Indications And Dose
Some lymphomas and chronic leukaemias (used either alone or in combination therapy) ▶BY MOUTH ▶Adult: (consult local protocol)
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Drug reference
Some lymphomas and chronic leukaemias (used either alone or in combination therapy) ▶BY MOUTH ▶Adult: (consult local protocol)
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Children with nephrotic syndrome (increased seizure risk). history of epilepsy (increased seizure risk)
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NICE decisions ▶Obinutuzumab in combination with chlorambucil for untreated chronic lymphocytic leukaemia (June 2015) NICE TA343 Obinutuzumab, in combination with chlorambucil, is an option for untreated chronic lymphocytic leukaemia in patients who have comorbidities that make full-dose fludarabine-based therapy unsuitable for them, only if: . bendamustine-based therapy is not suitable, and . the manufacturer provides obinutuzumab with the discount agreed in the patient access scheme. Patients currently receiving obinutuzumab that is not recommended according to the above criteria should have the option to continue treatment until they and their NHS clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta343 ▶Ofatumumab in combination with chlorambucil or bendamustine for untreated chronic lymphocytic leukaemia (June 2015) NICE TA344 Ofatumumab in combination with chlorambucil is an option for untreated chronic lymphocytic leukaemia only if: . the patient is ineligible for fludarabine-based therapy, and . bendamustine is not suitable, and . the manufacturer provides ofatumumab with the discount agreed in the patient access scheme. Patients currently receiving ofatumumab that is not recommended according to the above criteria should have the option to continue treatment until they and their NHS clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta344
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RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES See Cytotoxic drugs p. 938.
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→Appendix 1: alkylating agents
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▶Common or very common Anaemia. bone marrow disorders . diarrhoea. gastrointestinal disorder. leucopenia. nausea . neoplasms. neutropenia. oral ulceration. seizures. thrombocytopenia. vomiting ▶Uncommon Skin reactions ▶Rare or very rare Cystitis. fever. hepatic disorders. movement disorders. muscle twitching. peripheral neuropathy. respiratory disorders. severe cutaneous adverse reactions (SCARs). tremor ▶Frequency not known Amenorrhoea. azoospermia SIDE-EFFECTS, FURTHER INFORMATION Secondary malignancy Use of chlorambucil is associated with an increased incidence of acute leukaemia, particularly with prolonged use. Skin reactions Manufacturer advises assessing continued use if rash occurs—has been reported to progress to Stevens-Johnson syndrome and toxic epidermal necrolysis.
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Contraceptive advice required, see Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Avoid. See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Discontinue breast-feeding.
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Manufacturer advises caution— monitor for signs and symptoms of toxicity. Dose adjustments Manufacturer advises consider dose reduction in severe impairment—limited information available.
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There can be variation in the licensing of different medicines containing the same drug. Tablet ▶Chlorambucil (Non-proprietary) Chlorambucil 2 mg Chlorambucil 2mg tablets | 25 tablet P £42.87 DT = £42.87
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(consult local protocol)
First-line fragment. Read the complete Indications and Dose section above.
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