Patients should never be allowed to take the drug without medical supervision and should consult their physician if they experience skin rash, bleeding, fever, jaundice, persistent cough, seizures, nausea, vomiting, amenorrhea, or unusual lumps/masses. Severe neutropenia appears to be related to dosage and usually occurs only in patients who have received a total dosage of 6.5 mg/kg or more in one course of therapy with continuous dosing. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. History of seizure disorder or head trauma. However, irreversible bone marrow failure has been reported.Gastrointestinal disturbances such as nausea and vomiting, diarrhea, and oral ulceration occur infrequently.Tremors, muscular twitching, myoclonia, confusion, agitation, ataxia, flaccid paresis, and hallucinations have been reported as rare adverse experiences to chlorambucil which resolve upon discontinuation of drug. About one quarter of all patients receiving the continuous-dose schedule, and one third of those receiving this dosage in 8 weeks or less may be expected to develop severe neutropenia.Patients should be informed that the major toxicities of chlorambucil are related to hypersensitivity, drug fever, myelosuppression, hepatotoxicity, infertility, seizures, gastrointestinal toxicity, and secondary malignancies. The following information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. A recent study has shown Chlorambucil to be detoxified by human glutathione transferase Pi (GST P1-1), an enzyme that is often found over-expressed in cancer tissues.This is important since chlorambucil, as an electrophile, is made less reactive by conjugation with glutathione, thereby making the drug less toxic to the cell. It is considered dangerous to allow a patient to go more than 2 weeks without hematological and clinical examination during treatment.There are no known drug/drug interactions with chlorambucil.See WARNINGS section for information on carcinogenesis, mutagenesis, and impairment of fertility.It is not known whether this drug is excreted in human milk. Chlorambucil is probably mutagenic and teratogenic in humans. Available for Android and iOS devices. Reduce dose if leukocyte or platelet counts fall below normal values and discontinue if more severe depression occurs. The lymphocyte count usually rapidly returns to normal levels upon completion of drug therapy. OSHA, 1999. http://www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.html3. Chlorambucil was approved for medical use in the United States in 1957.Chlorambucil's current use is mainly in chronic lymphocytic leukemia, as it is well tolerated by most patients, though chlorambucil has been largely replaced by Chlorambucil produces its anti-cancer effects by interfering with DNA replication and damaging the DNA in a cell. It is given by mouth. The dosage must be carefully adjusted according to the response of the patient and must be reduced as soon as there is an abrupt fall in the white blood cell count. ed.) Prices are for cash paying customers only and are not valid with insurance plans. 2005. This usually amounts to 4 to 10 mg per day for the average patient. (2006) 63:1172-1193.4. When lymphocytic infiltration of the bone marrow is present, or when the bone marrow is hypoplastic, the daily dose should not exceed 0.1 mg/kg (about 6 mg for the average patient). Each film-coated tablet contains 2 mg chlorambucil and the inactive ingredients colloidal silicon 21 dioxide, hypromellose, lactose (anhydrous), macrogol/PEG 400, microcrystalline cellulose, red 22 iron oxide, stearic acid, titanium dioxide, and yellow iron oxide. When heated to decomposition it emits very toxic fumes of hydrogen chloride and nitrogen oxides.Nitrogen mustards arose from the derivatization of sulphur mustard gas after military personnel exposed to it during World War I were observed to have decreased white blood cell counts.With an acceptable therapeutic index in humans, nitrogen mustards were first introduced in the clinic in 1946.In the 1950s, aromatic mustards like chlorambucil were introduced as less toxic alkylating agents than the aliphatic nitrogen mustards, proving to be less electrophilic and react with DNA more slowly.