Parenteral Manual

Mechlorethamine

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
NITROGEN MUSTARD, HN2, MUSARGEN, MUSTINE
Classification: 
Antineoplastic, Alkylator - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
June 2015
Indications: 
  • Relapsed Hodgkin's Disease

THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.

Reconstitution and Stability: 
  • Reconstitute 10 mg vial of powder with 10 mL SWI, for a final concentration of 1 mg/mL.
  • Use immediately.  Stable for only 1 hour after reconstitution.
  • Do not further dilute; solution is not stable.
  • Ensure that patient is ready to receive dose (ie: antiemetics and pre-medications have been administered) before asking pharmacy to prepare drugs
  • Do not use the solution if discoloured or if water droplets form within the vial before constitution
  • 4% sodium thiosulfate is provided with nitrogen mustard to neutralize syringe or any accidental spillage or extravasation.
Compatibility: 

- Solutions Compatible: D5W-saline combinations

- Additive/Above Cassette Compatible: no information

- Y-site Compatible: no information

- Incompatible: neutral or alkaline solutions; DO NOT mix with any other drug or solution because of extremely short stability

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

Yes, certified RN only

Usual dilution: undiluted (1 mg/mL)

Infusion time: into a freely running IV, preferably central line

IV Intermittent Infusion NO
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • 6 mg/m2 days 1 and 8 of a 28 day cycle (MOPP)

** Dosage may vary according to protocol

Potential hazards of parenteral administration: 
  • Nitrogen mustard is potentially carcinogenic, mutagenic and teratogenic, always wear double gloves (latex and PVC), gown and wear a mask and goggles (nitrogen mustard is unstable and may vaporize) when handling or administering.

Immediate (within a few minutes to hours):

  • Nausea, vomiting (>90%) often severe (usally wihin 1-3 hours), lasting approximately 8-24 hours
  • Thrombophlebitis
  • Metallic taste following injection
  • Vertigo, fever, headache, drowsiness, lethargy
  • Lacrimation, tinnitus
  • Rare: hypersensitivity reactions, diaphoresis
  • Mucositis

VESICANT: extravasation causes pain, swelling, tissue necrosis, induration and sloughing of skin.  If there is any suspicion of extravasation, physician should be called to assess immediately.  If extravasation occurs, infiltrate the site immediately with sodium thiosulfate provided with the drug from oncology pharamcy, then apply cold compresses.  Refer to Treatment of Infiltration, Section H, Infusion Therapy Manual. If extravasation occurs, click HERE for treatment guidelines.   

Delayed (within a few days to weeks):

  • Bone marrow suppression, nadir 6-8 days (severe)
  • Hyperuricemia especially at initiation of treatment (patients with Hodgkin's lymphoma)
  • Sclerosis of IV sites- painful, thickened veins wth pigmentation
  • Amenorrhea and azospermia (sterility)
  • Alopecia

- Treatment for unusual side effects are available through the study chair identified on the front page of the protocol and/or pharmacy

Notes: 
  • Ensure adequate fluid intake in patient
  • Hematological status must be monitored
  • Avoid inhalation of dust or vapours
  • Avoid contact with skin, eyes, mucous membrane
  • Should accidental contact with skin occur, irrigate the area thoroughly for 15 minutes
  • If accidental contact with eyes occurs, copious irrigation for at least 15 minutes with NS or a balanced salt opthalmologic irrigating solution should be instituted IMMEDIATELY, followed by prompt opthalmologic consultation.  WEAR PROTECTIVE EYEWEAR.

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