Lomustine Chemotherapy: Uses, Dosage, and Side Effects Explained

Summary of Key Points

Lomustine is a chemotherapy medication used to treat various cancers, including brain tumors and Hodgkin’s lymphoma. It works by slowing or stopping the growth of cancer cells. Lomustine is typically taken as a single dose every 6 to 8 weeks. It is important to follow your doctor’s instructions carefully and report any side effects you may experience. Always consult your healthcare provider before making any changes to your treatment plan.

Names of Medication

US Brand Name: Gleostine

Generic Name: Lomustine

The generic name refers to the active ingredient, while the brand name is assigned by the manufacturer. In this case, Lomustine is the generic name.

Pharmacologic Category

Alkylating Agent: Lomustine belongs to a class of chemotherapy drugs known as alkylating agents. These medications work by damaging the DNA of cancer cells, preventing them from growing and dividing.

Lomustine Dosage

Lomustine is used to treat several types of cancer. Dosage and treatment schedules vary depending on the specific condition being treated. Always consult your doctor before adjusting your dose. Below are typical dosages for adults:

Lomustine for Hodgkin’s Lymphoma

Dosage: 100-130 mg/m² as a single dose every 6 to 8 weeks.

Lomustine for Non-Hodgkin’s Lymphoma

Dosage: 100-130 mg/m² as a single dose every 6 to 8 weeks.

Lomustine for Brain Tumors (including Glioblastoma, Medulloblastoma, Oligodendroglioma)

Dosage: 100-130 mg/m² as a single dose every 6 to 8 weeks.

Lomustine for Multiple Myeloma

Dosage: 130 mg/m² as a single dose every 6 weeks, often combined with other chemotherapy drugs.

Lomustine for Ewing’s Sarcoma

Dosage: 100-130 mg/m² as a single dose every 6 to 8 weeks.

Lomustine for Testicular Cancer

Dosage: 100-130 mg/m² as a single dose every 6 to 8 weeks.

Lomustine for Neuroblastoma

Dosage: 100-130 mg/m² as a single dose every 6 to 8 weeks.

Always follow your healthcare provider’s instructions. If you have any questions about your dosage or treatment plan, consult one of our providers through telemedicine for personalized advice.

Dosage Forms and Strengths

Lomustine is available in the following forms and strengths:

1. Capsules: 5 mg, 10 mg, 40 mg, 100 mg

Administration Instructions for Lomustine

Lomustine is taken orally as a single dose every 6 to 8 weeks. It should be taken on an empty stomach, at least 1 hour before or 2 hours after a meal, to help reduce nausea. Swallow the capsule whole with a full glass of water. Do not crush, chew, or open the capsules.

Since Lomustine can lower blood cell counts, your doctor will likely monitor your blood work regularly. Be sure to follow all instructions from your healthcare provider and report any unusual symptoms immediately.

Lomustine Side Effects and Adverse Reactions

Like all medications, Lomustine can cause side effects. Some are common, while others are rare but more serious. If you experience any side effects, contact your healthcare provider right away. Below are some potential side effects:

1. Nausea and Vomiting (Very Common): Many patients experience nausea or vomiting after taking Lomustine. Your doctor may prescribe medication to help manage these symptoms.
2. Low Blood Cell Counts (Very Common): Lomustine can reduce the number of white blood cells, red blood cells, and platelets, increasing the risk of infection, fatigue, and bleeding.
3. Fatigue (Common): Feeling unusually tired or weak is a common side effect. Rest and staying hydrated may help, but consult your doctor if it persists.
4. Hair Loss (Common): Some patients may experience hair thinning or loss during treatment.
5. Liver Toxicity (Rare but Serious): Lomustine can affect liver function. Your doctor will monitor your liver enzymes during treatment.
6. Lung Toxicity (Rare but Serious): In rare cases, Lomustine can cause lung damage. Report any new or worsening cough, shortness of breath, or chest pain to your doctor immediately.

Contraindications for Lomustine

A contraindication is a specific condition where a medication should not be used due to potential harm. For Lomustine, several contraindications exist. If any of the following apply to you, discuss them with your healthcare provider before starting Lomustine. You can also schedule a telemedicine appointment with one of our providers to review your medical history and ensure Lomustine is safe for you.

1. Severe bone marrow suppression: Lomustine can further suppress bone marrow function, leading to dangerously low blood cell counts. If you already have severe bone marrow suppression, Lomustine could increase the risk of serious infections, bleeding, and anemia.
2. Severe liver or kidney disease: Lomustine is processed by the liver and kidneys. If these organs are not functioning properly, the drug may not be cleared effectively, leading to toxic levels and increased side effects.
3. Allergy to Lomustine or similar drugs: If you have a known allergy to Lomustine or other nitrosoureas (a class of chemotherapy drugs), taking this medication could cause a severe allergic reaction.
4. Pregnancy: Lomustine can harm an unborn baby (see more details in the pregnancy section below).

