Mechlorethamine, also known as nitrogen mustard or mustine, is a type of alkylating agent used in the treatment of cancer. It's one of the earliest chemotherapy agents developed and was derived from mustard gas.

Mechlorethamine (Valchlor) is a nitrogen mustard that is used as a topical treatment in patients with cutaneous T-cell lymphoma.

Mechlorethamine Uses:

• Cutaneous T-cell lymphoma:
  • It is indicated for the topical treatment of patients with stage IA and IB mycosis fungoides-type cutaneous T-cell lymphoma who have previously been treated with skin-directed therapy.

Mechlorethamine (Valchlor) Dose in Adults:

Mechlorethamine (Valchlor) Dose in the treatment of Cutaneous T-cell lymphoma (mycosis fungoides):

• Dosage: Apply a thin film of mechlorethamine once daily to the affected areas of the skin.
• Duration of Treatment: Treatment is continued for 1 year.
• Concurrent Use of Corticosteroids: In the clinical study, the concurrent use of topical or systemic corticosteroids was not allowed alongside mechlorethamine treatment.

It's important to note that the dosing and treatment duration might vary based on individual patient characteristics, the stage of the disease, and the treating physician's judgment.

Use in Children:

Not indicated.

Pregnancy Risk Factor D

• Mechlorethamine might harm an unborn baby if a pregnant woman is exposed to it.
• There are stories of birth defects in babies when their mothers were given this drug.
• Women who might become pregnant should avoid getting pregnant while using mechlorethamine.
• This medicine can also reduce the ability for both men and women to have children.
• For more details, check the main guide on mechlorethamine.

Use of memorethamine while breastfeeding

• We don't know if mechlorethamine gets into breast milk when applied to the skin.
• Because it could be harmful to a baby if they are exposed to it through breastfeeding, the maker of the drug suggests that mothers either stop breastfeeding or stop using the drug.
• The decision should consider how important the treatment is for the mother.

Mechlorethamine Dose in Kidney Disease:

• The company that makes the drug hasn't given specific instructions about changing the dose for people with kidney problems.
• But since the drug doesn't seem to affect the whole body much, it's probably not needed to change the dose for these people.

Mechlorethamine Dose in Liver disease:

• The company that makes the drug hasn't given specific guidelines about adjusting the dose for people with liver problems.
• But since the drug doesn't seem to spread much throughout the body, it's probably not needed to change the dose for these people.

Common Side Effects of Mechlorethamine (Valchlor):

• Dermatologic:
  • Dermatitis
  • Pruritus
  • Bacterial skin infection
• Hematologic & oncologic:
  • Hematologic abnormality (decreased hemoglobin, neutrophils, or platelets)

Less Common Side Effects of Mechlorethamine (Valchlor):

• Dermatologic:
  • Dermal ulcer
  • Skin hyperpigmentation
• Hematologic & oncologic:
  • Malignant neoplasm

Contraindications to Mechlorethamine (Valchlor):

• If someone has had a strong allergic reaction to mechlorethamine before or to any ingredient in the drug, they should not use it.

Warnings and precautions

Accidental exposure

• If mechlorethamine accidentally gets into the eyes, it can cause pain, burning, and blurred vision.
• In serious cases, it might even lead to blindness.
• If this happens, rinse the eyes with a lot of water or special eye solutions for at least 15 minutes and get medical help quickly, especially from an eye doctor.
• If the drug touches the inside linings of the body, like the mouth, it can cause pain and soreness.

Dermatitis

• Skin reactions, like rashes, are common with this drug.
• Look out for symptoms like redness, swelling, itching, or blisters.
• The face, private areas, bottom, and skin folds are more likely to have these reactions.
• If these skin problems become severe, the dose of the drug might need to be reduced.

Hypersensitivity

• Some people have had allergic reactions, even severe ones, when they used mechlorethamine on their skin.

Secondary exposure

• Be careful not to let others come into contact with mechlorethamine, except where the patient is being treated.
• Touching the medicine can cause skin reactions, harm to inner body linings, and even increase the risk of cancer.
• To keep others safe, always use the medicine as instructed.

Secondary malignancy

• In a study, some people developed skin cancers other than melanoma during or within a year after using the medicine.
• Some of these people had used other treatments before that can also lead to this kind of skin cancer.
• Keep an eye out for signs of skin cancers during and after treatment.
• These cancers can appear on any part of the skin, even areas that didn't get the medicine.

Monitoring parameters:

• Skin Problems
  • Skin ulcers
  • Blisters
  • Rashes (dermatitis)
  • Infections on the skin
• Cancer Signs
  • Any signs or symptoms of skin cancers other than melanoma
• Allergic Reactions
  • Symptoms like swelling, redness, itching, or difficulty breathing indicating an allergic response.

How to administer Mechlorethamine (Valchlor)?

Application

• Put a thin layer on the affected skin area.
• Use right away (or within 30 minutes) after taking it out of the fridge and put it back in the fridge quickly after using.
• Make sure skin is dry. Wait at least 4 hours after or 30 minutes before showering or washing.
• Let the medicine dry on the skin for 5 to 10 minutes before wearing clothes.

Using Moisturizers

• You can put on moisturizers 2 hours before or 2 hours after using the medicine.

Things to Avoid

• Don't use airtight bandages on areas where you applied the medicine.
• Stay away from fire or cigarettes until the medicine has dried on the skin.

Safety for Caregivers

• Caregivers should use nitrile gloves when putting the medicine on patients.
• Wash hands well after handling the medicine.

If Medicine Touches Unintended Areas

• If the medicine gets on skin where it shouldn't, wash it off with soap and water for at least 15 minutes and take off any clothing that got the medicine on it.

Mechanism of action of Mechlorethamine (Valchlor):

• Type of Drug
  • Mechlorethamine is a kind of medicine called a nitrogen mustard alkylating agent.
• How it Acts on DNA
  • It creates links between and within DNA strands, stopping them from copying properly.
  • This leads to a block in making new DNA.
• Topical Application Advantage
  • Putting it on the skin targets treatment to the skin area.
  • It reduces the amount of the drug that enters the whole body.
• Purpose of Topical Use
  • This kind of use is meant for treating skin problems.
  • It helps minimize the effects on the rest of the body (systemic exposure).
• Source
  • This information is based on a study by Lessin in 2013.

Absorption through the Skin

• When applied on the skin, none of the medicine was found to be absorbed into the body (based on the study by Lessin in 2013).

Spread in the Body

• After applying it on the skin, no signs were found that the medicine spread through the body (systemic exposure) in the research done by Lessin in 2013.

International Brand Names of Mechlorethamine:

• Valchlor

Mechlorethamine Brand Names in Pakistan:

Not Availabel.