Lomustine (Oral)

Overview

Used to treat certain types of cancers, Lomustine is effective against malignancies in the blood and solid tumors. Although Lomustine can be used to treat some types of lung cancers, non-Hodgkin's lymphoma and melanoma, it is primarily used to treat primary or metastatic brain tumors.

Like many antineoplastic agents, Lomustine affects the replication and growth of cells. By cross-linking deoxyribonucleic acid (DNA) and ribonucleic acid (RNA), Lomustine prevents the cells from replicating and, therefore, stops the cancer from spreading. In addition to this, Lomustine acts as a cytotoxic agent and induces cell death. As a result, Lomustine can facilitate the destruction of existing cancer cells, as well as preventing the disease from worsening and/or spreading to other areas of the body.

As Lomustine is a lipid-soluble medication, it is able to cross the blood-brain barrier. Due to this, Lomustine is a first-line treatment for brain tumors and other cancers affecting this area. Although Lomustine is effective in destroying cancer cells, it can also affect healthy cells in the patient's body. When this happens, patients can experience side effects as a result of their treatment. In some cases, Lomustine can cause patients to develop side effects months or years after their treatment and the medication may have a permanent effect on some people.

Similar to many antineoplastic medicines, the use of Lomustine does carry some risks. Despite this, the benefits of treatment with Lomustine generally outweigh the risks of developing long-term or permanent side effects.

Whilst Lomustine may be used as a monotherapy, it can also be used alongside other chemotherapy drugs or anti-cancer medications. If patients are prescribed Lomustine amongst other treatments, their dose of medication may be modified or altered to reflect this. Although patients may experience some side effects during their treatment, if Lomustine is used successfully, cancer cells within the patient's body can be destroyed and, as a result, their prognosis can be significantly improved.

Conditions Treated

Brain tumors

Non-Hodgkin's lymphoma

Melanoma

Lung cancer

Type Of Medicine

Alkylating nitrosourea compound

Chemotherapy drug

Side Effects

Before patients are treated with Lomustine, they should discuss the possibility of side effects occurring with their physician. Often, doctors and nurses are able to advise patients how to minimize the side effects associated with chemotherapy treatment. When patients are taking Lomustine, they may develop any of the following side effects:

  • Blurred vision
  • Darkening of the skin
  • Changes in rhythms and patterns of speech
  • Shakiness and/or unsteady walk
  • Confusion about time, place and identity
  • Decreased vision
  • Thinning of the hair and hair loss
  • Eye pain
  • Diarrhea
  • Inflammation or swelling of the mouth
  • Unusual dullness, drowsiness, weakness, tiredness or a feeling of sluggishness
  • Trouble with speaking
  • Trembling, unsteadiness or other problems with coordination or muscle control

Although the above side effects can be distressing, if they are fairly mild, patients may not require additional treatment. However, if patients experience the following side effects when taking Lomustine, they should inform their physician immediately:

  • Bleeding gums
  • Stomach or abdominal tenderness or pain
  • Chest pain
  • Unusual weakness or tiredness
  • Shortness of breath
  • Unusual bruising or bleeding
  • Sore throat
  • Ulcers, white spots or sores in the mouth or on the lips
  • Awkwardness
  • Tarry, black stools
  • Swelling of the lower legs or feet
  • Blood in the stools or urine
  • Troubled breathing with exertion
  • Confusion
  • Hoarseness or cough
  • Decrease in urination
  • Chills or fever
  • Pain in the side or lower back
  • Difficulty or painful urination
  • Slurred speed
  • Pale skin
  • Red, pinpoint spots on the skin
  • Bone pain
  • Change in the amount of urine or the frequency of urination
  • Nausea or vomiting
  • Clay-colored stools
  • Itching
  • Dark urine
  • Increased thirst
  • Decreased appetite
  • Increased blood pressure
  • Dizziness
  • Loss of appetite
  • Drowsiness
  • Rash on the skin
  • Dry mouth
  • Weight gain
  • Headache
  • Yellowing of the skin or eyes

Although patients may experience side effects when taking Lomustine, the medication can also cause patients to develop delayed side effects which may become apparent months or years after their treatment. Taking Lomustine may increase the patient's risk of developing certain types of cancers, such as leukemia, for example. If patients notice any side effects following treatment with Lomustine, they should obtain medical help straight away.

Dosage

When patients are prescribed Lomustine, their dose will depend on numerous factors, such as their condition, their age, weight and medical history. If patients are being treated for a brain tumor, they are usually advised to take 130mg per square meter of body surface area. Typically, this is taken as a single dose every six weeks.

However, patients should always follow their physician's instructions when taking Lomustine and should be aware that their dose could be modified. When patients are prescribed Lomustine, their physician will assist them in calculating the appropriate dose to take, based on their body surface area.

When patients are given Lomustine capsules, they may notice that the capsules are different colors. Although patients should always check that they've been given the right dose of medication, being given different colored capsules is not uncommon. This simply means that each capsule contains a different amount of medication and they are used in conjunction to ensure that the patient takes the appropriate dose of Lomustine.

Patients should not touch Lomustine capsules unnecessarily and should use disposable gloves when handling the medication. Patients should not open, crush or break the capsules. If the medication comes into contact with the patient's nose, mouth or ears, they should rinse the affected area with clean water. Similarly, if Lomustine gets into the patient's eyes, they should rinse them with clean water and contact their doctor immediately.

Whilst taking Lomustine, patients may experience nausea and/or vomiting. This may be worsen in the 24 hours after patients have taken a dose of Lomustine. If symptoms persist, patients should seek medical advice. If patients vomit shortly after taking Lomustine, they should notify their physician as they may need to take more medication.

