Mechlorethamine

Mechlorethamine is a type of chemotherapy used to treat lung cancer or certain types of blood, bone marrow, or metastatic cancer. Mechlorethamine belongs to a group of drugs called alkylating agents. It works by slowing or stopping the growth of cancer cells in your body.

This medication is available as an injection and is given slowly into a vein (IV) or directly into a body cavity by a healthcare professional. This medication is also available as a topical gel that is applied to the affected skin area once a day.

Common side effects of mechlorethamine may include nausea, weakness, vomiting, and skin redness. Mechlorethamine can also cause dizziness. Do not drive or operate heavy machinery until you know how mechlorethamine affects you.

Mechlorethamine is a prescription medication available as an injection and topical (applied to the skin) form.

The mechlorethamine injection is used in the treatment of the following:

• Hodgkin's lymphoma (Hodgkin's disease)
• certain types of non-Hodgkin's lymphoma (type of cancer that begins in a type of white blood cell that normally fights infection)
• mycosis fungoides (a type of immune system cancer that first appears as skin rashes)
• chronic lymphocytic or chronic myelocytic leukemia (cancer of the white blood cells)
• lung cancer
• polycythemia vera (disease in which too many red blood cells are made in the bone marrow)
• malignant effusions (fluid collects in the lungs or around the heart)

The mechlorethamine topical form is used in the treatment of mycosis fungoides-type cutaneous T-cell lymphoma (a type of immune system cancer that begins with skin rashes).

This medication may be prescribed for other uses.  Ask your doctor or pharmacist for more information.

Mechlorethamine may be found in some form under the following brand names:

• Mustargen

• Valchlor

Serious side effects have been reported with mechlorethamine. See the "Drug Precautions" section.

Common side effects of the mechlorethamine injection include the following:

• nausea
• weakness
• vomiting

Common side effects of the mechlorethamine topical form include the following:

• redness
• swelling
• itching
• skin ulcers or blisters
• skin infection
• darkening of skin areas

This is not a complete list of mechlorethamine side effects.  Ask your doctor or pharmacist for more information.  Tell your doctor if you have any side effect that bothers you or that does not go away. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

No drug interactions have been studied by the manufacturer. However, you should tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Not all drug interactions are known or reported and new drug interactions are continually being reported.

Serious side effects have been reported with mechlorethamine.

The following serious side effects have been reported with the mechlorethamine injection:

• thrombosis (blood clot). Tell your doctor right away if you have any of the following symptoms: warmth and tenderness over the vein, pain or swelling in the part of the body affected, skin redness, chest pain, shortness of breath.
• lowered blood count. This may cause certain symptoms and may increase the risk that you will develop a serious or life-threatening infection or bleeding.  If you experience any of the following symptoms, call your doctor immediately: fever, chills, sore throat, ongoing cough and congestion, or other signs of infection; unusual bleeding or bruising; bloody or black tarry stools; bloody vomit; or vomiting blood or brown material that resembles coffee grounds.
• low platelet count (thrombocytopenia). Tell your doctor right away if you have any unusual bleeding, such as nosebleeds, or bruising under your skin.
• hypersensitivity (severe allergic reaction). Tell your healthcare provider about any signs or symptoms of hypersensitivity, which include the following: chest pain, swelling of the face, eyes, lips, tongue, arms, or legs, difficulty breathing or swallowing, rash.
• hemolytic anemia. This occurs when mechlorethamine triggers the body's immune system to attack its own red blood cells causing the red blood cells to break down. Tell your doctor right away if you have any of the following symptoms: dark urine, fatigue, pale skin color, rapid heart rate, shortness of breath, yellow skin.
• severe skin reactions. Severe skin reactions may happen after treatment with mechlorethamine injection, especially if you have lymphoma in or under your skin. If your skin reactions are severe, they may lead to serious illness or death. Tell your doctor right away if you have any of the following skin reactions: rash, peeling and loss of skin, sores, blisters.
• interference with normal menstrual cycle (period) in women, may stop sperm production in men, and may cause infertility (difficulty becoming pregnant). You should not assume that you or your partner cannot become pregnant. Tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. You should not become pregnant or breastfeed while you are receiving mechlorethamine injection since it may harm the fetus.

The following serious side effects have been reported with the mechlorethamine topical gel:

• risk of secondary exposure to mechlorethamine. You may have a risk of inflammation of your skin (dermatitis), injury to your eyes, mouth, or nose, and certain types of cancers. Caregivers who accidentally come into contact with mechlorethamine gel must wash the affected area with soap and water right away for at least 15 minutes and remove any contaminated clothing.  Get medical help right away if mechlorethamine gel gets in your eyes, mouth, or nose.
• inflammation of your skin (dermatitis). It is common and may sometimes be severe. Your risk for dermatitis is increased if mechlorethamine gel is applied to your face, genital area, anus, or skin folds. Tell your healthcare provider if you develop skin reactions such as redness, swelling, itching, blisters, ulcers, and skin infections.
• increased risk of certain types of skin cancers. Certain types of skin cancer can develop on areas of your skin that are treated with mechlorethamine gel and areas of your skin that are not treated with mechlorethamine gel. Your healthcare provider will check your skin for skin cancers during and after your treatment with mechlorethamine gel. Tell your healthcare provider if you get any new skin lesions.

