Chlorambucil belongs to the group of cancer-fighting medications known as antineoplastics, and specifically to the group of antineoplastics called alkylating agents. It prevents the growth of cancer cells by interfering with the genetic material DNA, which is necessary for reproduction of cells.

Chlorambucil is used to treat cancers of the blood and lymph system, such as certain types of leukemia (e.g., chronic lymphocytic leukemia) and certain types of lymphoma (e.g., non-Hodgkin's lymphomas, Waldenstrom's macroglobulinemia, and Hodgkin's disease).

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The recommended dose of chlorambucil depends on the condition being treated.

For chronic lymphocytic leukemia, the usual adult starting dose is 0.15 mg per kilogram body weight per day until the total white blood cell count reaches the desired range. 4 weeks after the first course of treatment, the medication may be restarted at a dose of 0.1 mg per kilogram body weight per day.

For Hodgkin's disease, the usual dose is 0.2 mg per kilogram body weight per day for 4 to 8 weeks.

For non-Hodgkin's lymphoma, the usual dose is 0.1 mg to 0.2 mg per kilogram body weight per day for 4 to 8 weeks initially. Maintenance treatment is then started at a reduced daily dose or with intermittent courses of treatment. Chlorambucil may be included as part of a combination treatment with other antineoplastic medications.

For Waldenstrom's macroglobulinemia, usual dose is 0.1 mg to 0.2 mg per kilogram body weight per day initially. Maintenance treatment is then given at a reduced daily dose of 0.03 mg to 0.1 mg per kilogram body weight per day.

As well as interfering with the genetic material DNA of cancer cells, chlorambucil can interfere with some of your normal cells. This can cause a number of side effects. Keep track of any side effects and report them to your doctor as suggested in the section, "What side effects are possible with this medication?"

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. Do not stop taking this medication without talking with your doctor. If you vomit shortly after taking a dose of the medication, call your doctor for instructions on whether to skip that dose or to take another dose. If you miss a dose, ask your doctor for instructions. Do not take a double dose to make up for a missed one.

Store this medication in a refrigerator, protect it from light and moisture, and keep it out of the reach of children.

Each brown, film-coated, round, biconvex tablet, engraved "GX EG3" on one side and "L" on the other side, contains 2 mg of chlorambucil. Nonmedicinal ingredients: anhydrous lactose, colloidal silicon dioxide, microcrystalline cellulose, and stearic acid; coating: hydroxypropyl methylcellulose, macrogol, synthetic red iron oxide, synthetic yellow iron oxide, and titanium dioxide.

Do not take this medication if you:

• are allergic to chlorambucil or any ingredients of this medication
• have had a full course of radiation or chemotherapy within the previous 4 weeks

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• changes in menstrual period
• diarrhea
• nausea and vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• mouth ulcers
• muscle twitching or jerking movements
• muscle weakness or numbness
• numbness or tingling in fingers and toes
• persistent cough with shortness of breath
• signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
• signs of bladder inflammation (e.g., pain or burning with urination, frequent or urgent need to urinate)
• signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• skin rash
• symptoms of an infection such as fever, chills, or painful and difficult urination
• tremors

Stop taking the medication and seek immediate medical attention if any of the following occur:

• blisters on skin
• seizures
• severe skin rash or skin blisters
• symptoms of a serious allergic reaction such as hives; difficulty breathing; or swelling of the eyelids, throat, and mouth

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.

Blood clotting: This medication can reduce the number of platelet cells in the blood. Platelets help the blood to clot, and a shortage could make you bleed more easily. Tell your doctor of any signs that your blood is not clotting as quickly. Such symptoms may include black and tarry stools, blood in the urine, easy bruising, or cuts that won't stop bleeding.

Infection: As well as killing cancer cells, this medication can reduce the number of cells that fight infection in the body (white blood cells). Avoid contact with people who have contagious infections and tell your doctor if you begin to notice signs of an infection such as fever or chills.

Kidney problems: If you have kidney problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver problems: If you have severe liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Secondary cancer: When used for long periods of time, this medication can increase the risk of developing leukemia. If you are concerned about this, talk to your doctor about the risks and benefits of using this medication.

Seizures: Chlorambucil may increase the risk of seizures in people with a history of seizures, with nephrotic syndrome, or with a head injury. Talk to your doctor about whether any special monitoring is needed.

Surgery: If you need surgery, tell your doctor or anesthetist that you are taking this medication.

Pregnancy: There is a possibility of birth defects if either the man or woman is taking chlorambucil at the time of conception, or if it is taken during pregnancy. Infertility may occur with the use of chlorambucil. Use effective birth control while taking this medication. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication may pass into breast milk. Women taking this medication should not breast-feed.

Children: The safety and effectiveness of using this medication have not been established for children.

There may be an interaction between chlorambucil and any of the following:

• bacillus Calmette-Guérin (BCG)
• clozapine
• deferiprone
• denosumab
• echinacea
• immunomodulatory agents (includes medications used to treat conditions such as cancer, inflammatory bowel disease, multiple sclerosis, psoriasis, rheumatoid arthritis)
• roflumilast
• tacrolimus (when applied to the skin)
• vaccines

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.