loe-MUS-teen

Therapeutic Classification: antineoplastics

Pharmacologic Classification: alkylating agents

• Used alone or with other agents for:
  • Primary and metastatic brain tumors,
  • Hodgkin’s disease.

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

• Death of rapidly replicating cells, particularly malignant ones.

Absorption: Rapidly absorbed following oral administration.

Distribution: Widely distributed. Active metabolites enter the CSF well. Enters breast milk.

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).

(effects on blood counts)

Contraindicated in:

• Hypersensitivity
• OB: Pregnancy (may cause fetal harm)
• Lactation: Lactation.

Use Cautiously in:

• Active infections
• ↓ bone marrow reserve (dosage ↓ required)
• Hepatic impairment
• Rep: Women of reproductive potential
• Geri: Older adults or patients with other chronic debilitating illnesses.

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: fibrosis, pulmonary infiltrates.

Misc: secondary malignancy (long-term use).

Drug-Drug:

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

• PO (Adults and Children): 100–130 mg/m² as a single dose every 6 wk.

• Capsules: 10 mg; 40 mg; 100 mg;

• 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 increased 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 or more of therapy.

• 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, reduce dose by 30%. If leukocytes <2000/mm³ or platelets <25,000/mm³, reduce dose by 50%. Hold dose for >6 wks 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 physician if leukocyte count is <4,000/mm³ or platelet count is <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 studies (AST, ALT, LDH, bilirubin) and renal function studies (BUN, serum creatinine) prior to and periodically during therapy to detect hepatotoxicity and nephrotoxicity.
  • May cause ↑ uric acid. Monitor periodically during therapy.

• PO: Administer on empty stomach at bedtime. Preadministration of an antiemetic and a hypnotic may help control nausea.
  • Wear impervious gloves when handling bottle containing lomustine 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.

• Instruct patient to take lomustine exactly as directed, even if nausea and vomiting occur. If vomiting occurs shortly after dose is taken, consult health care professional.
• 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; bleeding gums; bruising; petechiae; or blood in urine, stool, or emesis occurs. 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 decreased 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. Advise patient that, although lomustine may cause infertility, contraception is necessary because of potential teratogenic effects in the fetus. 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 3.5 mo after last dose. Advise women to avoid breastfeeding during and for 2 wk after last dose. May lead to decreased fertility for males and females.
• Emphasize need for periodic lab tests to monitor for side effects.

• Decrease in size and spread of malignant tissue.

Gleostine

CeeNu

NDC Code^*

• 58181- NextSource Biotechnology, LLC
  • 58181-3040- Gleostine
    • 58181-3040-5- 1 BOTTLE in 1 CARTON (58181-3040-5) > 5 CAPSULE, GELATIN COATED in 1 BOTTLE

• 58181- NextSource Biotechnology, LLC
  • 58181-3041- Gleostine
    • 58181-3041-5- 1 BOTTLE in 1 CARTON (58181-3041-5) > 5 CAPSULE, GELATIN COATED in 1 BOTTLE

• 58181- NextSource Biotechnology, LLC
  • 58181-3042- Gleostine
    • 58181-3042-5- 1 BOTTLE in 1 CARTON (58181-3042-5) > 5 CAPSULE, GELATIN COATED in 1 BOTTLE