Adult Dosing

Chemotherapy

• Dosage varies with clinical situation, response and hematologic depression
• 0.4 mg/kg ideal body weight IV per course of therapy as a single dose or in divided doses as 0.1-0.2 mg/kg/day; may repeat q3-6 wks

Advanced Hodgkin's disease (MOPP regimen)

• 6 mg/m² IV on days 1 and 8 of 28-day cycle. Subsequent doses are based on leukocyte and platelet counts

Malignant effusions

• Usual intracavitary dose is 0.4 mg/kg
• Usual intrapericardial dose is 0.2 mg/kg (10-20 mg)

Pediatric Dosing

• Safety and effectiveness in pediatric patients have not been established

• Mechlorethamine IV is indicated for the palliative treatment of hodgkin's disease (stages III and IV), lymphosarcoma, chronic myelocytic lymphoma or chronic lymphocytic leukemia, polycythemia vera, mycosis fungoides and bronchogenic carcinoma
• Mechlorethamine administered intrapleurally, intraperitoneally or intrapericardially, is indicated for the palliative treatment of metastatic carcinoma resulting in effusion

• Hypersensitivity to any of the ingredients of the product
• Presence of known infectious disease

• Mechlorethamine should be administered only under supervision of a physician experienced in cancer chemotherapy
• Special handling procedures should be reviewed and followed diligently to handle and administer the drug due to the toxic properties of mechlorethamine. Avoid exposure during pregnancy. Avoid inhalation of dust or vapors and contact with skin or mucous membranes
• Extravasation of the drug can cause induration and sloughing. If extravastion is obvious, infiltrate the area with sterile isotonic sodium thiosulphate (1/6 molar) and apply ice compress for 6-12 hrs
• For 1/6 molar solution, use 4.14 grams of sodium thiosulphate per 100 mL of SWI or 2.64 grams of anhydrous sodium thiosulphate per 100 mL of Sterile Water for Inj or dilute 4 mL of sodium thiosulphate injection (10%) with 6 mL of Sterile Water for Inj

Renal Dose Adjustment

• Renal impairment: Use with caution; dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Obtain an accurate histologic diagnosis of the disease, its natural course and adequate clinical history before starting treatment. Carefully weigh anticipated benefits with expected risks
• Since nitrogen mustard therapy can contribute to extensive and rapid development of amyloidosis, it should be used only if foci of acute and chronic suppurative inflammation are present
• Nitrogen mustard therapy may be associated with an increased incidence of second malignant tumor
• Mechlorethamine can cause fetal harm when administered to a pregnant woman. Advise women of child bearing potential to avoid becoming pregnant during therapy
• Therapy with mechlorethamine is associated with significant hematologic toxicities. Lymphocytopenia occurs within 24 hrs after the first injection; significant granulocytopenia occurs within 6 to 8 days and lasts for 10 days to 3 wks. Erythrocyte and hemoglobin levels may decline, during the first 2 wks after therapy. Depression of the hematopoietic system may occur up to 50 days or more after starting therapy
• It is possible for repeated courses of therapy as early as three weeks after treatment. However, subsequent courses should not be given until patient has recovered hematologically from previous course
• It is a highly toxic drug. Follow special handling procedures for administration (US Black Box Warning)
• If contact with skin occurs, copius irrigation for atleast 15 mins with water, followed by 2% sodium thiosulphate is recommended. Contaminated clothing should be destroyed
• If accidental eye exposure occurs, copius irrigation for atleast 15 mins with water, normal saline or a balanced salt opthalmic irrigating solution , followed by prompt ophthalmic consultation is recommended
• Monitor renal, hepatic and bone marrow function periodically during treatment

Cautions: Use cautiously in

• Myelosuppression (extreme caution required)
• Myelosuppressive agent use
• Decreased bone marrow reserve
• Obesity
• Edema
• Elderly population
• Gout
• Chronic lymphatic leukemia (extreme caution required due to risk of myelosuppression)
• Previous chemotherapy and XRT

Pregnancy Category:D

Breastfeeding: Most sources consider breastfeeding to be contraindicated with antineoplastic therapy. Due to the potential to cause serious adverse events, it is recommended that patients receiving mechlorethamine should not breastfeed.

• CNS: Drowsiness, headache, vertigo, weakness, seizures
• EENT: Tinnitus, hearing impairment
• GI: Nausea, vomiting, anorexia, diarrhea, GI bleeding
• GU: Azoospermia, impaired spermatogenesis, total germinal aplasia, menstrual abnormalities, oligomenorrhea
• DERM: Rashes, maculopapular eruptions, erythema multiforme, alopecia
• HEMA: Leukopenia, thrombocytopenia, anemia, hemolytic anemia, agranulocytosis, hematopoietic depression
• LOCAL: Local toxicity, thrombophlebitis, extravasation
• METABOLIC: Hyperuricemia
• MISC: Hypersensitivity, anaphylaxis, reactivation of herpes zoster

• Alkylating agent; it exerts cytotoxic action by interfering with DNA and RNA synthesis by cross-linking strands (cell-cycle phase–nonspecific)
• Rapidly degraded in body tissues and fluids
• Apparently renally eliminated
• Half-life: 15 mins

US Trade Name(s)

• Mustargen

US Availability

Mustargen

• PWDR for INJ: 10 mg/vial

Canadian Trade Name(s)

• Mustargen

Canadian Availability

Mustargen

• PWDR for INJ: 10 mg/vial

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

Hematology/Oncology

Antineoplastics

Alkylating Agents