1. Chlorambucil oral tablet is available as a brand-name drug. It isn’t available as a generic drug. Brand name: Leukeran.
  2. Chlorambucil comes only as a tablet you take by mouth.
  3. Chlorambucil is used to treat certain types of cancer of the blood and lymph nodes. This drug doesn’t cure cancer, but it helps relieve its symptoms.

FDA warning: Chemotherapy drug warning

  • This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.
  • Chlorambucil is a chemotherapy medication. Like other cancer drugs, chlorambucil may increase your risk of other cancers (secondary malignancies).
  • In women, chlorambucil may also cause infertility or lead to birth defects in a baby if you take it during pregnancy. In men, this drug can cause damage to your sperm and significantly reduce your sperm count. This may or may not be permanent.
  • This drug can also severely suppress your bone marrow function. Your bone marrow makes your red blood cells (which deliver oxygen throughout your body), white blood cells (which help fight off infections), and platelets (which help your blood to clot). If your blood cell counts are low, your doctor may decrease your dosage of this drug. Call your doctor right away if you have any symptoms of low blood cell counts. These include unexpected bleeding or bruising, blood in your urine or stools, extreme tiredness, fever, or any signs of an infection.

Other warnings

  • Severe skin reactions warning: This drug can cause severe skin reactions. These can be fatal (cause death). Let your doctor know if you have any signs of a skin reaction. Symptoms include a severe rash, painful sores, blistering skin, or peeling skin. If you develop any of these reactions, your doctor may temporarily or permanently stop your treatment with this drug.

Chlorambucil is a prescription drug. It comes only as an oral tablet.

Chlorambucil isn’t available as a generic drug. It only comes as the brand-name drug Leukeran.

This drug may be used as part of a combination therapy. This means you may need to take it with other medications.

Why it's used

Chlorambucil is used to treat certain types of cancer of the blood and lymph nodes. These types include:

Chlorambucil doesn’t cure cancer, but it helps relieve its symptoms.

How it works

Chlorambucil belongs to a class of drugs called antineoplastic (anti-cancer drugs), or more specifically, alkylating agents. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Chlorambucil works by disrupting DNA replication in cells in the body. Cells can become cancerous when their DNA reproduction is out of control. When this process is disrupted, it kills off cancer cells.

Chlorambucil doesn’t cause drowsiness, but it can cause other side effects.

More common side effects

The more common side effects that can occur with chlorambucil include:

  • Bone marrow suppression. This means you’ll have fewer red and white blood cells and platelets. Symptoms can include:
    • unexpected bleeding or bruising
    • blood in your urine or stools
    • extreme tiredness
    • fever
    • any signs of an infection
  • Mouth irritation or sores
  • Nausea
  • Vomiting
  • Diarrhea

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Fever
  • Seizures. Symptoms can include:
    • convulsions
    • falling down or sudden loss of muscle tone
    • sudden loss of urine or bowel control
    • passing out and then waking up feeling confused
  • Liver damage. Symptoms can include:
    • yellowing of your skin or the whites of your eyes
    • pain in the upper right part of your stomach
    • nausea or vomiting
    • dark-colored urine
    • tiredness
  • Low platelet counts. Symptoms can include:
    • bleeding that won’t stop
    • bruising more easily than normal
  • Low white blood cell count. This can lead to an increased risk of infections. Symptoms can include:
    • fever
    • cold symptoms, such as runny nose or sore throat that don’t go away
    • flu symptoms, such as cough, tiredness, and body aches
    • earache or headache
    • pain during urination
    • white patches in your mouth or throat
  • Anemia (low red blood cell count). Symptoms can include:
    • pale skin
    • extreme tiredness
    • lightheadedness
    • fast heartbeat
  • Inflammation of mucous membranes (such as the lining of your nose or mouth). Symptoms can include:
    • swelling
    • redness
    • painful ulcers or sores in your mouth
  • Stomach problems. Symptoms can include:
    • severe nausea and vomiting
  • Severe skin rashes. These may include toxic epidermal necrolysis or Stevens-Johnson syndrome. Symptoms can include:
    • widespread redness and rash on your skin
    • skin peeling
    • blisters
    • painful sores
    • fever
  • Peripheral neuropathy (nerve pain). Symptoms can include the following in your legs or arms:
    • numbness
    • tingling
    • burning sensations
    • extreme sensitivity to touch
    • pain
    • weakness in your feet, legs, or hands
  • Lung damage. Symptoms can include:
    • cough
    • shortness of breath
  • Infertility
  • Other cancers

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well. To help prevent interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking.

To find out how chlorambucil oral tablet might interact with something else you’re taking, talk to your doctor or pharmacist.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we can not guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

This drug comes with several warnings.

Allergy warning

Chlorambucil can cause a severe allergic reaction. Symptoms can include:

  • widespread redness and rash on your skin
  • skin peeling
  • blisters
  • painful sores
  • itching
  • hives or skin welts
  • fever
  • swelling of your tongue or throat
  • trouble breathing

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Contact with drug warning

Chlorambucil can harm others if they touch it. Ask your doctor or pharmacist how to handle this drug safely.

Warnings for people with certain health conditions

For people with liver problems: If you have liver problems or a history of liver disease, you may not be able to clear this drug from your body well. This may increase the levels of chlorambucil in your body and cause more side effects. Your doctor may start you at a lower dosage and watch you more closely for side effects. This drug can also cause liver damage. This means it may make your liver disease worse.