Mechlorethamine injection can cause dizziness. Do not drive or operate heavy machinery until you know how mechlorethamine injection affects you.

Do not use mechlorethamine injection if you:

• have known infectious diseases
• are allergic to mechlorethamine or any of its ingredients

Do not use mechlorethamine topical gel if you are allergic to mechlorethamine or any of its ingredients.

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of mechlorethamine, there are no specific foods that you must exclude from your diet when receiving this medication.

Before taking mechlorethamine, tell your doctor about all of your medical conditions.  Especially tell your doctor if you:

• are allergic to mechlorethamine or to any of its ingredients
• have an infection
• have previously received or will be receiving radiation (x-ray) therapy or other chemotherapy
• are pregnant, plan to become pregnant, or are breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories -A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Mechlorethamine falls into category D. It has been shown that use of mechlorethamine in pregnant women caused some babies to be born with problems.  However, in some serious situations, the benefit of using this medication may be greater than the risk of harm to the baby. 

Tell your doctor if you are breastfeeding or plan to breastfeed.

It is not known if mechlorethamine crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using mechlorethamine.

Use mechlorethamine exactly as prescribed.

Mechlorethamine is available in an injectable form to be given directly into a vein (IV) or directly into a body cavity by a healthcare professional.

Mechlorethamine is available as a topical gel applied once a day to affected skin areas. 

Please follow these instructions when using mechlorethamine topical gel:

• Keep this medicine away from your eyes, mouth, and nose. If mechlorethamine gel gets in your eyes, rinse your eyes out right away for at least 15 minutes with a large amount of water, normal saline, or an eye wash solution. If mechlorethamine gel gets in your mouth or nose, rinse the affected area right away for at least 15 minutes with a large amount of water. Get medical help right away if mechlorethamine gel gets in your eyes, mouth, or nose.
• Caregivers must wear disposable nitrile gloves when applying mechlorethamine gel.
• Wash your hands with soap and water after touching or applying mechlorethamine gel.
• Safely throw away used disposable nitrile gloves in household trash.
• Apply mechlorethamine gel right away or within 30 minutes after you take it out of the refrigerator.
• Return mechlorethamine gel to the refrigerator right after each use.
• Apply a thin layer of mechlorethamine gel to completely dry skin at least 4 hours before or 30 minutes after showering or washing.
• Let the treated areas dry for 5 to 10 minutes after applying mechlorethamine gel before covering with clothing.
• Moisturizers may be applied to the treated areas 2 hours before or 2 hours after applying mechlorethamine gel.
• You should not use air or water-tight bandages on areas of the skin treated with mechlorethamine gel.
• Mechlorethamine gel is flammable so fire and flame sources should be avoided until it has dried.

If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of mechlorethamine at the same time.

Take this medication exactly as prescribed by your doctor.  Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

• the condition being treated
• other medical conditions you have
• other medications you are taking
• how you respond to this medication
• your weight
• your height
• your age
• your gender

The dosage of Mustargen (mechlorethamine) injection is based on your body weight and response to treatment.  Your healthcare provider will determine the appropriate dose to give to you.

Valchlor (mechlorethamine) topical gel is applied as a thin film of gel once a day to affected skin areas. Talk to your doctor about how you are feeling while you are taking the gel. Your doctor may stop the medication for a time or tell you to apply it less often if you experience side effects. See the "Drug Usage" section for additional information on using Valchlor (mechlorethamine) gel.

If you use too much mechlorethamine, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If mechlorethamine is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

• Store mechlorethamine gel in the refrigerator and keep away from food.
• With clean hands, place mechlorethamine gel back in the box it came in and return it to the refrigerator right after each use.
• Talk with your pharmacist before you use mechlorethamine gel that has been out of the refrigerator for more than one hour a day.
• Safely throw away mechlorethamine gel that is not used after 60 days. Unused mechlorethamine gel, empty tubes, and used disposable nitrile gloves should be safely thrown away in household trash.
• Keep this and all medicines out of reach of children.

Mechlorethamine should be administered only under the supervision of a physician who is experienced in the use of cancer chemotherapeutic agents.
This drug is HIGHLY TOXIC and both powder and solution must be handled and administered with care. Inhalation of dust or vapors and contact with skin or mucous membranes, especially those of the eyes, must be avoided. Avoid exposure during pregnancy. Due to the toxic properties of mechlorethamine (e.g., corrosivity, carcinogenicity, mutagenicity, teratogenicity), special handling procedures should be reviewed prior to handling and followed diligently. Extravasation of the drug into subcutaneous tissues results in a painful inflammation. The area usually becomes indurated and sloughing may occur. If leakage of drug is obvious, prompt infiltration of the area with sterile isotonic sodium thiosulfate (1/6 molar) and application of an ice compress for 6 to 12 hours may minimize the local reaction. For a 1/6 molar solution of sodium thiosulfate, use 4.14 g of sodium thiosulfate per 100 mL of Sterile Water for Injection or 2.64 g of anhydrous sodium thiosulfate per 100 mL or dilute 4 mL of Sodium Thiosulfate Injection (10%) with 6 mL of Sterile Water for Injection.