Chlorambucil

Decrease in white blood cell count

• This may increase your chances of getting an infection.

• To reduce the risk of infections:
  • Maintain good hand hygiene. Wash your hands before handling food and after using the toilet.
  • Avoid crowds and do not go near people who are sick. Wear a mask if necessary.
  • Eat freshly cooked and well-cooked food. Avoid raw meats, vegetables and eggs, or half-cooked or uncooked food.
• Proceed to the A&E department immediately if you have any signs of infection, such as having
  • A fever of 38°C and above
  • Chills
  • Bad sore throat
  • Pain when you pass urine
  • Mouth sores or wounds that do not heal
• You should avoid taking Paracetamol to relieve fever as this may mask your fever and delay the treatment of your infection.

Decrease in platelet count 

• Low platelet levels can increase your chance of bleeding.

• To reduce the risk of bleeding:
  • Be careful when using sharp objects such as scissors or knives.
  • Brush your teeth gently with a soft bristle toothbrush to prevent gum bleeding.
  • Try not to bruise, cut, or knock yourself. Apply direct pressure to any cuts or wounds to help stop bleeding.
• Proceed to the A&E department immediately if you have symptoms of serious bleeding including:
  • Blood in the urine
  • Black, sticky or bloody stools
  • Unexplained large bruises
  • Coughing up blood or coffee ground-like vomit
  • Bleeding that does not stop

Decrease in the number of red blood cells (anaemia)

• This means there are less red blood cells in your body to carry oxygen to your organs and tissues.
• Symptoms may include worsening tiredness, pale skin or lips, feeling breathless more easily, or having a fast heartbeat while resting.

• Proceed to the A&E department immediately if you have:
  • Unusual giddiness or light-headedness that does not go away
  • Severe breathlessness or rapid breathing
  • An unusually fast heartbeat while resting

• Take small and frequent meals.
• Avoid foods or smells that may make you feel nauseous, such as oily, fried, or strong-smelling food.
• Avoid tight-fitting clothes around the waist.
• Your doctor may prescribe medications to help relieve or prevent nausea or vomiting. Take these as instructed.

• Drink plenty of clear fluids (at least 2 litres or 8 glasses every day).
• Eat food that is gentler on the stomach such as porridge or soup.
• Avoid milk, dairy products, high-fibre food and oily or spicy food.
• Your doctor may prescribe medications to help relieve diarrhoea. Take these as instructed.
• Proceed to the A&E Department immediately if you have very bad diarrhoea (for example increase in bowel movement of more than 4 times per day) that does not improve even after taking medications for diarrhoea.

Mouth ulcers or sores 

• This can occur on the tongue, the sides of the mouth or in the throat and can lead to an infection.

• Rinse your mouth regularly with an alcohol-free mouthwash or salt water to help reduce the  chances of infection.
• Brush your teeth gently after eating and at bedtime with a soft bristle toothbrush.
• Rinse and brush your dentures after eating and soak them in denture solution overnight.
• Avoid spicy food and take soft foods e.g. porridge.
• Your doctor may prescribe medications to help relieve or prevent the mouth sores. Use these as instructed.
• Inform your doctor if you are eating or drinking a lot less because of mouth pain.

• Do not drive or operate machinery if you are feeling tired.
• Eat well and get enough sleep. Prioritize tasks to ensure you make the best use of your energy.
• Simple exercise such as walking can help to boost your energy.
• Avoid alcohol as this may cause you to feel more tired and drowsy.

Drug Allergy 

Symptoms may include:

• Swollen face, eyes, lips or tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body

• If you experience any of these symptoms you should stop your medication and see your healthcare professional immediately

Liver problems

• Rarely, this medication can injure or damage the liver. A liver injury may recover on its own. However, in some cases, it can cause serious liver damage

• Stop this medication and proceed to the A&E department immediately if you experience any:
  • Dark coloured urine
  • Llight-coloured stools
  • Yellowing of your skin or eyes
  • Nausea, vomiting that does not go away
  • Severe abdominal pain

• Proceed to the A&E department immediately if you have any new or worsening symptoms of lung problems such as shortness of breath, cough, or chest pain.

Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN)

• These are rare but severe skin side effects.
• Symptoms include mouth ulcers, face swelling, blisters on skin, skin rashes that spread throughout the body within hours to days after starting the medication.
• This usually occurs within the first few months of treatment.

• Proceed to the A&E Department immediately if you experience very bad or painful rashes such as the symptoms described.

Change in mental status

• Symptoms such as confusion, fits and hallucination

• Proceed to the A&E Department immediately