

Adult: Typically 0.1-0.2 mg/kg/day orally, divided into doses, with adjustments based on response and tolerability.

Pediatric: Use is limited; doses are calculated based on body surface area or weight, under specialist supervision.

Geriatric: Start at lower doses due to increased sensitivity and potential for adverse effects.

Renal Impairment: Use with caution; monitor renal function and adjust dose if necessary.

Hepatic Impairment: Use cautiously; consider dose adjustments and close monitoring.

Pharmacokinetics

Absorption: Well absorbed after oral administration

Distribution: Widely distributed in body tissues, crosses the blood-brain barrier

Metabolism: Metabolized in the liver, forms active metabolites

Excretion: Primarily excreted in urine

Half Life: Approximately 1.5 hours, though active metabolites may last longer

Contraindications

  • Hypersensitivity to chlorambucil or other alkylating agents.
  • Pregnancy and lactation (see detailed precautions)

Precautions

  • Use cautiously in patients with bone marrow suppression, hepatic or renal impairment, active infections, or history of secondary malignancies. Monitor blood counts regularly. Pregnant women should avoid use; effective contraception is advised during treatment.

Adverse Reactions - Common

  • Bone marrow suppression (anemia, leukopenia, thrombocytopenia) (Common)
  • Alopecia (Common)
  • Nausea and vomiting (Common)

Adverse Reactions - Serious

  • Secondary malignancies, such as leukemia (Rare)
  • Severe immunosuppression leading to infection (Rare)
  • Gastrointestinal ulceration (Rare)

Drug-Drug Interactions

  • Other myelosuppressive agents, including chemotherapies and immunosuppressants.
  • CNS depressants.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor complete blood counts regularly; assess for signs of infection or bleeding.

Diagnoses:

  • Risk for infection
  • Impaired skin integrity
  • Risk for bleeding

Implementation: Administer as prescribed; monitor blood counts; educate patient on signs of infection or bleeding.

Evaluation: Therapeutic response and toxicity; adjustments as needed.

Patient/Family Teaching

  • Report signs of infection, unusual bleeding, or fatigue.
  • Avoid live vaccines during therapy.
  • Use contraception during and for at least 6 months after treatment.

Special Considerations

Black Box Warnings:

  • Risk of secondary malignancies, including leukemia and other solid tumors.

Genetic Factors: N/A

Lab Test Interference: N/A

Overdose Management

Signs/Symptoms: Severe myelosuppression, infection, bleeding, gastrointestinal toxicity.

Treatment: Supportive care; management of cytopenias; consider hemofiltration or exchange transfusion in severe cases; use of rescue agents not well established.

Storage and Handling

Storage: Store at room temperature, away from moisture and light.

Stability: Stable under recommended storage conditions for the shelf life specified by manufacturer.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.