Drug to Drug Interactions

Lomustine, a chemotherapy drug, can interact with other medications, potentially increasing side effects or reducing its effectiveness. It’s important to inform your healthcare provider about all the medications you are taking, including prescription drugs, over-the-counter products, and supplements. Below are some medications that may interact with Lomustine:

1. Phenytoin (Dilantin): This anti-seizure medication may decrease the effectiveness of Lomustine.
2. Warfarin (Coumadin): Lomustine can increase the risk of bleeding when taken with blood thinners like warfarin.
3. Live vaccines: Vaccines such as the measles, mumps, and rubella (MMR) vaccine may be less effective when taken with Lomustine, and there may be an increased risk of infection.
4. Other chemotherapy drugs: Combining Lomustine with other chemotherapy agents may heighten the risk of severe bone marrow suppression.

Lomustine in Pregnancy

Is it Safe to Take Lomustine During Pregnancy?

No, Lomustine is not safe during pregnancy. This chemotherapy drug has been shown to cause harm to an unborn baby, including birth defects and miscarriage. If you are pregnant or planning to become pregnant, you should not take Lomustine. Women of childbearing age should use effective contraception while taking Lomustine and for a period after treatment. If you become pregnant while taking Lomustine, contact your healthcare provider immediately to discuss your options. You can also schedule a telemedicine consultation with one of our providers for further guidance.

Lomustine While Breastfeeding

Is it Safe to Take Lomustine While Breastfeeding?

No, Lomustine is not safe while breastfeeding. Although it is unclear whether Lomustine passes into breast milk, the potential for serious side effects in a nursing infant means breastfeeding is not recommended while taking this medication. If you are currently breastfeeding or plan to breastfeed, discuss alternative options with your healthcare provider.

Estimated Cost of Lomustine Medication

The cost of Lomustine can vary depending on the pharmacy and location. Without insurance, the estimated cost of a 30-day supply of Lomustine using a GoodRx coupon is approximately $500 to $1,000. Prices may fluctuate, so it’s a good idea to check with your local pharmacy or use a prescription discount service like GoodRx to find the best available price.

Possible Alternatives to Lomustine

If Lomustine is not the right option for you, there are alternative treatments available for the conditions it is commonly used to treat. Always consult with your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine visit with one of our providers to explore these alternatives.

1. Hodgkin’s lymphoma: Other chemotherapy regimens, such as ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine), or radiation therapy may be considered as alternatives.
2. Non-Hodgkin’s lymphoma: Rituximab (Rituxan) combined with chemotherapy (e.g., CHOP regimen) is a common alternative treatment.
3. Brain tumors: Temozolomide (Temodar) is often used as an alternative chemotherapy drug for brain tumors, particularly gliomas.
4. Multiple myeloma: Bortezomib (Velcade) and lenalidomide (Revlimid) are other common treatments for multiple myeloma.
5. Glioblastoma: In addition to Temozolomide, radiation therapy and targeted therapies like bevacizumab (Avastin) may be used.
6. Medulloblastoma: Surgery, radiation therapy, and chemotherapy with drugs like cisplatin and vincristine are common alternatives.
7. Ewing’s sarcoma: Surgery, radiation, and chemotherapy with drugs such as vincristine, doxorubicin, and cyclophosphamide are often used.
8. Oligodendroglioma: Temozolomide and radiation therapy are common alternatives to Lomustine for this type of brain tumor.
9. Testicular cancer: Cisplatin-based chemotherapy regimens (e.g., BEP: Bleomycin, Etoposide, and Cisplatin) are commonly used.
10. Neuroblastoma: Surgery, radiation, and chemotherapy with drugs like cyclophosphamide and doxorubicin are common treatments.

Recent Updates on Lomustine Research

Recent studies have focused on improving the effectiveness of Lomustine in treating brain tumors, particularly glioblastoma. Researchers are investigating combination therapies that include Lomustine with newer targeted drugs and immunotherapies. One promising area of research is the combination of Lomustine with bevacizumab (Avastin), which has shown potential in improving survival rates for patients with recurrent glioblastoma. Additionally, clinical trials are exploring the use of Lomustine in combination with other chemotherapy agents to reduce tumor resistance and improve outcomes.

As research continues, it is important to stay informed about new developments in treatment options. If you are currently taking Lomustine or considering it as part of your treatment plan, we encourage you to discuss the latest research with your healthcare provider. You can also book a telemedicine appointment with one of our providers to review your treatment options and stay up-to-date on the latest advancements in cancer care.

James Kingsley

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