lomustine

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.

Availability ⬆ ⬇

Capsules: 10 mg; 40 mg; 100 mg

Route/Dosage ⬆ ⬇

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

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Inhibits DNA and RNA synthesis by alkylation (cell-cycle phase-nonspecific).

Therapeutic effects:

Death of rapidly replicating cells, particularly malignant ones.

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: alkylating agents

Pharmacokinetics ⬆ ⬇

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).

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

(effects on blood counts)

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

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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Indications ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