chlorambucil at a glance
Medicine class
Cytotoxic chemotherapy; nitrogen-mustard alkylating agent
Licensed uses
Selected lymphomas, chronic lymphocytic leukaemia and Waldenström’s macroglobulinaemia
Administration
Take on an empty stomach and swallow the tablet whole with water
Key monitoring
Close blood-count monitoring is essential because bone-marrow suppression can be severe or irreversible
Storage
Keep refrigerated in its original container and out of children's reach
What is chlorambucil used for?
UK-licensed indications for the selected product are:
Hodgkin lymphoma
Certain forms of non-Hodgkin lymphoma
Chronic lymphocytic leukaemia
Waldenström’s macroglobulinaemia
How does chlorambucil work?
Chlorambucil is converted partly to another active alkylating compound. These substances form links within DNA, disrupting DNA replication and promoting programmed cell death. This can reduce abnormal lymphoid and blood-cell populations but can also suppress healthy bone marrow.
chlorambucil preparations and strengths
Tablet
Route: Oral
Strengths: 2 mg
How to take chlorambucil
Use chlorambucil only as directed by the specialist team. Take it on an empty stomach, at least one hour before or three hours after food.
Swallow tablets whole with a glass of water.
Do not divide, break, crush or chew them.
Wash your hands before and after handling them, and avoid unnecessary handling by other people.
Keep the tablets refrigerated in their original container.
Return unused tablets to a pharmacy; do not put them in household waste or wastewater.
chlorambucil side effects
Common or expected effects
- Reduced white cells, platelets or other blood cells due to bone-marrow suppression
- Anaemia, which may cause tiredness, weakness or breathlessness
- Nausea or vomiting
- Diarrhoea
- Mouth ulcers
Get urgent medical advice
- Severe or irreversible bone-marrow suppression, presenting with infection, fever, bleeding or profound tiredness
- Severe allergic reaction, including hives or tissue swelling
- Stevens–Johnson syndrome or toxic epidermal necrolysis: painful, blistering or peeling rash, often affecting the mouth or eyes
- Seizures or other neurological toxicity
- Liver injury or jaundice
- Interstitial lung disease, with new or worsening breathlessness
- Secondary blood cancers, particularly after prolonged exposure
chlorambucil in pregnancy
Chlorambucil can harm fetal development and should be avoided during pregnancy whenever possible, particularly in the first trimester. Effective contraception is advised when either partner is receiving treatment. Anyone who is pregnant, planning pregnancy or concerned about exposure should contact the specialist team promptly and should not stop treatment without advice.
chlorambucil while breastfeeding
Do not breastfeed while receiving chlorambucil. Cytotoxic chemotherapy may enter breast milk and harm a nursing infant; ask the oncology and maternity teams when breastfeeding could safely be considered after treatment.
chlorambucil interactions
The specialist team should review all prescribed, non-prescription and complementary products. Important examples include:
Live vaccines
Avoid during chlorambucil-related immunosuppression because the vaccine organism may cause infection.
Fludarabine, pentostatin or cladribine
These purine nucleoside analogues increased chlorambucil cytotoxicity in laboratory testing, although the clinical significance is uncertain.
Recent radiotherapy or other cytotoxic chemotherapy
Overlapping bone-marrow toxicity may be increased, so treatment timing and blood counts require specialist assessment.
Common questions about chlorambucil
Answers are fully visible for fast scanning and source review.
Is chlorambucil a chemotherapy medicine?
Yes. Chlorambucil is an oral cytotoxic chemotherapy belonging to the nitrogen-mustard alkylating-agent class.
Which cancers is chlorambucil licensed to treat in the UK?
The selected product is licensed for Hodgkin lymphoma, certain non-Hodgkin lymphomas, chronic lymphocytic leukaemia and Waldenström’s macroglobulinaemia.
Why must chlorambucil be taken on an empty stomach?
Food reduces and delays chlorambucil absorption, so the tablet should be taken at least one hour before or three hours after food.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.