Temozolomide: Uses, Dosage, and Side Effects Explained

Summary of Key Points

Temozolomide is a prescription medication used to treat certain types of brain tumors, including glioblastoma and anaplastic astrocytoma. It works by slowing or stopping the growth of cancer cells. Available in both capsule and powder form, Temozolomide is typically taken once daily. Like all medications, it may cause side effects, so it’s important to take it exactly as prescribed and consult your healthcare provider if you have any concerns.

Names of Medication

US Brand Name: Temodar (Temozolomide)

The generic name refers to the chemical composition of the medication, while the brand name is assigned by the manufacturer. In this case, Temozolomide is the generic name.

Pharmacologic Category

Alkylating Agent

Other medications in this category include: Carmustine, Lomustine, Dacarbazine

Temozolomide Dosage

Temozolomide is used to treat various cancers, including brain tumors and melanoma. Dosage varies depending on the condition being treated. Always consult your healthcare provider before making any changes to your dose. If you need to discuss your treatment plan, you can schedule a telemedicine appointment with one of our providers.

Temozolomide for Glioblastoma

The typical dose is 75 mg/m² once daily for 42 days, followed by a 28-day break. After this, the dose increases to 150-200 mg/m² for 5 days every 28 days, for up to 6 cycles.

Temozolomide for Anaplastic Astrocytoma

The usual dose is 150 mg/m² once daily for 5 days every 28 days. This cycle may be repeated for up to 12 cycles.

Temozolomide for Other Brain Tumors

The dose is typically 150-200 mg/m² once daily for 5 days every 28 days.

Temozolomide for Oligodendroglioma

The dose is 150-200 mg/m² once daily for 5 days every 28 days.

Temozolomide for Melanoma

The dose is 150-200 mg/m² once daily for 5 days every 28 days.

Temozolomide for Neuroblastoma

The dose is 150-200 mg/m² once daily for 5 days every 28 days.

Temozolomide for Ependymoma

The dose is 150-200 mg/m² once daily for 5 days every 28 days.

Temozolomide for Medulloblastoma

The dose is 150-200 mg/m² once daily for 5 days every 28 days.

Temozolomide for Pancreatic Cancer

The dose is 150-200 mg/m² once daily for 5 days every 28 days.

Temozolomide for Colorectal Cancer

The dose is 150-200 mg/m² once daily for 5 days every 28 days.

Dosage Forms and Strengths

Capsules: 5 mg, 20 mg, 100 mg, 140 mg, 180 mg, 250 mg

Powder for Oral Suspension: 100 mg/5 mL

Administration Instructions for Temozolomide

Temozolomide should be taken on an empty stomach, at least one hour before or two hours after a meal. Swallow the capsules whole with water. Do not crush, chew, or open the capsules. If you miss a dose, take it as soon as you remember, unless it’s almost time for your next dose. In that case, skip the missed dose and continue with your regular schedule. Do not double the dose to make up for a missed one.

Temozolomide Side Effects

Like all medications, Temozolomide can cause side effects. Some are common and mild, while others may be more serious. Always report any side effects to your healthcare provider. If you experience severe side effects, seek medical attention immediately.

Common Side Effects of Temozolomide

1. Nausea and vomiting: These are the most frequent side effects. Taking the medication on an empty stomach may help reduce these symptoms.
2. Fatigue: Feeling unusually tired is common during treatment.
3. Loss of appetite: You may notice a decrease in your desire to eat.

Less Common Side Effects

1. Hair loss: Some patients experience thinning or loss of hair during treatment.
2. Headache: You may experience mild to moderate headaches.
3. Constipation: Difficulty with bowel movements can occur.

Serious Side Effects

1. Low blood cell counts: Temozolomide can lower the number of white blood cells, red blood cells, and platelets, increasing the risk of infection, anemia, or bleeding.
2. Allergic reactions: Signs include rash, itching, swelling, severe dizziness, or trouble breathing.
3. Liver problems: Symptoms may include yellowing of the skin or eyes, dark urine, or severe stomach pain.

Contraindications for Temozolomide

A contraindication is a specific condition where a medication should not be used because it may cause harm. It’s essential to know if you have any contraindications before starting Temozolomide.

Contraindications for Temozolomide Treatment

Allergic reaction to Temozolomide or dacarbazine (DTIC): If you’ve had an allergic reaction to Temozolomide or a similar chemotherapy drug like dacarbazine, you should not take Temozolomide. Allergic reactions can be life-threatening and may include symptoms such as rash, swelling, or difficulty breathing.

Severe bone marrow suppression: Temozolomide can reduce the number of blood cells your bone marrow produces, increasing the risk of infections, bleeding, and anemia. If you already have low blood cell counts, taking Temozolomide could worsen this condition.

Pregnancy: Temozolomide can harm an unborn baby. It is contraindicated during pregnancy unless the potential benefit outweighs the risk. If you are pregnant or planning to become pregnant, consult your healthcare provider before taking Temozolomide.

Severe liver or kidney disease: Temozolomide is processed by the liver and kidneys. If you have severe liver or kidney disease, your body may not handle the medication safely, leading to increased side effects or toxicity.

Drug to Drug Interactions

Temozolomide can interact with other medications, potentially increasing side effects or reducing treatment effectiveness. Inform your healthcare provider about all medications you are taking, including over-the-counter drugs and supplements.

