Chlorambucil is a chemotherapy drug that is given as a treatment for some types of cancer. It is most commonly used to treat chronic lymphocytic leukaemia, low-grade non-Hodgkin lymphoma, Hodgkin lymphoma, and Waldenstrom's macroglobulinaemia. This information describes chlorambucil, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer, which give more information and advice.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

Chlorambucil is available as 2mg brown tablets.

The tablets should be swallowed whole. You should take them as directed by your doctor, nurse or pharmacist.

Chemotherapy is usually given as a course of several sessions (or cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on which type of cancer or leukaemia you are being treated for. Your nurse or doctor will discuss your treatment plan with you.

Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given chlorambucil, and may be different if you are having more than one chemotherapy drug.

We have outlined the most common side effects and some of the less common ones, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you do notice any effects which you think may be due to the drug but which are not listed here, please discuss them with your doctor or chemotherapy nurse.

Lowered resistance to infection Chlorambucil can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin 10–14 days after chemotherapy and your lowered resistance to infection may last for a few days. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next course of chemotherapy.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Chlorambucil can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with chlorambucil you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if you develop these symptoms.

Feeling sick (nausea) and being sick (vomiting) You may start feeling sick 2–3 hours after the treatment is given. This may last until a few days after you stop taking the course of tablets. If you have this side effect it is usually mild. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting. If the sickness is not controlled, or continues, tell your doctor; they can prescribe other anti-sickness drugs which may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Loss of appetite A dietitian or specialist nurse at your hospital can give advice and tips on boosting appetite, coping with eating difficulties and maintaining weight.

Changes to the lungs Rarely, chlorambucil may cause some changes to lung tissue. Tell your doctor if you smoke and if you notice any coughing or breathlessness. You may have a chest x-ray done to check your lungs before you are given any chlorambucil.

Skin changes Chlorambucil may cause a rash, which may be itchy. Your doctor can prescribe medicine to help with this.

Fits or seizures There is a small risk that you will have fits while taking chlorambucil. This is more likely if you already have a history of fits. Your doctor can discuss this with you.

Your liver may be temporarily affected Chlorambucil may cause changes in the way that your liver works, although your liver will return to normal when the treatment is finished. This is unlikely to cause you any harm, but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to check that your liver is working properly.

Diarrhoea This can usually be easily controlled with medicine, but let your doctor know if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

Sore mouth and ulcers Your mouth may become sore or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as special mouthwashes and medicines to prevent or clear any mouth infection can be prescribed.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Chlorambucil may be prescribed for conditions other than cancer. The drug dosage may be reduced and therefore the side effects may be different from those mentioned above.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking chlorambucil, as the developing foetus may be harmed. It is necessary to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

• Chlorambucil tablets should be kept dry and stored in the refrigerator.
• It is important to take your tablets at the right times. You must take them as directed by your doctor.
• Keep the tablets in a safe place where children can't reach them, as chlorambucil could harm them.
• If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
• If you are sick just after taking the tablets let your doctor know as you may need to take another dose. Do not take another tablet without first telling your doctor.
• If you forget to take a tablet do not take a double dose. Tell your doctor and keep to your regular dose schedule.

This section is based on our Chlorambucil factsheet which has been compiled using information from a number of reliable sources including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Medicines.org.uk website - www.medicines.org.uk (November 2007).
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott, Williams and Wilkins, 2001.

For further references, please see general bibliography.