Chlorambucil for nephrotic syndrome

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Chlorambucil for nephrotic syndrome

This leaflet is about the use of chlorambucil for nephrotic syndrome in children.

Information Standard quality markThis leaflet has been written specifically for parents and carers about the use of this medicine in children. The information may differ from that provided by the manufacturer. Please read this leaflet carefully. Keep it somewhere safe so that you can read it again.

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Brand name:

Why is it important for my child to take this medicine?

Your doctor may recommend this treatment if your child’s nephrotic syndrome keeps coming back. Usually, chlorambucil is taken for 8 weeks. It is taken at the same time as and in addition to the steroid treatment and should increase the time that the nephrotic syndrome stays in remission (i.e. doesn’t come back).

What is chlorambucil available as?

  • Tablets: 2 mg
  • Liquid medicine can be ordered specially from your pharmacist

When should I give chlorambucil?

Chlorambucil is usually given once a day. This is usually in the morning.

Give it at about the same time each day so that this becomes part of your child’s daily routine, which will help you to remember.

How much should I give?

Your doctor will work out the amount of chlorambucil (the dose) that is right for your child. The dose will be shown on the medicine label.

It is important that you follow your doctor’s instructions about how much to give.

How should I give it?

TabletsTablets should be swallowed with a glass of water, milk or juice. Your child should not chew the tablet. The tablet should not be cut or crushed. Wash your hands immediately after handling and giving the dose.

Liquid medicine with oral syringeLiquid medicine: measure out the right amount using a medicine spoon or oral syringe. You can get these from your pharmacist. Do not use a kitchen teaspoon as it will not give the right amount.

When should the medicine start working?

The medicine will start working straight away, although this may not be obvious. The aim of treatment with chlorambucil is to increase the time that your child’s nephrotic syndrome stays in remission, so it will take some time to know if it has helped.

What if my child is sick (vomits)?

  • If your child is sick less than 30 minutes after having a dose of chlorambucil give them the same dose again.
  • If your child is sick more than 30 minutes after having a dose of chlorambucil you do not need to give them another dose. Wait until the next normal dose.

What if I forget to give it?

Give the missed dose when you remember during the day, as long as this is at least 12 hours before the next dose is due.

Never give a double dose of chlorambucil.

What if I give too much?

It may be dangerous to give too much chlorambucil.

If you think you may have given your child too much chlorambucil, contact your doctor or NHS Direct (0845 46 47 in England and Wales; 08454 24 24 24 in Scotland) or take your child to hospital.

Take the medicine container or packet with you, even if it is empty. This will be useful to the doctor. Have the medicine packet with you if you telephone for advice.

Are there any possible side-effects?

We use medicines to make our children better, but sometimes they have other effects that we don’t want (side-effects).

Side-effects you must do something about

Contact your doctor straight away if your child has a fever (temperature above 38°C) with a sore throat or cough, or if they have unusual bleeding that is difficult to stop, or severe bruising.

  • If your child’s skin or the whites of the eyes get a yellowish tinge, contact your doctor, as there may be a problem with their liver.
  • If your child has pain when they urinate (do a wee) or have any difficulty urinating, contact your doctor.
Other side-effects you need to know about

When your child first starts taking chlorambucil they may feel sick (nausea) or be sick (vomit) and they may get diarrhoea. It may help for your child to take the medicine with some food or a small glass of milk. These effects should wear off as your child gets used to the medicine. If they are still a problem after 2 weeks, contact your doctor.

Chlorambucil may affect your child’s blood.

  • They may bruise more easily and they may get tiny bruises or spots on their arms or legs.
  • They may get nose bleeds, their gums may bleed when they brush their teeth, and it make take longer than usual for bleeding to stop.
  • They are more likely to get infections, and they may take longer than usual to fight these off. They may also become ill very quickly, in which case you should contact your doctor.
  • Your child’s stools (poo) may seem black and tar-like, but this is rare.
  • Your child may get swollen feet or ankles, sores in the mouth or on the lips, or a rash that spreads over the body or mouth, but these are rare.
  • Girls may find their periods become irregular or stop, but they will return to normal after stopping the treatment.

There may, sometimes, be other side-effects that are not listed above. If you are concerned, contact your doctor.

Can other medicines be given at the same time as chlorambucil?

  • You can give your child medicines that contain paracetamol, unless your doctor has told you not to.
  • Chlorambucil should not be taken with some medicines that you get on prescription. Tell your doctor and pharmacist about any other medicines your child is taking before giving chlorambucil.
  • Check with your doctor or pharmacist before giving any other medicines to your child. This includes herbal or complementary medicines.

Is there anything else I need to know about this medicine?

  • Your doctor will test your child’s blood regularly to check that chlorambucil has not affected their liver, kidneys or blood.

If your child comes into contact with anyone who has measles, chickenpox or shingles, contact your doctor straight away, as they may need special preventative treatment.

  • Chlorambucil is also used for chemotherapy in cancer, but at a higher dose and for a longer time. You may have heard about some serious side-effects associated with chemotherapy. These are very rare when used for nephrotic syndrome. Talk to your doctor if you are worried.
  • Chlorambucil may, rarely, cause infertility in males and females who have reached puberty, but this is very unlikely as it is only used for a short period in nephrotic syndrome.
  • If your child takes chlorambucil for a long time, there is a low risk of some forms of blood cancer. Your doctor will discuss this with you before starting the medicine and will do regular blood tests to check for these effects. However, the benefit of taking the medicine is greater than the risk of cancer.
  • Chlorambucil may harm an unborn baby. If your daughter is sexually active, it is very important that she uses adequate contraception to prevent unplanned pregnancy and continues it for at least 1 month after stopping treatment. The oral contraceptive pill can be used safely in woman or girls taking chlorambucil. If your daughter thinks that she may be pregnant, it is important that she sees your family doctor as early as possible. She should keep taking her medicine until she sees her doctor.

General advice about medicines

  • Try to give medicines at about the same times each day, to help you remember.
  • If you are not sure a medicine is working, contact your doctor but continue to give the medicine as usual in the meantime. Do not give extra doses as you may do harm.
  • Only give this medicine to your child. Never give it to anyone else, even if their condition appears to be the same, as this could do harm.

If you think someone else may have taken the medicine by accident, contact your doctor straight away.

  • Make sure that you always have enough medicine. Order a new prescription at least 2 weeks before you will run out.
  • Make sure that the medicine you have at home has not reached the ‘best before’ or ‘use by’ date on the packaging. Give old medicines to your pharmacist to dispose of.

Where should I keep this medicine?

  • Keep the medicine in the fridge. Make sure that the medicine does not freeze.
  • Make sure that children cannot see or reach the medicine.
  • Keep the medicine in the container it came in.

Who to contact for more information

Your doctor, pharmacist or nurse will be able to give you more information about chlorambucil and about other medicines used to treat nephrotic syndrome.

You can also get useful information from: 
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