How does it work?

Leukeran tablets contain the active ingredient chlorambucil,which is a type of anti-cancer or chemotherapy medicine known as an 'alkylatingagent'.

Cancers form when some cells within the body multiplyuncontrollably and abnormally. These cells spread, destroying nearby tissues.Chlorambucil works by stopping the cancer cells from multiplying. It does thisby binding to and damaging the DNA in the cancer cells. This stops the cellsfrom growing and multiplying.

Unfortunately, chlorambucil can also affect normal, healthycells, particularly those that multiply quickly, such as blood cells and haircells. The most important side effect is on the bone marrow where blood cellsare made. Chlorambucil can decrease the production of blood cells, leavingpeople susceptible to infection. Regular blood tests are therefore needed tomonitor the levels of blood cells.

Chlorambucil is used to treat lymphomas and leukaemias. It istaken by mouth as tablets.

What is it used for?

• Lymph node cancer (Hodgkin's disease)
• Non-Hodgkin's lymphoma
• A rare type of cancer of the lymphatic system (non-Hodgkins lymphoma) called Waldenstrom's macroglobulinaemia
• Chronic lymphocytic leukaemia

Warning!

• Leukeran tablets must be swallowed whole with water - do not break, cut, crush or chew them.
• The tablets should be stored in a refrigerator at 2°C to 8°C and kept dry. Make sure that the tablets are kept in a safe place well out of the reach of children, as the medicine could harm them.
• Chemotherapy medicines can decrease the number of blood cells in your blood. A low white blood cell count can increase your susceptibility to infections; a low red blood cell count causes anaemia and a low platelet count can cause problems with blood clotting. For this reason, you will need regular blood tests to monitor your blood cells during treatment with this medicine. Tell your doctor immediately if you experience any of the following symptoms during your treatment, as they may indicate problems with your blood cells: unexplained bruising or bleeding, purple spots, sore mouth or throat, mouth ulcers, high temperature (fever) or other signs of infection, or suddenly feeling tired, breathless, or generally unwell.
• If you get an unexplained rash while taking this medicine you should let your doctor know immediately.
• This medicine may be harmful to an unborn baby, and for this reason you should use effective contraception to avoid becoming pregnant or fathering a child during treatment. You should continue to use contraception to prevent pregnancy for at least a few months after stopping this medicine, but discuss this with your doctor. Women should consult their doctor immediately if they get pregnant during treatment.
• Your ability to get pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.
• Long-term treatment with chlorambucil may increase the risk of developing developing acute leukaemia (cancer of the white blood cells) after many years. After your treatment you will have regular blood tests which will detect any possible leukaemic changes early, if they do occur. Your doctor or nurse can discuss the risks of this with you.

Use with caution in

• Decreased liver function
• Decreased kidney function
• Children with nephrotic syndrome, which is caused by kidney inflammation and is characterised by a large amount of protein in the urine, swelling, weight gain and high blood pressure
• History of fits (seizures), eg epilepsy
• Hereditary blood disorders called porphyrias
• Low levels of a type of white blood cell (neutrophils) in the blood (neutropenia)
• People who have recently received radiotherapy or other chemotherapy treatment.
• Rare hereditary problems of glucose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption (Leukeran tablets contain lactose).

Not to be used in

• Known sensitivity or allergy to any ingredient.

This medicine should not be used if you are allergic to one orany of its ingredients. Please inform your doctor or pharmacist if you havepreviously experienced such anallergy.If you feel you haveexperienced an allergic reaction, stop using this medicine and inform yourdoctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy orbreastfeeding. However, other medicines may be safely used in pregnancy orbreastfeeding providing the benefits to the mother outweigh the risks to theunborn baby. Always inform your doctor if you are pregnant or planning apregnancy, before using any medicine.

• This medicine may be harmful to an unborn baby. It should be avoided where possible during pregnancy, particularly during the first trimester, unless considered essential by your doctor. In this case the risks to the foetus should be weighed against the benefits to the mother. It is important to discuss this with your doctor.
• Pregnant women should avoid handling the tablets, particularly if the tablet coating is damaged.
• People taking this medicine should use contraceptive measures to avoid becoming pregnant or fathering a child during treatment, and for at least a few months after treatment is finished. Seek medical advice from your doctor.
• Mothers who need to take this medicine should not breastfeed. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individualpeople in different ways. The following are some of the side effects that areknown to be associated with this medicine. Because a side effect is statedhere, it does not mean that all people using this medicine will experience thator any side effect.

• Decreased production of blood cells by the bone marrow (bone marrow suppression)
• Increased risk of infection
• Nausea and vomiting
• Diarrhoea
• Mouth ulcers (oral ulcers)
• Skin rashes
• Seizures
• Liver problems
• Serious skin conditions such as Stevens-Johnson Syndrome or toxic epidermal necrolysis
• Shaking, usually of the hands (tremor)
• Disorder of the peripheral nerves causing weakness and numbness (peripheral neuropathy)

The side effects listed above may not include all of the sideeffects reported by the drug'smanufacturer.For moreinformation about any other possible risks associated with this medicine,please read the information provided with the medicine or consult your doctoror pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicinesyou are already taking, including those bought without a prescription andherbal medicines, before you start treatment with this medicine. Similarly,check with your doctor or pharmacist before taking any new medicines duringtreatment this one, to ensure that thecombination is safe.

Chemotherapy decreases the body's immune response. This meansthat vaccines may be less effective if given during treatment, and livevaccines may cause serious infections. Live vaccines should usually bepostponed until six months after finishing chemotherapy. Live vaccines include:measles, mumps, rubella, MMR, oral polio, oral typhoid and yellow fever. Iflive vaccines are needed they should be postponed until at least six monthsafter finishing chemotherapy.

If you are taking phenylbutazone your doctor may prescribe you alower than normal dose of chlorambucil.

Other medicines containing the same active ingredient

There are currently no other medicines available in the UK thatcontain chlorambucil as the active ingredient.