Medications that Interact with Temozolomide

Valproic acid (Depakote): This anti-seizure medication may increase the risk of bone marrow suppression when taken with Temozolomide.

Phenytoin (Dilantin): Another anti-seizure medication, phenytoin, may decrease the effectiveness of Temozolomide by speeding up how quickly your body processes the drug.

Carbamazepine (Tegretol): This medication, used to treat seizures and mood disorders, can also reduce the effectiveness of Temozolomide by increasing its breakdown in the liver.

Clozapine (Clozaril): An antipsychotic medication, clozapine may increase the risk of bone marrow suppression when used with Temozolomide.

Warfarin (Coumadin): This blood thinner may increase the risk of bleeding when taken with Temozolomide, as both can affect blood clotting.

Temozolomide in Pregnancy

Is it safe to take Temozolomide when pregnant?

No, Temozolomide is not considered safe during pregnancy. It is classified as a Category D medication, meaning there is evidence of potential harm to an unborn baby. Temozolomide can lead to birth defects or miscarriage. If you are pregnant or planning to become pregnant, it’s crucial to discuss alternative treatment options with your healthcare provider. Should you become pregnant while taking Temozolomide, contact your healthcare provider immediately. Our telemedicine providers are available to guide you through these concerns and help you make informed decisions.

Temozolomide while Breastfeeding

Is it safe to take Temozolomide while breastfeeding?

No, it is not safe to take Temozolomide while breastfeeding. The medication can pass into breast milk and may pose risks to a nursing infant. If you are breastfeeding or planning to breastfeed, it’s important to discuss this with your healthcare provider before starting Temozolomide. They may recommend either discontinuing breastfeeding or considering alternative treatments. If you have any concerns, our telemedicine providers are here to support you in making the best decision for both your health and your baby’s well-being.

Estimated Cost of Temozolomide

The cost of a 30-day supply of Temozolomide can vary depending on the dosage and the pharmacy you use. Without insurance, and with the help of a GoodRX coupon, the estimated cost for a 30-day supply of Temozolomide (100 mg) ranges from approximately $2,000 to $3,000. Prices may fluctuate, so it’s advisable to check with your pharmacy or use a discount service like GoodRX to find the most affordable option.

Possible Alternatives to Temozolomide Treatment

Depending on the type of cancer or condition you are being treated for, there may be alternative treatments or lifestyle changes that could be beneficial. It’s essential to discuss these options with your healthcare provider before making any changes to your treatment plan. Our telemedicine providers can assist you in exploring these alternatives and finding the best approach for your specific situation.

Glioblastoma Treatment Options

1. Radiation therapy: Often used alongside chemotherapy, radiation therapy can help shrink tumors and slow their progression.
2. Targeted therapy: Drugs like bevacizumab (Avastin) may target specific pathways that contribute to tumor growth.
3. Clinical trials: New treatments are continually being studied, and participating in a clinical trial may be an option worth considering.

Anaplastic Astrocytoma Treatment

1. Surgery: In some cases, surgery may be an option to remove as much of the tumor as possible.
2. Radiation therapy: Often used after surgery to target any remaining cancer cells.

Brain Tumor Treatment Options

1. Observation: For slow-growing tumors, your healthcare provider may recommend regular monitoring with imaging tests.
2. Targeted therapy: Some brain tumors may respond to targeted therapies that attack specific cancer cells.

Oligodendroglioma Treatment

1. Chemotherapy: Other chemotherapy drugs, such as procarbazine, lomustine, and vincristine, may be used as alternatives to Temozolomide.

Melanoma Treatment Options

1. Immunotherapy: Drugs like pembrolizumab (Keytruda) or nivolumab (Opdivo) can help boost the immune system to fight cancer cells.
2. Targeted therapy: If your melanoma has specific genetic mutations, targeted therapies like vemurafenib (Zelboraf) may be effective.

Neuroblastoma Treatment

1. Surgery: In some cases, surgery may be used to remove the tumor.
2. Stem cell transplant: High-dose chemotherapy followed by a stem cell transplant may be an option for certain patients.

Ependymoma Treatment

1. Radiation therapy: Often used after surgery to target any remaining cancer cells.

Medulloblastoma Treatment

1. Radiation therapy: A common treatment for medulloblastoma, especially in children.
2. Chemotherapy: Other chemotherapy drugs may be used in combination with radiation therapy.

Pancreatic Cancer Treatment Options

1. Surgery: If the cancer is detected early, surgery may be an option to remove the tumor.
2. Targeted therapy: Drugs like erlotinib (Tarceva) may target specific cancer cells.

Colorectal Cancer Treatment

1. Surgery: Surgery is often the first-line treatment for colorectal cancer.
2. Immunotherapy: For certain types of colorectal cancer, immunotherapy drugs like pembrolizumab (Keytruda) may be an option.

Recent Updates on Temozolomide Research

Recent studies have focused on enhancing the effectiveness of Temozolomide, particularly for patients with glioblastoma. Researchers are exploring the combination of Temozolomide with other therapies, such as immunotherapies, to improve its ability to target cancer cells. Additionally, ongoing clinical trials are investigating the use of Temozolomide in other cancers, including melanoma and pancreatic cancer, to assess its potential benefits in these areas. As research progresses, new treatment options may become available. It’s important to stay informed and discuss any new developments with your healthcare provider. If you have questions about ongoing research or clinical trials, our telemedicine providers are here to help you understand your options and guide you through the decision-making process.

James Kingsley

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