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):

• Topical: Apply a thin film once a day to the affected areas of skin.
• In clinical trials, treatment without concomitant corticosteroids has been given to patients for upto one year.

Use in Children:

Not indicated.

Pregnancy Risk Factor D

• Case reports from humans as well as data from animal reproduction studies have shown that fetal harm can be documented.
• In case reports, systemic exposure was associated with teratogenic effects.
• Reproductive potental females are advised not to get pregnant during therapy.
• Both genders have experienced infertility after mechlorethamine treatment.

Use of memorethamine while breastfeeding

• The drug may be present in breast milk after topical application. It is not known whether it is. It is not absorbed so it can be used while breastfeeding.
• The manufacturer suggests that the infant be stopped from taking the drug. This is in consideration of the possible adverse effects on the infant.

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Dose in Kidney Disease:

• There are no dosage adjustments provided in the manufacturer's labeling.
• Since the drug does not get absorbed, it can be safely used in patients with kidney disease without the need for dosage adjustment.

Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer's labeling. Since the drug does not get absorbed, it can be safely used in patients with liver disease.

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):

• Patients who have had a severe allergic reaction to mechlorethamine, or any component of the formulation, should consult a physician immediately.

Warnings and precautions

• Accidental exposure

  • Eye injuries can cause severe pain, burning, stinging and inflammation.
  • Blindness can occur in severe cases. This is often irreversible.
  • For at least 15 minutes, you should immediately irrigate the eyes with water, saline or a balanced ophthalmic irrigation solution. 
  • An ophthalmologist should be contacted immediately for medical attention.
  • The mucous membranes can cause severe pain, redness and ulceration. 
  • Exposure to mucous membranes should be treated immediately with water. You should seek medical advice.

• Dermatitis

  • Patients who have been treated for dermatitis are more likely to develop it. It is often mild-to-severe.
  • You should inspect the skin for redness, itching and swelling.
  • Dermatitis is more common in intertriginous areas such as the facial, genital and skin around anus. It may be necessary to reduce the dosage.

• Hypersensitivity

  • The topical application, including anaphylaxis, can cause allergic reactions.

• Secondary exposure

  • Avoid direct contact with the drug, except in the area that is being treated.
  • Drug exposure can cause dermatitis, mucositis and secondary skin cancers.
  • To avoid drug exposure in uninfected areas, patients should be instructed to follow the guidelines for drug application.

• Secondary malignancy

  • Non-melanoma skin tumors have been seen in patients within one year of treatment.
  • Nonmelanoma skin carcinomas should be closely monitored during and after treatment. 
  • Secondary cancers can develop on any part of the skin, even in areas that have not been treated.

Monitoring parameters:

• Monitor for skin toxicity such as skin ulcers, blistering, dermatitis, and secondary skin infections.
• Monitor for the signs and symptoms of nonmelanoma skin cancer or hypersensitivity reactions.

How to administer Mechlorethamine (Valchlor)?

• Apply a thin layer of sunscreen topically to the area within 30 minutes after taking it out of the fridge. 
• It should be stored in the refrigerator immediately following its use.
• Dry your skin at least 4 hours before, or 30 minutes after washing.
• Let the skin dry for between 5-10 minutes before covering it. 
• Moisturizers and emollients can be applied 2 hours prior to or 2 hours after drug application.
• Do not apply occlusive dressings to the areas being treated. 
• Do not touch the treated areas with flames, fire, or smoke until mechlorethamine is dry.
• Caretakers should wear nitrile gloves when administering the medicine to patients. 
• After applying the drug to patients' hands, it is important that they thoroughly wash their hands with soap and water.
• Accidental exposure should be reported immediately.
• Hands and exposed areas should be washed with soap and water for at least 15 mins.

Mechanism of action of Mechlorethamine (Valchlor):

• It is a nitrogen mustard acidkylating agent, which inhibits DNA synthesis through the formation of inter-stand and intrastrand DNA cross-links.
• Topically applied, the drug's systemic exposure and side effects are reduced. This allows for skin-directed treatment.

Absorption:

• When applied topically, no systemic exposure has been detected.

Distribution:

• It acts locally and since systemic exposure does not occur, it is not distributed into tissues.

International Brand Names of Mechlorethamine:

• Valchlor

Mechlorethamine Brand Names in Pakistan:

No Brands Available in Pakistan.