Mechlorethamine (Chlormethine, Mustargen, Mustine, nitrogen mustard)

Mechlorethamine is a chemotherapy drug used to treat Hodgkin's lymphoma, non Hodgkin's lymphoma and some types of chronic leukemia. It is not commonly used in the UK but may be used as part of clinical trials. Its brand name is Mustargen.

Mechlorethamine is pronounced mee-claw-eth-a-meen. It used to be called nitrogen mustard, mustine or chlormethine. It is an alkylating agent. These drugs work by sticking to one of the cancer cell's DNA strands. The cell cannot then grow and divide into 2 new cells.

Mechlorethamine is a clear liquid that you have as an injection through a fine tube (cannula) into a vein (intravenously). Or you may have it through a tube called a central line that goes into a vein near your collarbone.

You usually have chemotherapy as a course of several cycles of treatment. To find out more about the way chemotherapy treatment is planned go to the planning chemotherapy section.

The side effects associated with mechlorethamine are listed below. You can use the links (underlined) to find out more about each side effect or go to the cancer drug side effects section.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these  effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Tiredness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Feeling or being sick occurs in up to half the people having mechlorethamine and is most likely to happen within 3 hours of starting treatment – it may last for up to 24 hours but can usually be controlled with anti sickness medications. Let your doctor or nurse know if you still feel sick.
• Hair Loss is most likely to start about 3 to 4 weeks after your treatment but your hair will grow back when your treatment ends
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if having a baby is important to you 
• Women may stop having periods (amenorrhoea) but this may be temporary
• Mechlorethamine may have a harmful effect on a developing baby so do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant
• Inflammation around the drip site – if you have any pain or notice signs of redness, swelling or leaking at your drip site, tell your doctor or chemotherapy nurse immediately

Between 1 and 10 in every 100 people have one or more of these.

• Mechlorethamine can cause pain and burning where you have your injection – hot or cold packs may help
• Diarrhoea – drink plenty of fluid and tell your doctor or nurse if diarrhoea becomes severe, or continues for more than 3 days
• A skin rash

Fewer than 1 in 100 people have these.

• Headaches
• Drowsiness
• Ringing in your ears (tinnitus) or deafness
• Very rarely, another cancer can develop years after finishing the treatment

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.