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Valchlor

mechlorethamine
Used for Non-Hodgkin Lymphoma, Skin Cancer
Used for Non-Hodgkin Lymphoma, Skin Cancer

Valchlor (mechlorethamine) is a topical gel that’s used to treat mycosis fungoides, a type of cutaneous T-cell lymphoma. The medication is applied directly onto areas of the skin that’s affected by this cancer. It’s usually used after people have already tried other medications to treat the affected skin. Valchlor (mechlorethamine) can cause side effects like itching, skin irritation, blisters, or skin infections.

Reviewed by:
reviewer
Belinda Li, PharmD, BCOP
reviewer
Cydnee Ng, PharmD
Last reviewed on March 26, 2024
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsAlternativesReferencesPricesMedicare
basics-icon

What is Valchlor (mechlorethamine)?

What is Valchlor (mechlorethamine) used for?

How Valchlor (mechlorethamine) works

Valchlor (mechlorethamine) is an alkylating agent. The exact way it works isn’t fully understood. But the medication is thought to work to treat the cancer by preventing cells from dividing and growing, which leads to cell death.

Drug Facts

Common BrandsValchlor
Drug ClassAlkylating agent
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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What are the side effects of Valchlor (mechlorethamine)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Dermatitis (skin irritation; 56%)
  • Itchy skin (20%)
  • Low blood counts (13%)
  • Bacterial skin infection (11%)
  • Skin ulcers or blisters (6%)
  • Skin darkening (hyperpigmentation; 5%)

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Eye, mouth, or nose injury from accidental exposure: pain, blurry vision, sensitivity to light, burning, redness
  • Skin reactions: redness, swelling, itchiness, blisters, ulcers, skin infection
  • Non-melanoma skin cancer: abnormal changes to skin

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Blistering, crusting, irritation, itching, or reddening of the skin

cracked, dry, scaly skin

pain, swelling, tenderness, or warmth on the skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

Darkening of the skin

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Valchlor (mechlorethamine)

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Pros

Only applied onto the skin once per day

A recommended skin treatment for mycosis fungoides

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Cons

Can transfer onto other people’s skin through skin contact and can be harmful

Not a good choice if you’re pregnant or planning on becoming pregnant since it can cause harm to an unborn baby

Must keep in the refrigerator

pharmacist-tips

Pharmacist tips for Valchlor (mechlorethamine)

pharmacist

  • You should store Valchlor (mechlorethamine) in the refrigerator to keep the medication stable for it to work. Also keep the tube of medication in the original box and away from your food.

    • Apply Valchlor (mechlorethamine) onto your skin immediately or within 30 minutes of taking it out of the refrigerator. Wash your hands with soap and water right after you’re done applying. Then, put the medication back into the refrigerator.

      • Apply Valchlor (mechlorethamine) onto completely dry skin. Wait at least 30 minutes to apply the medication after a bath or shower. If you’ve already applied Valchlor (mechlorethamine) to your skin, it’s best to wait at least 4 hours before showering, bathing, or swimming.

        • Once you’ve placed Valchlor (mechlorethamine) on your skin, let it dry completely for 5 to 10 minutes before covering your skin with clothing.

          • Don’t use any moisturizers or lotions on the treated area unless it’s been at least 2 hours before or after you’ve applied Valchlor (mechlorethamine).

            • Don’t place any bandages or dressings on the skin where you applied Valchlor (mechlorethamine).

              • Avoid fire, flames, or smoking until Valchlor (mechlorethamine) has fully dried on your skin. This medication is alcohol-based and flammable.

                • Write the date you opened a tube of Valchlor (mechlorethamine) on the box. Once it’s opened, the medication is good to use for 90 days. After 90 days, you should throw away any medication that’s left into your trashcan.

                  • If Valchlor (mechlorethamine) gets into anyone’s eyes, nose, or mouth, immediately rinse the exposed area with water for at least 15 minutes.

                    • If Valchlor (mechlorethamine) gets onto anyone’s skin, wash the area well with soap and water for at least 15 minutes and remove anything that might’ve been contaminated.

                      faqs

                      Frequently asked questions about Valchlor (mechlorethamine)

