Indications
Lomustine (also called CCNU) is an anticancer medicine taken by mouth. It is used to treat certain brain tumours, such as gliomas and medulloblastoma, and is sometimes used for Hodgkin lymphoma when other treatments have not worked. It is used only under the care of a cancer specialist.
How It Works
Lomustine is an alkylating agent of the nitrosourea group. It attaches to the DNA of dividing cells and links its strands together, so cancer cells cannot copy their DNA and die. Because it dissolves easily in fat, it can cross into the brain, which makes it useful for brain tumours.
Dosage and Administration
Lomustine is taken as prescribed by a cancer specialist, usually as a single dose once every 6 weeks, with the dose based on body size and blood counts. Take it exactly as directed; it is not a daily medicine. Taking extra doses can cause dangerous, even fatal, bone marrow damage. It is usually taken on an empty stomach, often at bedtime, with anti-sickness medicine if advised. Swallow capsules whole; do not open or crush them. Carers should wear gloves when handling capsules.
Interactions
Other medicines that lower blood counts, such as other chemotherapy or Clozapine, increase the risk of bone marrow suppression. Live vaccines (for example oral polio, yellow fever, measles mumps rubella) should not be given during treatment. Tell your doctor about all medicines, herbal products and supplements you use.
Contraindications
Do not use if allergic to Lomustine, if you have severe bone marrow suppression, during pregnancy or breastfeeding, or in people with coeliac disease or wheat allergy if the capsule contains wheat starch.
Side Effects
Common side effects are nausea and vomiting (usually within hours of a dose), loss of appetite, hair thinning, mouth sores, tiredness, and delayed lowering of blood counts (usually 4 to 6 weeks after a dose), which raises the risk of infection, bleeding and anaemia. Long term use can affect the lungs, kidneys and liver, and may raise the risk of a second cancer later.
Get urgent medical help for fever or chills, unusual bruising or bleeding, blood in urine or stools, new or worsening cough or breathlessness, yellowing of the skin or eyes, or severe vomiting that stops you keeping fluids down.
Pregnancy and Lactation
Lomustine can harm an unborn baby. Both men and women must use reliable contraception during treatment and for a period afterwards, as advised by the specialist. It may cause infertility; ask about fertility preservation before starting. Do not breastfeed during treatment.
Precautions and Warnings
Regular blood tests are needed before each dose and for several weeks after. Lung function and liver and kidney tests may be checked. Avoid contact with people who have infections, and report any sign of infection early. Do not take any extra capsules from the pack; only the prescribed number for that cycle should be dispensed.
Overdose
Overdose can cause life threatening bone marrow failure. If more than the prescribed dose is taken, go to hospital immediately with the pack. There is no specific antidote; supportive care is given.
Therapeutic Class
Antineoplastic agent, alkylating agent (nitrosourea).
Storage
Store below 30°C in a dry place, away from light, in the original pack. Keep well out of the reach of children; this is a cytotoxic medicine.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.