chlorambucil (Leukeran)
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Introduction
Tradename: Leukeran.
Indications
- chronic lymphocytic leukemia
- induction 0.1-0.2 mg/kg/day for 3 weeks
- 0.4 mg/kg every 2-4 weeks
- Hodgkin's disease
- non-Hodgkin's lymphoma
- 16 mg/m2/day for 5 days every 4 weeks
- macroglobulinemia
- polycythemia vera
- trophoblastic neoplasms
- ovarian neoplasms
- nephrotic syndrome unresponsive to conventional therapy
- minimal change disease[3]
Contraindications
* contraception indicated during therapy
Dosage
Tabs: 2 mg
Pharmacokinetics
- well absorbed orally
- food slows absorption
- metabolized by liver
- 1/2life 1-2 hours
elimination via liver
1/2life = 1-2 hours
Adverse effects
- common (> 10%)
- myelosuppression
- onset 7 days
- nadir 10-14 days
- recovery 28 days
- increased incidence of secondary malignancy, especially acute myelogenous leukemia (AML)
- myelosuppression
- less common (1-10%)
- menstrual changes*, skin rashes, hyperuricemia, diarrhea, oral ulceration*, nausea/vomiting
- uncommon (< 1%)
- drug fever, hepatic necrosis, weakness, rash, leukopenia, thrombocytopenia, tremors, twitching, confusion, agitation, ataxia, hallucinations, seizures, peripheral neuropathy, fertility impairment (oligospermia, amenorrhea) pulmonary fibrosis (cumulative effect), keratitis, hepatotoxicity, skin hypersensitivity
* notify physician if bleeding or sore throat occurs
Drug interactions
- barbiturates may increase the toxicity of chlorambucil