Patients may be advised to take Lomustine at bedtime, on an empty stomach, as this can help to reduce stomach discomfort and upsets.

If patients are taking Lomustine alongside other medications, they may need to take certain medicines at different times. Patients should ask their physician to help them create a treatment schedule so that they are taking the right dose of each medication at the appropriate time.

It is important that Lomustine is taken in accordance with a fixed schedule. If patients forget to take a dose of Lomustine, they should contact their physician for advice.

Potential Drug Interactions:

Although Lomustine can be taken alongside some other medications, it cannot be used in conjunction with all medicines. Due to this, patients should tell their physician if they are using any other medications, supplements or vitamins before they start taking Lomustine. In most cases, patients will not be treated with Lomustine if they have recently been given the following vaccines:

  • Mumps Virus Vaccine, Live
  • Rotavirus Vaccine, Live
  • Measles Virus Vaccine, Live
  • Varicella Virus Vaccine
  • Rubella Virus Vaccine, Live

Similarly, Lomustine is not usually recommended for use if patients have recently received the following vaccines:

  • Adenovirus Vaccine
  • Influenza Virus Vaccine, Live
  • Bacillus of Calmette and Guerin Vaccine, Live
  • Smallpox Vaccine
  • Typhoid Vaccine
  • Cholera Vaccine, Live
  • Yellow Fever Vaccine
  • Poliovirus Vaccine, Live

Once patients have started taking Lomustine, they should obtain medical advice before using any new medicines, vitamins or supplements.

Warnings

If patients have any other health conditions, they should notify their physician before they start taking Lomustine. There are some conditions which can affect treatment with this medication and they may include:

  • Low levels of white blood cells in the blood (Leukopenia)
  • Bone marrow problems
  • Low levels of red blood cells in the blood (Anemia)
  • Shingles (Herpes zoster)
  • Lung disease
  • Chickenpox
  • Low levels of platelets in the blood (Thrombocytopenia)
  • Kidney disease
  • Infection

During and following treatment with Lomustine, patients should not have any vaccines without their doctor's express approval. This medication can affect the patient's immune system and they could develop the condition or illness the vaccine is trying to prevent. Similarly, other people in the patient's household should not have the oral polio vaccine as the virus could be transferred to the patient. Patients should avoid people who have recently had vaccinations and/or wear a protective face mask to reduce the risk of contracting an illness.

If patients develop the following symptoms when taking Lomustine, they should obtain immediate medical help:

  • Dry cough
  • Chills
  • Sore throat
  • Fever
  • Shortness of breath
  • Confusion
  • Unusual bruising or bleeding
  • Swelling of the lower legs or feet
  • Yellowing of the skin or eyes

Lomustine can temporarily lower the amount of platelets and/or white blood cells in the patient's blood. Due to this, patients may have problems with excessive bleeding and may be prone to illness and infection. If patients feel unwell or exhibit symptoms of an infection, they should access medical treatment straight away.

In order to avoid any complications, patients should try to avoid other people who they know are unwell and should wash their hands before touching their face. Patients should also avoid contact sports or potential injury-inducing activities. Due to the risk of bleeding gums, patients may also need to modify their oral hygiene routine while they are taking Lomustine.

If patients exhibit any of the following symptoms whilst taking Lomustine, they should access medical help straight away:

  • Tarry, black stools
  • Chills
  • Hoarseness
  • Fever
  • Pain in the lower back or side
  • Cough
  • Blood in the stools or urine
  • Difficulty or painful urination
  • Red pinpoint spots on the skin

If Lomustine is taken by patients who are pregnant, it can cause severe harm to the unborn fetus. Due to this, Lomustine should only be used to treat pregnant patients in a life-threatening situation. Patients are usually advised to use an effective form of birth control whilst they are taking Lomustine and for some time after their final dose.

If patients become pregnant whilst taking Lomustine or shortly after their treatment has been discontinued, they should inform their physician immediately.

Due to the risks to the infant, patients are advised not to breastfeed whilst taking Lomustine or for some time after their treatment has finished. Patients should obtain medical advice before breastfeeding, even if their treatment finished some time ago.

Before using Lomustine, patients should inform their physician if they have any known allergies. This includes allergies to medicines, animals, dyes, foods and/or preservatives. In rare cases, patients may develop an allergic reaction when taking Lomustine. If so, they will require emergency medical treatment. An allergic reaction may include the following symptoms:

  • Itching
  • Hoarseness
  • Wheezing
  • Hives
  • Shortness of breath
  • Difficulty swallowing
  • Difficulty breathing
  • Swelling of the face, hands, tongue, lips, throat or mouth
  • Rash on the skin

Storage

Due to the strength and toxicity of Lomustine, patients should use extreme caution when keeping the medication at home. It is essential that Lomustine is stored in a safe location and that children and/or pets cannot access it.

Generally, Lomustine can be kept at room temperature, providing it is protected from heat, light and moisture. However, patients should follow the manufacturer's instructions when storing Lomustine.

If the medication reaches its use-by date or if patients are advised to stop taking Lomustine, they should dispose of it carefully. Lomustine should not be discarded along with regular household waste as it may pose a risk to other people. Patients should contact their physician's office or pharmacist and make use of a specialist medicine disposal service.

Summary

Although Lomustine is associated with a number of short and long-term side effects, treatment with Lomustine may be required in order to save the patient's life. Whilst patients should be warned of the risks associated with this medication, treatment with Lomustine may be preferable to leaving their condition untreated.

When patients are prescribed Lomustine, they should be monitored regularly and regular tests should be carried out to ensure the medication isn't having any unwanted effects. As Lomustine is able to prevent the growth of cancer cells and promotes cell death, the medication can be effective in preventing the spread of cancer and destroying existing cancer cells within the patient's body.