This is an antineoplastic drug that act as a bifunctional alkylating agent.

Indications: multiple myeloma; advanced ovarian adenocarcinoma, advanced breast cancer, childhood neuroblastoma and polycythaemia vera.

Cautions: reduce dose in renal failure; not to be taken with food (bioavailability is reduced by food).

Contra-indications: pregnancy; breast feeding.

Side effect: bone-marrow depression; hypersensitivity reactions (anaphylaxis); gastro intestinal disturbances; interstitial pneumonitis; pulmonary fibrosis; carcinogenic, mutagenic and teratogenic potential.

Dose: By mouth: Dose may vary according to regimen; Multiple myeloma: Typical dose 150 mcg /kg daily for 4 weeks, repeated every 6 weeks.

Ovarian adrenocarcinoma: 200 mcg /kg daily for 5 days, repeated every 4-8 weeks.

Advanced breast cancer: 150 mcg /kg daily for 5 days, repeated every 6 weeks.

Polycythaemia vera: initially 6-10mg daily reduced after 5-7 days to 2-4mg daily until satisfactory response then further reduce to 2-6mg per week.