Chlorambucil adverse effects

CHLORAMBUCIL H2 RECEPTOR BLOCKERS -CIMETIDINE t adverse effects of alkylating agent, e.g. myelosuppression Additive toxicity Monitor more closely monitor FBC regularly... 

CIMETIDINE BUSULFAN, CARMUSTINE, CHLORAMBUCIL CYCLOPHOSPHAMIDE, ESTRAMUSTINE, IFOS-FAMIDE, LOMUSTINE, THIOTEPA, TREOSULFAN T adverse effects of cytotoxic, e.g. myelosuppression Additive toxicity. Possible minor inhibition of cyclophosphamide metabolism via CYP2C9 Monitor more closely monitor FBC regularly. Avoid co-administration of cimetidine with cyclophosphamide... 

Nephrotic syndrome. Patients with minimal change disease respond well to daily or alternate day therapy. With a total of prednisolone 60 mg/d, 90% of those who will lose their proteinuria will have done so within 4-6 weeks, and the dose is tapered off over 3-4 months. Longer courses only induce adverse effects. Relapses are common (50%) and it is then necessary to find a minimum dose of steroid that will keep the patient well. If a steroid is for any reason undesirable, cyclophosphamide or chlorambucil may be substituted. Membranous nephropathy may respond to high dose corticosteroid with or without chlorambucil. 

The controversy surronnding CLL management with low-dose alkylating agents was evalnated in a meta-analysis. The results of that analysis showed that delayed treatment did not have an adverse effect on 10-year survival. If only deaths caused by CLL were considered, there was a statistically significant improvement in survival when treatment was deferred. Chlorambucil continues to be widely used in elderly patients as initial treatment for CLL, but its use is based on a small number of smdies. The addition of prednisone to chlorambucil is likely to increase infectious risk with no advantage in the treatment of CLL. However, prednisone may have value in CLL-associated autoimmnne blood dyscrasias. ... 

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