Valchlor (mechlorethamine topical) dosing, indications, interactions, adverse effects, and more

Sections

Sections mechlorethamine topical
Dosing & Uses
Adverse Effects
Warnings
Pregnancy
Pharmacology
Images
Patient Handout
Formulary

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

topical gel

0.016% (equivalent to 0.02% mechlorethamine HCl)

Cutaneous T-Cell Lymphoma

Indicated for stage 1A and 1B mycosis fungoides-type cutaneous T-cell lymphoma in patients who have received prior skin-directed therapy

Apply a thin film of gel topically to affected areas of the skin once daily

Dosage Modifications

Skin toxicities

Stop treatment for any grade of skin ulceration, blistering, or moderately–severe or severe dermatitis (ie, marked skin redness with edema)
Upon improvement, may resume at reduced application frequency of once q3days
After 1 week at q3days, may increase frequency to every other day for at least 1 week, and then to once daily if tolerated

Administration

Apply immediately or within 30 minutes after removal from the refrigerator; return gel to the refrigerator immediately after each use

Apply to completely dry skin at least 4 hr before or 30 minutes after showering or washing

Allow treated areas to dry for 5-10 minutes after application before covering with clothing

Emollients (moisturizers) may be applied to the treated areas 2 hr before or 2 hr after application

Do not use occlusive dressings on areas of the skin where gel applied

Avoid fire, flame, and smoking until the gel has dried

Storage

Before dispensing, store in freezer (–13-5°F (–25°C to –15°C)
Following dispensing, instruct patient that gel requires refrigeration

Cytotoxic handling

Cytotoxic drug; follow applicable special handling and disposal procedures
Patients must wash hands thoroughly with soap and water after handling or applying
Caregivers must wear disposable nitrile gloves when applying gel to patients and wash hands thoroughly with soap and water after removal of gloves
If there is accidental skin exposure, caregivers must immediately wash exposed areas thoroughly with soap and water for at least 15 minutes and remove contaminated clothing

Safety and efficacy not established

>10%

Dermatitis, any grade (56%)

Dermatitis, moderately-severe or severe (23%)

Pruritus, any grade (20%)

Bacterial skin infection, any grade (11%)

1-10%

Skin ulceration or blistering (3-6%)

Skin hyperpigmentation (5%)

Pruritus, moderately-severe or severe (4%)

Bacterial skin infection, moderately-severe or severe (2%)

Contraindications

Hypersensitivity

Cautions

Avoid eye exposure; may cause pain, burns, inflammation, photophobia, and blurred vision; blindness and severe irreversible anterior eye injury may occur Avoid direct skin contact with individuals other than the patient; risk of secondary exposure include dermatitis, mucosal injury, and secondary cancers

Dermatitis occurs commonly (see Adverse Effects); modify dose if skin toxicity occurs (see Dosage Modifications)

Nonmelanoma skin cancer reported

Based on its mechanism of action, case reports in humans, and findings in animals, mechlorethamine topical can cause fetal harm when administered pregnant women

Alcohol-based gels are flammable

Pregnancy & Lactation

Pregnancy Category: D; case reports of children born with malformations in pregnant women systemically administered mechlorethamine

Mechlorethamine was teratogenic in animals after a single SC administration

Lactation: Unknown if distributed in human breast milk; a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the mother

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

Mechanism of Action

Alkylating agent which inhibits rapidly proliferating cells

Also known as nitrogen mustard

Absorption

Systemic exposure was undetectable after topical administration

Images

No images available for this drug.

Patient Handout

A Patient Handout is not currently available for this monograph.

Formulary

FormularyPatient Discounts

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Compare formulary status to other drugs in the same class.
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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

View explanations for tiers and restrictions

Tier	Description
1	This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2	This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC	NOT COVERED – Drugs that are not covered by the plan.

Code	Definition
PA	Prior Authorization Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL	Quantity Limits Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST	Step Therapy Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR	Other Restrictions Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.

Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.

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