Chlorambucil can cause a decrease in the number of blood cells in your bone marrow. Your doctor will order laboratory tests before, during, and after your treatment to see if your blood cells are affected by this drug. Keep all appointments with the laboratory.

Chlorambucil may increase the risk that you will develop other cancers. Talk to your doctor about this risk.

Chlorambucil may interfere with the normal menstrual cycle (period) in women and may stop sperm production in men. Chlorambucil may cause permanent infertility (difficulty becoming pregnant); however, you should not assume that you cannot get pregnant, or that you cannot get someone else pregnant. Women who are pregnant should tell their doctors before they begin taking this drug. You should not plan to have children while receiving chemotherapy or for a while after treatments. (Talk to your doctor for further details.) Use a reliable method of birth control to prevent pregnancy. If you become pregnant while taking chlorambucil, call your doctor immediately. Chlorambucil may harm the fetus.

Chlorambucil is used treat a certain type of chronic lymphocytic leukemia (CLL; a type of cancer of the white blood cells). Chlorambucil is also used to treat non-Hodgkin’s lymphoma (NHL) and Hodgkin’s disease (types of cancer that begin in certain white blood cells that normally fight infection). Chlorambucil is in a class of medications called alkylating agents. It works by slowing or stopping the growth of cancer cells in your body.

Chlorambucil comes as a tablet to take by mouth. It is usually taken once a day for 3 to 6 weeks, but sometimes may be taken intermittently, as a single dose once every 2 weeks, or as a single dose once a month. The length of treatment depends on the types of drugs you are taking, how well your body responds to them, and the type of cancer you have. Take chlorambucil at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take chlorambucil exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor may adjust your dose of chlorambucil depending on your response to treatment and any side effects that you experience. Talk to your doctor about how you are feeling during your treatment. Do not stop taking chlorambucil without talking to your doctor.

Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.

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

Before taking chlorambucil,

• tell your doctor and pharmacist if you are allergic to chlorambucil, other alkylating agents such as bendamustine (Treanda), busulfan (Myleran, Busulfex), carmustine (BiCNU, Gliadel Wafer), cyclophosphamide (Cytoxan), ifosfamide (Ifex), lomustine (CeeNU), melphalan (Alkeran), procarbazine (Mutalane), or temozolomide (Temodar), any other medications, or any of the ingredients in chlorambucil. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.
• tell your doctor if you have taken chlorambucil before, but your cancer did not respond to the medication. Your doctor will probably tell you not to take chlorambucil.
• tell your doctor if you have received radiation therapy or other chemotherapy within the last 4 weeks.
• tell your doctor if you have ever had seizures or a head injury.
• tell your doctor if you are breast-feeding.
• do not have any vaccinations without talking to your doctor.

Unless your doctor tells you otherwise, continue your normal diet.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Chlorambucil may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• vomiting
• sores in the mouth and throat
• tiredness
• missed menstrual periods (in girls and women)

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

• skin rash
• unusual bruising or bleeding
• black, tarry stools
• red urine
• cough
• sore throat
• congestion
• fever
• difficulty breathing
• seizures
• yellowing of the skin or eyes
• pain in the upper right part of the stomach
• dark colored urine
• frequent urination
• unusual lumps or masses

Chlorambucil may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it in the refrigerator.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

Keep all appointments with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

• Leukeran^®