Mustargen (Intravenous)

Mechlorethamine is part of a group of medicines known as alkylating agents. It is used to treat certain types of cancer and some noncancerous conditions.

Mechlorethamine works by interfering with the growth of cancer cells, leading to their destruction. It can also affect the growth of normal body cells, which may lead to other effects. Some of these effects can be serious and should be reported to your doctor. Other effects, such as hair loss, might not be serious but can still be concerning. Some effects may not show up for months or even years after using the medicine.

Before starting treatment with mechlorethamine, you and your doctor should discuss the benefits of this medicine as well as the risks associated with it.

Mechlorethamine must be given only by or under the immediate supervision of your doctor.

It is very important that your doctor checks your progress at regular visits to make sure this medicine is working properly and to check for unwanted effects.

While you are being treated with mechlorethamine, and after you stop treatment with it, do not have any immunizations (vaccinations) without your doctor's approval. Mechlorethamine may lower your body's resistance, and there is a chance you might get the infection the immunization is meant to prevent. In addition, others in your household should not take the oral polio vaccine since there is a chance they could pass the polio virus on to you. Also, avoid people who have taken the oral polio vaccine. Do not get close to them, and do not stay in the same room with them for very long. If you cannot take these precautions, you should consider wearing a protective face mask that covers your nose and mouth.

Mechlorethamine can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this happens, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

• If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
• Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in urine or stools; or pinpoint red spots on your skin.
• Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
• Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
• Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
• Avoid contact sports or other situations where bruising or injury could occur.

If mechlorethamine accidentally seeps out of the vein into which it is injected, it may damage some tissues and cause scarring. Tell the healthcare professional right away if you notice redness, pain, or swelling at the injection site.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the benefits it will provide. This is a decision you and your doctor will make. For this medicine, consider the following:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also inform your healthcare professional if you have any other allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

There is no specific information comparing the use of mechlorethamine in children to its use in other age groups, but it is not expected to cause different side effects or problems in children than it does in adults.

Geriatric

Many medicines have not been studied specifically in older adults. Therefore, it may not be known whether they work the same way they do in younger adults or if they cause different side effects or problems in older adults. There is no specific information comparing the use of mechlorethamine in the elderly to its use in other age groups.

Breast Feeding

There are no adequate studies in women to determine the risk to infants when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Some medicines should not be used together at all, while in other cases, two different medicines might be used together even if an interaction could occur. If you are taking this medicine, it is especially important for your healthcare professional to know if you are taking any of the medicines listed below. The following interactions have been chosen based on their potential significance and are not all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Measles Virus Vaccine, Live
• Mumps Virus Vaccine, Live
• Rotavirus Vaccine, Live
• Rubella Virus Vaccine, Live
• Varicella Virus Vaccine, Live
• Zoster Vaccine, Live

Using this medicine with any of the following medicines is usually not recommended, but may be necessary in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Adenovirus Vaccine
• Bacillus of Calmette and Guerin Vaccine, Live
• Cholera Vaccine, Live
• Dengue Tetravalent Vaccine, Live
• Influenza Virus Vaccine, Live
• Poliovirus Vaccine, Live
• Smallpox Vaccine
• Typhoid Vaccine, Live
• Warfarin
• Yellow Fever Vaccine

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or specific types of food, as interactions may occur. Using alcohol or tobacco with certain medicines may also lead to interactions. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

Having other medical problems may affect the use of this medicine. Make sure to inform your doctor if you have any other medical issues, especially:

• Chickenpox (including recent exposure) or
• Herpes zoster (shingles)—Risk of severe disease affecting other parts of the body

• Gout or
• Kidney stones—Mechlorethamine may increase levels of uric acid in the body, which can lead to gout and kidney stones

• Infection—Mechlorethamine may lower your body's ability to fight infection

Along with its necessary effects, a medicine may cause some unwanted effects. Not all of these side effects will occur, but if they do, they may need medical attention.

Additionally, because of how cancer medicines work in the body, there is a chance that they might cause other effects that may not appear until months or years after using these medicines. These delayed effects may include certain types of cancer. Talk about these possible effects with your doctor.

Check with your doctor immediately if any of the following side effects happen:

Less common

• Black, tarry stools
• Blood in urine or stools
• Cough or hoarseness
• Fever or chills
• Lower back or side pain
• Pain or redness at the injection site
• Painful or difficult urination
• Pinpoint red spots on skin
• Unusual bleeding or bruising

Rare

• Shortness of breath, itching, or wheezing

Check with your doctor as soon as possible if any of the following side effects happen:

More common

• Missing menstrual periods
• Painful rash

Less common

• Dizziness
• Joint pain
• Loss of hearing
• Ringing in ears
• Swelling of feet or lower legs

Rare

• Numbness, tingling, or burning of fingers, toes, or face
• Sores in mouth and on lips
• Yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Your health care professional may also be able to tell you how to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome, or if you have any questions about them:

More common

• Nausea and vomiting (usually lasts only 8 to 24 hours)

Less common

• Confusion
• Diarrhea
• Drowsiness
• Headache
• Loss of appetite
• Metallic taste
• Weakness

This medicine may cause a temporary loss of hair in some people. After treatment with mechlorethamine has ended, normal hair growth should return.

After you stop using this medicine, it may still cause some side effects that need attention. During this time, check with your doctor immediately if you notice the following side effects:

• Black, tarry stools
• Blood in urine or stools
• Cough or hoarseness
• Fever or chills
• Lower back or side pain
• Painful or difficult urination
• Pinpoint red spots on skin
• Unusual bleeding or bruising

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

In the U.S.

• Mustargen

Pharmacologic Class: Alkylating Agent

Chemical Class: Nitrogen Mustard

Mechlorethamine is sometimes given together with certain other medicines. If you are using a combination of medicines, it is important that you receive each one at the proper time. If you are taking some of these medicines by mouth, ask your health care professional to help you plan a way to take them at the right times.

While you are using this medicine, your doctor may want you to drink extra fluids so that you will pass more urine. This will help prevent kidney problems and keep your kidneys working well.

Mechlorethamine often causes nausea and vomiting, which usually last only 8 to 24 hours. It is very important that you continue to receive the medicine, even if you begin to feel ill. Ask your health care professional for ways to lessen these effects.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.