istration of such agents.Safe Handling of Leukeran tablets:Immunisation using a live organism vaccine has the potential to cause infection in immunocompromised hosts. Therefore, immunisations with live organism vaccines are not recommended.Monitoring: Since Leukeran is capable of producing irreversible bone marrow suppression, blood counts should be closely monitored in patients under treatment.At therapeutic dosage Leukeran depresses lymphocytes and has less effect on neutrophil and platelet counts and on haemoglobin levels. Discontinuation of Leukeran is not necessary at the first sign of a fall in neutrophils but it must be remembered that the fall may continue for 10 days or more after the last dose.Leukeran should not be given to patients who have recently undergone radiotherapy or received other cytotoxic agents.When lymphocytic infiltration of the bone marrow is present or the bone marrow is hypoplastic, the daily dose should not exceed 0.1 mg/kg body weight.Children with nephrotic syndrome, patients prescribed high pulse dosing regimens and patients with a history of seizure disorder, should be closely monitored following administration of Leukeran, as they may have an increased risk of seizures.Renal impairment:Patients with evidence of impaired renal function should be carefully monitored as they are prone to additional myelosuppression associated with azotaemia.Hepatic impairment:The metabolism of Leukeran is still under investigation and consideration should be given to dose reduction in patients with gross hepatic dysfunction.Mutagenicity and Carcinogenicity:Leukeran has been shown to cause chromatid or chromosome damage in man.Development of acute leukaemia after Leukeran therapy for chronic lymphocytic leukaemia has been reported. However, it was not clear whether the acute leukaemia was part of the natural history of the disease or if the chemotherapy was the cause.A comparison of patients with ovarian cancer who received alkylating agents with those who did not, showed that the use of alkylating agents, including Leukeran, significantly increased the incidence of acute leukaemia.Acute myelogenous leukaemia has been reported in a small proportion of patients receiving Leukeran as long term adjuvant therapy for breast cancer.The leukaemogenic risk must be balanced against the potential therapeutic benefit when considering the use of Leukeran.Sugar intolerances:Patients with rare hereditary problems of glucose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medication. Each Leukeran 2mg tablet contains 68mg of lactose.
Interactions
Vaccinations with live organism vaccines are not recommended in immunocompromised individuals.Patients receiving phenylbutazone may require a reduced dose of Leukeran.
Adverse Reactions
For this product there is no modern clinical documentation which can be used as support for determining the frequency of undesirable effects. Undesirable effects may vary in their incidence depending on the dose received and also when given in combination with other therapeutic agents.The following convention has been utilised for the classification of frequency: Very common (1/10), common (1/100 and <1/10), uncommon (1/1000 and <1/100), rare (1/10,000 and <1/1000) and very rare (<1/10,000).Blood and lymphatic system disorders Very common:Leucopenia, neutropenia, thrombocytopenia, pancytopenia or bone marrow supp
