Drug reference

Bendamustine

Alkylating agent + purine analog (antineoplastic) · Antineoplastic

Also known as Bendamustine hydrochloride, LEVACT

START

CLL: 100 mg/m² IV d1,2 q28d; NHL: 120 mg/m² IV d1,2 q21d

TYPICAL MAX

120 mg/m² per dose day

STOP IF

Grade ≥3 hypersensitivity, severe hepatotoxicity, or persistent cytopenia

WATCH

CBC, LFTs, infusion reactions; TLS prophylaxis in high-burden disease

CDSCO approvedSchedule HATC L01AA09

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 6min · infusion start
PEAK: 30min · end infusion
t½: 42min · t½ parent
DURATION: 4w · q28d cycle

EXCRETION

Renal/faecal — metabolites

route + CYP

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Can cause fetal harm — avoid; effective contraception during and 3 months after.

FDA category + note

Top interactionssee all 12 →

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Mechanism

Bifunctional alkylator with a benzimidazole purine-like ring and a nitrogen-mustard moiety — forms DNA crosslinks and disrupts DNA repair; activity in low-grade lymphoma and CLL.

Indications

Chronic lymphocytic leukaemia (CLL)Indolent B-cell non-Hodgkin lymphoma (rituximab-refractory)Multiple myeloma (selected)

Dosing

Adult: CLL: 100 mg/m² IV days 1, 2 of each 28-day cycle. Indolent NHL: 120 mg/m² IV days 1, 2 every 21 days. Reduce for cytopenias/hepatic dysfunction.
Pediatric: Specialist (paediatric AML/ALL regimens).
Renal adjustment: No adjustment for CrCl ≥40; CrCl <40 caution (use only if benefit clear).
Hepatic adjustment: Moderate (bilirubin 1.5–3): not recommended. Severe: contraindicated.
Geriatric: Higher cytopenia/infection risk; monitor.
Max dose: 120 mg/m² per cycle day (NHL)

Pharmacokinetics

Onset

Cytoreduction over cycles

Peak effect

End of infusion

Duration

21–28 day cycles

Half-life

~40 min (parent; active metabolites longer)

Bioavailability

IV 100%

Protein binding

~95%

Metabolism

Hepatic hydrolysis (rapid) + CYP1A2 (active hydroxymetabolites)

Excretion

Renal/faecal (metabolites)

Contraindications

Severe hypersensitivity to bendamustine / mannitol
Caution: significant hepatic impairment, marrow suppression, infection

Side effects

Common

Nausea/vomitingFatiguePyrexiaDiarrhoeaMyelosuppressionInfusion reactions

Serious

Severe myelosuppression / cytopenias
Severe infusion / hypersensitivity reactions
Hepatotoxicity / hepatic necrosis
Tumour lysis syndrome
Secondary malignancies (MDS)

Pregnancy & lactation

Pregnancy

Can cause fetal harm — avoid; effective contraception during and 3 months after.

Lactation

Avoid breastfeeding during and 1 week after therapy.