Warnings for other groups

For pregnant women: Chlorambucil is a category D pregnancy drug. That means two things:

  1. Research in humans has shown adverse effects to the fetus when the mother takes the drug.
  2. This drug should only be used during pregnancy in serious cases where it's needed to treat a dangerous condition in the mother.

Talk to your doctor if you’re pregnant or planning to become pregnant. Ask your doctor to tell you about the specific harm that may be done to your pregnancy. This drug should be only used if the potential risk is acceptable given the drug’s potential benefit.

Call your doctor right away if you become pregnant while taking this drug.

If you’re a male, this drug can cause damage to your sperm and significantly reduce your sperm count. This effect may or may not be permanent.

For women who are breastfeeding: It isn’t known if chlorambucil passes into breast milk. If it does, it may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: The liver of older adults may not work as well as it used to. This can cause your body to process drugs more slowly. As a result, a higher amount of a drug stays in your body for a longer time. This raises your risk of side effects.

For children: This drug hasn’t been studied in children. It shouldn’t be used in people younger than 18 years.

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Drug form and strength

Brand: Leukeran

  • Form: oral tablet
  • Strength: 2 mg

Dosage for chronic lymphocytic leukemia

Adult dosage (ages 18 to 64 years)

  • Typical dosage: You’ll take this drug once per day for 3–6 weeks. Your doctor will decide your exact dosage based on your body weight and condition. For most people, the dosage will range between 4–10 mg per day.
  • Dosage adjustments: Your doctor will monitor you during treatment and adjust your dosage as needed.
  • Alternative treatment schedules: Your doctor may give you a different dosing regimen or schedule. Be sure to take your dose exactly as directed by your doctor.

Child dosage (ages 0 to 17 years)

It hasn’t been confirmed that this drug is safe and effective for use in people younger than 18 years.

Senior dosage (ages 65 years and older)

The liver of older adults may not work as well as it used to. This can cause your body to process drugs more slowly. As a result, a higher amount of a drug stays in your body for a longer time. This raises your risk of side effects.

Your doctor may start you at the lower end of the dosing range. They’ll consider other conditions you have when they decide your dosage.

Dosage for malignant lymphoma (lymphosarcoma, giant follicular lymphoma, and Hodgkin’s disease)

Adult dosage (ages 18 to 64 years)

  • Typical dosage: You’ll take this drug once per day for 3–6 weeks. Your doctor will decide your exact dosage based on your body weight and condition. For most people, the dosage will range between 4–10 mg per day.
  • Dosage adjustments: Your doctor will monitor you during treatment and adjust your dosage as needed.
  • Alternative treatment schedules: Your doctor may give you a different dosing regimen or schedule. Be sure to take your dose exactly as directed by your doctor.

Child dosage (ages 0 to 17 years)

It hasn’t been confirmed that this drug is safe and effective for use in people younger than 18 years.

Senior dosage (ages 65 years and older)

The liver of older adults may not work as well as it used to. This can cause your body to process drugs more slowly. As a result, a higher amount of a drug stays in your body for a longer time. This raises your risk of side effects.

Your doctor may start you at the lower end of the dosing range. They’ll consider other conditions you have when they decide your dosage.

Dosage warnings

Your doctor will check the levels of your white and red blood cells and platelets during your treatment. If your levels are too low, your doctor will reduce your dosage.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Low white blood cells

  • Lymphocytes and neutrophils are white blood cells, which help protect you against infections. In most people, chlorambucil oral tablet causes a progressive lymphopenia (low levels of lymphocytes). This goes away shortly after stopping the drug. In addition, most people will have neutropenia (low levels of neutrophils) after the third week of treatment with this drug. This can last for up to 10 days after your last dose. Both of these issues increase your risk of developing an infection. Tell your doctor if you have any symptoms of an infection, such as fever, cough, or muscle pain.

Chlorambucil oral tablet is used for short-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all: This drug won’t work to relieve your cancer symptoms.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of this drug in your body. Symptoms of an overdose of this drug can include:

  • severe decreases in your blood cell counts. This can lead to anemia, infections, and bleeding.
  • agitation
  • problems with coordination or muscle control
  • seizures

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: Your cancer symptoms should improve. Your doctor will also do tests to check if this drug is working. They’ll look at your white blood cell count during the first 3–6 weeks of treatment.

Keep these considerations in mind if your doctor prescribes chlorambucil for you.

General

  • Don’t take this drug with food. You should take it on an empty stomach.
  • Take this drug at the time(s) recommended by your doctor.
  • You can cut or crush the tablet. However, this drug can harm others if they touch it. Ask your doctor or pharmacist how to handle this medication safely.

Storage

  • Store chlorambucil in a refrigerator. Keep it at a temperature between 36°F and 46°F (2°C and 8°C).
  • Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t harm your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
  • This medication needs to be refrigerated. When traveling, you may need to use an insulated bag with a cold pack to maintain the drug’s temperature.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

You and your doctor should monitor certain health issues. This can help make sure you stay safe while you take this drug. These issues include:

  • Blood cell counts. Each week, your doctor will monitor the number of white blood cells in your body. This will help make sure your levels don’t drop too low. During the start of your treatment, your doctor may also recheck your white blood cell count 3 or 4 days after each weekly count of all of your blood cells.
  • Liver function. Your doctor may do blood tests to check how well your liver is working. If your liver isn’t working well, your doctor may lower your dosage or stop treatment with this drug.

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.