                      Is Valchlor (mechlorethamine) considered to be chemotherapy?
                      Yes, Valchlor (mechlorethamine) is considered chemotherapy. It slows the growth of cancer cells in your body by killing cells that divide and spread quickly in the body. Because this medication is applied topically (onto the skin), not much gets absorbed into the body through the skin. With Valchlor (mechlorethamine), you’re less likely to have side effects that typically come with chemotherapy you take by mouth or chemotherapy that’s injected. For example, you’re less likely to experience hair loss, nausea, and fatigue. Valchlor (mechlorethamine) instead can cause itching, skin irritation, blisters, or skin infections.
                      What precautions should I take when I’m applying Valchlor (mechlorethamine)?
                      Valchlor (mechlorethamine) is hazardous, so anyone who’s applying the medication — to themselves or to others — must be careful. Wash your hands well with soap and water after applying Valchlor (mechlorethamine). If someone is helping you, they should wear disposable nitrile gloves when applying the medication onto your skin and then wash their hands with soap and water after removing their gloves. If Valchlor (mechlorethamine) accidentally gets on any skin that’s not meant to be treated, wash that area thoroughly with soap and water for at least 15 minutes and remove anything that was contaminated.
                      How long does it take Valchlor (mechlorethamine) to work?
                      In a clinical study, some people noticed improvements in their skin after 1 month of using Valchlor (mechlorethamine) along with other treatments, such as topical steroids and phototherapy. It took 1.5 years of use for people to see the most improvement from treatment. Be sure to continue to use Valchlor (mechlorethamine) as instructed by your oncologist, even if you don’t see improvement in your skin right away. It can take some time for the medication to work. Speak with your oncologist if you have concerns about whether Valchlor (mechlorethamine) is working for you.
                      How long will I need to use Valchlor (mechlorethamine)?
                      You will need to continue using Valchlor (mechlorethamine) as long as it’s working to control the symptoms of mycosis fungoides on your skin. But you might need to stop using the medication early if you have serious side effects from it. Notify your care team right away if you have any skin inflammation, skin ulcers or blisters, swelling, or skin infections. Your oncologist will discuss with you about whether you should continue treatment or stop Valchlor (mechlorethamine).
                      What should I do if I have side effects from Valchlor (mechlorethamine)?
                      Speak with your care team or oncologist if you experience any side effects from Valchlor (mechlorethamine), such as itching, skin blisters, or skin irritation. Your oncologist will tell you what you should do depending on how severe the side effect is. If you have blisters, sores, or severe skin irritation from Valchlor (mechlorethamine), your oncologist might recommend that you stop using the medication temporarily and then restart treatment later when your side effects improve. And when you restart the medication, your oncologist might suggest using it every 3 days at first and then, if you tolerate it, every other day before returning to daily dosing.
                      What should I do if I need to travel while I’m using Valchlor (mechlorethamine)?
                      For short trips, you can keep Valchlor (mechlorethamine) in a small cooler with ice until you can find a refrigerator at your destination to place the medication in. If you’re flying, you’ll need to ask your care team for a note to give to Travel Security Administration (TSA) and the airline so that you can bring the medication onto the plane. If you’re traveling for a long time and you can’t refrigerate Valchlor (mechlorethamine), you should discuss alternative options with your oncologist.
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                      What are the risks and warnings for Valchlor (mechlorethamine)?

                      Valchlor (mechlorethamine) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                      risk-warning

                      Eye, nose, or mouth injury with accidental exposure

                      • Risk factors: Exposure to the eye, nose, or mouth

                        Wash your hands right after applying Valchlor (mechlorethamine) to the affected areas. This helps lower the risk of getting the medication into your eyes, nose, or mouth.

                        If Valchlor (mechlorethamine) gets into your eyes, it can cause pain, burning, inflammation, sensitivity to light, and blurry vision. In rare cases, it can lead to severe, irreversible eye damage and blindness. Immediately rinse your eyes for at least 15 minutes with water and get urgent care right away if Valchlor (mechlorethamine) gets into your eye.

                        If Valchlor (mechlorethamine) gets into your nose or mouth, it can cause pain, redness, and sores. Rinse the area for at least 15 minutes with water and get medical help right away if you get the medication in any of these areas.

                        risk-warning

                        Risk for others to get exposed to the medication

                        Be careful when applying or after applying Valchlor (mechlorethamine) because it can transfer onto other people’s skin. If anyone besides the person who’s getting treated with Valchlor (mechlorethamine) gets the medication on their skin, they should wash the area with soap and water for at least 15 minutes and remove any contaminated clothing. Accidental exposure to Valchlor (mechlorethamine) can cause skin inflammation; injury to the eyes, mouth, or nose; and possibly certain types of skin cancers.

                        risk-warning

                        Dermatitis (skin irritation or inflammation)

                        • Risk factors: Applying the medication to the face, genital area, anus, or skin folds

                          Skin inflammation is common with Valchlor (mechlorethamine) and sometimes can be severe. The risk for skin irritation is higher if you apply the medication to the face, genital area, anus, or skin folds. If you have any redness, swelling, itching, blisters, ulcers, or skin infections, you should contact your care team. Your oncologist might recommend that you apply Valchlor (mechlorethamine) less frequently.

