MECHLORETHAMINE HYDROCHLORIDE
(me-klor-eth'a-meen)
Mustargen
Classifications: antineoplastic; alkylating agent; nitrogen mustard
Prototype: Cyclophosphamide
Pregnancy Category: D
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10 mg powder for injection
Analog of mustard gas and standard of reference for nitrogen mustards. Forms highly reactive carbonium ion, which causes cross-linking
and abnormal base-pairing in DNA, thereby interfering with DNA replication and RNA and protein synthesis.
Cell-cycle nonspecific inhibitor of DNA and RNA synthesis. Simulates actions of x-ray therapy, but nitrogen mustards produce
more acute tissue damage and more rapid recovery.
Generally confined to nonterminal stages of neoplastic disease. Employed as single agent or in combination with other agents
in palliative treatment of Hodgkin's disease (stages III and IV), lymphosarcoma, mycosis fungoides, polycythemia vera, bronchogenic
carcinoma, chronic myelocytic or chronic lymphocytic leukemia. Also for intrapleural, intrapericardial and intraperitoneal
palliative treatment of metastatic carcinoma resulting in effusion.
Myelosuppression; infectious granuloma; known infectious diseases, acute herpes zoster; intracavitary use with other systemic
bone marrow suppressants; pregnancy (category D), lactation.
Bone marrow infiltration with malignant cells, chronic lymphocytic leukemia; men or women in childbearing age; use with x-ray
treatment or other chemotherapy in alternating courses.
Advanced Hodgkin's Disease
Adult: IV 6 mg/m2 on day 1 and 8 of a 28 d cycle
Other Neoplasms
Adult: IV 0.4 mg/kg given as a single dose or in divided doses of 0.1–0.2 mg/kg/d, may repeat course in 3–6 wk
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Intravenous
- Wear surgical gloves during preparation and administration of solution.
- Avoid inhalation of vapors and dust and contact of drug with eyes and skin.
- Flush contaminated area immediately if drug contacts the skin. Use copious amounts of water for at least 15 min, followed
by 2% sodium thiosulfate solution. Irritation may appear after a latent period.
- Irrigate immediately if eye contact occurs. Use copious amounts of NS followed by ophthalmologic examination as soon as possible.
PREPARE: IV Infusion: Reconstitute immediately before use by adding 10 mL sterile water for injection or NS injection to vial to yield 1 mg/mL.
With needle still in stopper, shake vial several times to dissolve. Discard colored solution or contents of any vial which
has drops of moisture.
ADMINISTER: IV Infusion: To reduce risk of severe infections from extravasation or high concentration of the drug, inject into tubing or sidearm of
freely flowing IV infusion. Flush vein with running IV solution for 2–5 min to clear tubing of any remaining drug.
INCOMPATIBILITIES Solution/additive:
Methohexital.
Y-site:
Allopurinol,
cefepime.
- Be alert for extravasation. Treat promptly with subcutaneous or intradermal injection with isotonic sodium thiosulfate solution
(1/6 molar) and application of ice compresses intermittently for a 6–12 h period to reduce local tissue damage and discomfort.
Tissue induration and tenderness may persist 4–6 wk, and tissue may slough.
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CNS: Neurotoxicity: vertigo, tinnitus, headache, drowsiness, peripheral neuropathy, light-headedness, paresthesias, cerebral deterioration,
coma. GI: Stomatitis, xerostomia, anorexia, nausea, vomiting, diarrhea. Hematologic: Leukopenia, thrombocytopenia, lymphocytopenia, agranulocytosis, anemia, hyperheparinemia. Skin: Pruritus, hyperpigmentation, herpes zoster, alopecia. Urogenital: Amenorrhea, azoospermia, chromosomal abnormalities, hyperuricemia. Body as a Whole: Weakness, hypersensitivity reactions. With extravasation: painful inflammatory reaction, tissue sloughing, thrombosis, thrombophlebitis.
Drug:
Mechlorethamine (nitrogen mustards) may reduce effectiveness of antigout agents by raising serum uric acid levels; dosage adjustments may be necessary; may prolong neuromuscular blocking effects of succinylcholine; may potentiate bleeding effects of anticoagulants, salicylates, nsaids, platelet inhibitors.
Metabolism: Rapid transformation to metabolites. Elimination: Not detectable in blood within a few minutes; <0.01% excreted in urine.
Assessment & Drug Effects
- Establish baseline data for body weight, I&O ratio and pattern, and blood labs as reference for design of drug and care regimens.
- Lab tests: Monitor CBC with differential and platelet count. Periodic serum uric acid levels.
- Record daily weight. Alert physician to sudden or slow, steady weight gain.
- Monitor and record patient's fluid losses carefully. Prolonged vomiting and diarrhea can produce volume depletion.
- Report immediately petechiae, ecchymoses, or abnormal bleeding from intestinal and buccal membranes. Keep injections and other
invasive procedures to a minimum during period of thrombocytopenia.
- Report symptoms of agranulocytosis (e.g., unexplained fever, chills, sore throat, tachycardia, and mucosal ulceration).
- Prevent exposure to people with infection, especially upper respiratory tract infections.
- Note and record state of hydration of oral mucosa, condition of gingiva, teeth, tongue, mucosa, and lips.
Patient & Family Education
- Report any signs of bleeding immediately.
- Use caution to prevent falls or other traumatic injuries, especially during periods of low platelet counts.
- Increase fluid intake up to 3000 mL/d if allowed to minimize risk of kidney stones. Report promptly all symptoms, including
flank or joint pain, swelling of lower legs and feet, changes in voiding pattern.
- Do not breast feed while using this drug.
1%)
Canadian drug name; 
Prototype drug