[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Alkylating agents](https://durgical.com/en/pharmacology/classes/alkylating-agents/) › Bendamustine

# Bendamustine

## Alkylating agents?

Alkylating agents

## High alert?

An error with this medicine can cause serious harm: double checks and protocols are used.

A nitrogen mustard with a purine-like ring, given intravenously for chronic lymphocytic leukaemia and indolent B-cell lymphoma.

Updated Nov 1, 2026

Also called: bendamustine hydrochloride

## Quick facts

**Group**
[Alkylating agents](https://durgical.com/en/pharmacology/classes/alkylating-agents/)

**Target**
DNA, cross-linked between strands

**Used for**
Chronic lymphocytic leukaemia

**Key effects**
Lymphopenia · Nausea · Fatigue

**Monitor**
Blood counts · Temperature and signs of infection

**ATC**
L01AA09

No doses: the clinician sets them by the current guideline.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Clinical What the labels mean

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

Bendamustine is a bifunctional derivative of mechlorethamine with a benzimidazole ring that resembles a purine. Its two chloroethyl arms form reactive groups that bond covalently to DNA and create cross-links between the strands, which trigger cell death through several pathways. It acts on both resting and dividing cells.

- The chloroethyl arms form reactive groups
- They bond to DNA and cross-link the two strands
- Resting and dividing lymphoma cells die

## Indications

- Chronic lymphocytic leukaemia. [Chronic lymphocytic leukaemia →](https://durgical.com/en/conditions/chronic-lymphocytic-leukaemia/)
- Indolent B-cell non-Hodgkin lymphoma that progressed during or soon after a rituximab-containing regimen. [Non-Hodgkin lymphoma →](https://durgical.com/en/conditions/non-hodgkin-lymphoma/)

## Adverse effects

### Common

- Lymphopenia, neutropenia, anaemia, thrombocytopenia
- Nausea, vomiting, diarrhoea
- Fatigue, fever
- Rash

### Serious (rare, important)

- Severe infections and reactivation of latent infections; progressive multifocal leukoencephalopathy
- Anaphylaxis and infusion reactions
- Tumour lysis syndrome
- Severe skin reactions (Stevens–Johnson syndrome, toxic epidermal necrolysis, DRESS); extravasation injury

## Contraindications

- Known hypersensitivity to bendamustine or to the product's excipients

## Key interactions

**CYP1A2 inhibitors**
Higher bendamustine levels and more adverse reactions.

**CYP1A2 inducers**
Lower levels and possibly less effect.

## What is monitored

- Blood counts (neutrophils and platelets) before each cycle
- Temperature and signs of infection
- Skin at every visit
- Uric acid, potassium and creatinine early in treatment (tumour lysis)

## Administration and safety

- The infusion site is watched during and after the infusion because of extravasation injury.
- Patients with milder infusion reactions are premedicated in later cycles.
- Hazardous drug: chemotherapy handling precautions.

## Pregnancy and breastfeeding

Can cause fetal harm; effective contraception is advised.

## Nursing care

- Watch for fever, chills or rash during and after each infusion.
- Check the infusion site for redness, swelling or pain.
- Report new confusion, weakness or vision changes (progressive multifocal leukoencephalopathy).
- Teaching: report fever, sores or blistering rash promptly.

## Pharmacokinetics

**Absorption**
Intravenous infusion.

**Metabolism**
Mainly hydrolysis; CYP1A2 forms minor active metabolites.

## Memory aid

«BENDamustine BENDs DNA in B-cell disease»: a mustard for CLL and indolent lymphoma; watch infections, infusion reactions and skin.

## Test yourself

Think of the answer, then tap the question to see it.

## Which part of bendamustine's structure resembles a purine?

Its benzimidazole ring.

## Which diseases is bendamustine mainly used for?

Chronic lymphocytic leukaemia and indolent B-cell non-Hodgkin lymphoma.

## Which liver enzyme interaction can raise bendamustine levels?

Inhibition of CYP1A2.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/bendamustine/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## What the labels mean

**High alert**
An error with this medicine can cause serious harm: double checks and protocols are used.

## Connections

## Related drugs 2

- [Chlorambucil](https://durgical.com/en/pharmacology/chlorambucil/)
- [Cyclophosphamide](https://durgical.com/en/pharmacology/cyclophosphamide/)

## Related conditions 2

- [Chronic lymphocytic leukaemia](https://durgical.com/en/conditions/chronic-lymphocytic-leukaemia/)
- [Non-Hodgkin lymphoma](https://durgical.com/en/conditions/non-hodgkin-lymphoma/)

[← Back to the class: Alkylating agents](https://durgical.com/en/pharmacology/classes/alkylating-agents/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - BENDAMUSTINE HYDROCHLORIDE injection, solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=085dd54c-4212-d879-afef-ee52732a48c0) (DailyMed (U.S. National Library of Medicine), 2026); [Bendamustine Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a608034.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=L01AA09) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/) (World Health Organization, 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/bendamustine/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/bendamustine/