                          risk-warning

                          Non-melanoma skin cancer

                          A small percentage of people who used Valchlor (mechlorethamine) developed a non-melanoma skin cancer. Some cases happened in people who previously had treatments known to cause non-melanoma skin cancer. The skin cancer can occur anywhere on the skin (even on untreated areas) and can happen during or after treatment with Valchlor (mechlorethamine). Your oncologist might check your skin for new skin cancers at your follow-up appointments. Tell your oncologist right away if you get any new abnormal changes to your skin (skin lesions).

                          risk-warning

                          Harm to unborn baby

                          Valchlor (mechlorethamine) can likely harm an unborn baby. Because of this risk, if you or your partner can become pregnant, you should use birth control during treatment with Valchlor (mechlorethamine) to prevent pregnancy. Use barrier methods, such as condoms or diaphragms, to protect your genitals and reproductive system from getting exposed to the medication. Let your care team know right away if you or your partner becomes pregnant.

                          risk-warning

                          Not recommended to breastfeed during treatment

                          It’s not recommended to breastfeed while you’re using Valchlor (mechlorethamine). The medication is applied to the skin and can transfer onto someone else through skin-to-skin contact. So your baby could get Valchlor (mechlorethamine) onto their skin while breastfeeding. There are no studies that show how the medication affects breastfed children, but it could potentially be harmful. Ask your baby’s pediatrician what the best option is for nutrition and feeding.

                          dosage

                          Valchlor (mechlorethamine) dosage forms

                          Typical dosing for Valchlor (mechlorethamine)

                          You should apply a thin layer of Valchlor (mechlorethamine) gel once a day to the affected area of the skin.

                          interactions

                          Interactions between Valchlor (mechlorethamine) and other drugs

                          Valchlor (mechlorethamine) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Valchlor (mechlorethamine). Please note that only the generic name of each medication is listed below.

                          Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

                          alternatives

                          What are alternatives to Valchlor (mechlorethamine)?

                          There are a number of medications that your doctor can prescribe in place of Valchlor (mechlorethamine). Compare a few possible alternatives below.
                          Valchlor (mechlorethamine)
                          Used for:
                          View Prices
                          Targretin (bexarotene)
                          Used for:

                          • Cutaneous T-cell lymphoma (refractory or persistent)

                          $350.13 Lowest GoodRx priceView Prices
                          Poteligeo (mogamulizumab)
                          Used for:
                          View Prices

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                          References

                          Best studies we found

                          Ludmann, P. (2023). Cutaneous T-cell lymphoma: Overview. American Academy of Dermatology Association.

                          American Cancer Society. (n.d.). Skin cancer image gallery.

                          American Osteopathic College of Dermatology. (n.d.). Hyperpigmentation.

                          View All References (14)

                          American Osteopathic College of Dermatology. (n.d.). Mycosis fungoides.

                          Celano, P., et al. (2019). Safe handling of hazardous drugs: ASCO standards. Journal of Clinical Oncology.

                          Centers for Disease Control and Prevention. (2022). Infant and toddler nutrition.

                          Drugs and Lactation Database (LactMed®). (2023). Mechlorethamine. National Institute of Child Health and Human Development.

                          Helsinn Therapeutics (U.S.), Inc. (2024). Valchlor- mechlorethamine hydrochloride gel [package insert]. DailyMed.

                          Kim, E. J., et al. (2021). The PROVe Study: US real-world experience with chlormethine/mechlorethamine gel in combination with other therapies for patients with mycosis fungoides cutaneous T-cell lymphoma. American Journal of Clinical Dermatology.

                          Ludmann, P. (2023). Cutaneous T-cell lymphoma: Overview. American Academy of Dermatology Association.

                          McCann, S. A., et al. (2016). Gelling your dermatology nursing practice: A practical guide for managing the treatment of mycosis fungoides cutaneous T-cell lymphoma with mechlorethamine gel. Journal of the Dermatology Nurses' Association.

                          National Cancer Institute. (n.d.). Reproductive system.

                          National Cancer Institute. (2022). Mycosis fungoides (Including Sézary syndrome) treatment (PDQ®)–Patient version.

                          National Comprehensive Cancer Network. (2021). Mycosis fungoides/Sézary syndrome.

                          National Organization for Rare Disorders. (2013). Mycosis fungoides.

                          Olsen, E. A., et al. (2015). Guidelines for phototherapy of mycosis fungoides and Sézary syndrome: A consensus statement of the United States Cutaneous Lymphoma Consortium. Journal of the American Academy of Dermatology.

                          Querfeld, C., et al. (2021). Lack of systemic absorption of topical mechlorethamine gel in patients with mycosis fungoides cutaneous T-cell lymphoma. The Journal of Investigative Dermatology.

                          GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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