lomustine

Absorption: Rapidly absorbed following oral administration.

Distribution: Widely distributed. Active metabolites enter the CSF well.

Metabolism/Excretion: Mostly metabolized by the liver. Some metabolites are active antineoplastic agents. Metabolites are excreted by the kidneys.

Half-Life: 1–2 days (active metabolites).

Time/Action Profile ⬆ ⬇

(effects on blood counts)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	4–7 wk	1–2 wk

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Active infection;
↓bone marrow reserve (↓ dose);
Hepatic impairment;
Rep: Women of reproductive potential;
Geri: Older adults or patients with other chronic debilitating illnesses.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: alopecia

Endo: infertility

GI: nausea, vomiting, anorexia, hepatotoxicity, stomatitis

GU: azotemia, renal failure

Hemat: leukopenia, thrombocytopenia, anemia

Metab: hyperuricemia

Neuro: ataxia, disorientation, dysarthria, lethargy

Resp: pulmonary fibrosis, pulmonary infiltrates

Misc: SECONDARY MALIGNANCY(WITH LONG-TERM USE)

Interactions ⬆ ⬇

Drug-drug:

↑bone marrow depression with other antineoplastics or radiation therapy.
May ↓ antibody response to live-virus vaccines and ↑ risk of adverse reactions.

Route/Dosage ⬆ ⬇

PO (Adults and Children ): 100–130 mg/m² every 6 wk.

Availability ⬆ ⬇

Capsules: 10 mg; 40 mg; 100 mg

Assessment ⬆ ⬇

Monitor for bone marrow depression. Assess for bleeding (bleeding gums; bruising; petechiae; guaiac stools, urine, and emesis) and avoid IM injections and rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. Anemia may occur. Monitor for ↑ fatigue, dyspnea, and orthostatic hypotension.
Assess for nausea and vomiting; usually begin within 3 hr of administration and persist for 24 hr. Prophylactic antiemetics may be used. Monitor intake and output, daily weight, and appetite. Adjust diet as tolerated for anorexia.
Assess pulmonary function tests prior to initiation of therapy and periodically during therapy. Pulmonary toxicity may occur with cumulative doses of 600–1100 mg or with ≥6 mo of therapy.

Lab Test Considerations:

Monitor CBC and differential prior to and weekly during therapy. If leukocytes ≥3,000/mm³ or platelets ≥75,000/mm³, do not adjust dose. If leukocytes 2,000–2,999/mm³ or platelets 25,000–74,999/mm³,↓ dose by 30%. If leukocytes <2000/mm³ or platelets <25,000/mm³,↓ dose by 50%. Hold dose for >6 wk if necessary until platelet count recovers to ≥100,000/mm³ and leukocytes recover to ≥4,000/mm³. The nadir of leukopenia occurs in 4–6 wk. The nadir of thrombocytopenia occurs in 4 wk. Notify provider if leukocyte count <4,000/mm³ or platelet count <100,000/mm³. Recovery from leukopenia and thrombocytopenia occurs in 1–2 wk. Myelosuppression is cumulative; subsequent courses of therapy should be delayed until recovery occurs.
- Monitor liver function tests (AST, ALT, LDH, bilirubin) and renal function (BUN, serum creatinine) prior to and periodically during therapy.
- May cause ↑ uric acid. Monitor periodically during therapy.
- Obtain hepatitis B virus screening and management before starting therapy. Past infection may require antiviral prophylaxis and monitoring.

Implementation ⬆ ⬇

Administer only enough capsules for one dose. One dose is taken every 6 wk.
PO: Administer on empty stomach at bedtime. Antiemetics are recommended to prevent nausea and vomiting.
- Wear impervious gloves when handling bottle containing capsules to minimize risk of dermal exposure. DNC: Do not break capsules; avoid exposure to broken capsules. If dermal contact occurs, wash areas of skin contact immediately and thoroughly.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Advise patient to readPatient Information before starting therapy. Emphasize need for periodic lab tests. Instruct patient to take exactly as directed, even if nausea and vomiting occur. If vomiting occurs shortly after dose is taken, consult health care professional.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Inform patient that several different types of capsules may be found in medication container. Patient should take all the capsules at one time to receive the correct dose.
Advise patient to notify health care professional promptly if fever, chills, sore throat, signs of infection, or signs of bleeding occur. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor. Caution patient not to drink alcoholic beverages or take products containing aspirin or other NSAIDs.
Instruct patient to notify health care professional if abdominal pain, yellow skin, weakness, cough, slurred speech, or ↓ urine output occurs.
Instruct patient to inspect oral mucosa for redness and ulceration. If ulceration occurs, advise patient to use sponge brush and rinse mouth with water after eating and drinking. Consult health care professional if pain interferes with eating. Stomatitis pain may require treatment with opioid analgesics.
Discuss with patient the possibility of hair loss. Explore coping strategies.
Instruct patient not to receive any vaccinations without advice of health care professional.
Rep: May cause fetal harm. Instruct females of reproductive potential to use effective contraception during and for 2 wk after final dose. Instruct males with female partners of reproductive potential to use effective contraception during and for 4 mo after last dose. Advise women to avoid breastfeeding during and for 2 wk after last dose. May lead to fertility for males and females.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