Article Contents ::

Details About Generic Salt ::  Lomustin

Main Medicine Class::    

LOW-muss-teen
CeeNU
Capsules
10, 40, and 100 mg
Class: Alkylating agent
Nitrosoureas

 Indications

Adult

Brain tumors, Hodgkin disease.

Pediatric

Brain tumors, Hodgkin disease.

 Contraindications Standard considerations.

 Route/Dosage

Brain Tumors, Hodgkin Disease

ADULTS: PO 100 to 130 mg/m2 administered as a single dose q 6 wk. Do not administer repeat doses of lomustine until leukocyte and platelet counts have recovered to acceptable levels (usually 4000/mm3 and 100,000/mm3, respectively). Reduce lomustine dose if administered with other myelosuppressive drugs. Give 100 mg/m2 to patients with compromised bone marrow function. Some clinicians advocate dosage reductions of 25% when platelet nadirs are 50,000 to 74,999/mm3, 50% when platelet nadirs are 25,000 to 49,999/mm3, and 75% when platelet nadirs are < 25,000/mm3.

PEDIATRIC: PO 75 to 150 mg/m2 administered as a single dose q 6 wk. Do not administer repeat doses of lomustine until leukocyte and platelet counts have recovered to acceptable levels (usually 4000/mm3 and 100,000/mm3, respectively). Follow dosage adjustment guildelines recommended for adults.

Suggested Lomustine Dose Following Initial Dose

ADULTS: PO Give 100% of the prior dose if the leukocytes > 3000 cells/mm3 and the platelets > 75,000 cells/mm3. Give 70% of the prior dose if the leukocytes are 2000 to 2999 cells/mm3 and the platelets are 25,000 to 74,999 cells/mm3. Give 50% of the prior dose if the leukocytes are < 2000 cells/mm3 and the platelets < 25,000 cells/mm.

Interactions

Alcohol

Lomustine is soluble in alcohol. Some sources recommend avoidance of alcohol on days that lomustine is administered to avoid possible effects on the absorption of lomustine, although there is no documentation of an interaction.

Lab Test Interferences None well documented.

 Adverse Reactions

CNS: Disorientation; lethargy; ataxia; slurred speech. GI: Very high potential for nausea and vomiting with doses ³ 60 mg/m2, moderate to high potential for nausea and vomiting with doses < 60 mg/m2; anorexia; transient elevation of LFTs. HEMATOLOGIC: Bone marrow suppression, nadir at 4 to 6 wk. RENAL: Renal failure associated with large cumulative dose. OTHER: Acute leukemia and myelodysplastic disorders have occurred after long-term nitrosourea therapy.

 Precautions

Pregnancy: Category D. Lactation: Undetermined. Children: See Administration and Dosage. Hematologic: The most frequent and most serious toxicity is delayed myelosuppression. It usually occurs 4 to 6 wk after drug administration and is dose-related. Thrombocytopenia occurs » 4 wk after a dose. Leukopenia occurs » 5 to 6 wk after a dose and persists for 1 to 2 wk. About 65% of patients develop WBC counts < 5000/mm3, and 36% of patients develop WBC counts < 3000/mm3. Thrombocytopenia is generally more severe than leukopenia. Anemia also occurs, but is less frequent. Hepatic toxicity: A reversible type of hepatic toxicity, manifested by increased transaminase, alkaline phosphatase, and bilirubin levels, has occurred in a small percentage of patients. Renal toxicity: Decrease in kidney size, progressive azotemia, and renal failure have occurred in patients who received large cumulative doses after prolonged therapy. Pulmonary toxicity: Pulmonary toxicity characterized by pulmonary infiltrates or fibrosis occurs rarely and appears to be dose-related. Onset of toxicity has occurred after an interval of ³ 6 mo from start of therapy with cumulative doses usually > 1100 mg/m2. Fertility impairment: There have been reports of persistent testicular damage causing infertility. Secondary malignancies: Long-term use of nitrosoureas may be associated with development of secondary malignancies.

PATIENT CARE CONSIDERATIONS


 Administration/Storage

  • Store in well-closed containers at room temperature. Lomustine capsules are stable for ³ 2 yr when stored properly. Avoid excessive heat (> 40°C).
  • Adminster orally. Take lomustine on an empty stomach; avoid alcohol on that day.
  • Follow procedures for proper handling and disposal of anticancer drugs. Wear gloves and avoid skin exposure and inhalation of fumes.

 Assessment/Interventions

  • Major toxicity is delayed bone marrow suppression; monitor blood counts weekly for 6 wk after a dose. Monitor liver and renal function periodically.
  • Conduct baseline pulmonary function studies during treatment. Patients with a baseline < 70% of the predicted Forced Vital Capacity (FVC) or Carbon Monoxide Diffusing Capacity (DLCO) are particularly at risk.
  • Nausea and vomiting may occur 3 to 6 hr after an oral dose and usually lasts < 24 hr. Antiemetics prior to dosing may diminish and sometimes prevent these effects. May also be reduced by administration to fasting patients.

