chlormethine hydrochloride: clinical use

Prescribing considerations

• Initiation should be by a clinician experienced in treating mycosis fungoides-type cutaneous T-cell lymphoma.
• Assess dermatitis, pruritus, infection, blistering and ulceration; the face, genitalia, anus and skin folds are particularly susceptible.
• Give explicit instructions on cytotoxic handling, nitrile gloves for caregivers, mucosal exposure and refrigerated storage.
• Avoid secondary exposure to caregivers, children and untreated skin.

Contraindications and cautions

• Hypersensitivity to chlormethine or any excipient.
• Use is not recommended during pregnancy or without contraception in women of childbearing potential.
• Safety and efficacy have not been established in people under 18 years.

Monitoring

• Local skin toxicity and secondary infection during treatment.
• New or changing skin lesions and secondary skin cancers during and after treatment.
• Safe handling and avoidance of ocular, mucosal and caregiver exposure.

Clinical pharmacology

Chlormethine is a bifunctional DNA-alkylating nitrogen mustard that inhibits rapidly proliferating cells. Blood concentrations were not measurable at sampled times in clinical studies of topical gel, although this does not exclude all systemic exposure.

Formulation and product differences

• The product is a clear, colourless, alcohol-containing cytotoxic gel requiring refrigerated storage after defrosting.
• Propylene glycol may irritate skin; butylhydroxytoluene may cause local skin reactions or irritate eyes and mucous membranes.

Gel

Route: Cutaneous

Strengths: 160 micrograms/g