 Patient/Family Education

  • Notify physician if fever, chills, sore throat, unusual bleeding or bruising, shortness of breath, dry cough, swelling of feet or lower legs, yellowing of eyes and skin, confusion, sores on the mouth or lips, or unusual tiredness occurs.
  • Medication may cause loss of appetite; nausea; vomiting; hair loss; skin rash or itching (infrequent); notify health care provider if these reactions become pronounced.
  • Take on an empty stomach to reduce nausea.
  • Avoid alcohol for short periods after taking a dose of lomustine.
  • Contraceptive measures are recommended during therapy.

Medicscientist Drug Facts

 

Drugs Class ::

LOW-muss-teen
CeeNU
Capsules
10, 40, and 100 mg
Class: Alkylating agent
Nitrosoureas

Indications for Drugs ::

 Indications

Adult

Brain tumors, Hodgkin disease.

Pediatric

Brain tumors, Hodgkin disease.

Drug Dose ::

 Route/Dosage

Brain Tumors, Hodgkin Disease

ADULTS: PO 100 to 130 mg/m2 administered as a single dose q 6 wk. Do not administer repeat doses of lomustine until leukocyte and platelet counts have recovered to acceptable levels (usually 4000/mm3 and 100,000/mm3, respectively). Reduce lomustine dose if administered with other myelosuppressive drugs. Give 100 mg/m2 to patients with compromised bone marrow function. Some clinicians advocate dosage reductions of 25% when platelet nadirs are 50,000 to 74,999/mm3, 50% when platelet nadirs are 25,000 to 49,999/mm3, and 75% when platelet nadirs are < 25,000/mm3.

PEDIATRIC: PO 75 to 150 mg/m2 administered as a single dose q 6 wk. Do not administer repeat doses of lomustine until leukocyte and platelet counts have recovered to acceptable levels (usually 4000/mm3 and 100,000/mm3, respectively). Follow dosage adjustment guildelines recommended for adults.

Suggested Lomustine Dose Following Initial Dose

ADULTS: PO Give 100% of the prior dose if the leukocytes > 3000 cells/mm3 and the platelets > 75,000 cells/mm3. Give 70% of the prior dose if the leukocytes are 2000 to 2999 cells/mm3 and the platelets are 25,000 to 74,999 cells/mm3. Give 50% of the prior dose if the leukocytes are < 2000 cells/mm3 and the platelets < 25,000 cells/mm.

Contraindication ::

 Contraindications Standard considerations.

Drug Precautions ::

 Precautions

Pregnancy: Category D. Lactation: Undetermined. Children: See Administration and Dosage. Hematologic: The most frequent and most serious toxicity is delayed myelosuppression. It usually occurs 4 to 6 wk after drug administration and is dose-related. Thrombocytopenia occurs » 4 wk after a dose. Leukopenia occurs » 5 to 6 wk after a dose and persists for 1 to 2 wk. About 65% of patients develop WBC counts < 5000/mm3, and 36% of patients develop WBC counts < 3000/mm3. Thrombocytopenia is generally more severe than leukopenia. Anemia also occurs, but is less frequent. Hepatic toxicity: A reversible type of hepatic toxicity, manifested by increased transaminase, alkaline phosphatase, and bilirubin levels, has occurred in a small percentage of patients. Renal toxicity: Decrease in kidney size, progressive azotemia, and renal failure have occurred in patients who received large cumulative doses after prolonged therapy. Pulmonary toxicity: Pulmonary toxicity characterized by pulmonary infiltrates or fibrosis occurs rarely and appears to be dose-related. Onset of toxicity has occurred after an interval of ³ 6 mo from start of therapy with cumulative doses usually > 1100 mg/m2. Fertility impairment: There have been reports of persistent testicular damage causing infertility. Secondary malignancies: Long-term use of nitrosoureas may be associated with development of secondary malignancies.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CNS: Disorientation; lethargy; ataxia; slurred speech. GI: Very high potential for nausea and vomiting with doses ³ 60 mg/m2, moderate to high potential for nausea and vomiting with doses < 60 mg/m2; anorexia; transient elevation of LFTs. HEMATOLOGIC: Bone marrow suppression, nadir at 4 to 6 wk. RENAL: Renal failure associated with large cumulative dose. OTHER: Acute leukemia and myelodysplastic disorders have occurred after long-term nitrosourea therapy.

Drug Mode of Action ::  

LOW-muss-teen
CeeNU
Capsules
10, 40, and 100 mg
Class: Alkylating agent
Nitrosoureas

Drug Interactions ::

Interactions

Alcohol

Lomustine is soluble in alcohol. Some sources recommend avoidance of alcohol on days that lomustine is administered to avoid possible effects on the absorption of lomustine, although there is no documentation of an interaction.

Drug Assesment ::

 Assessment/Interventions

  • Major toxicity is delayed bone marrow suppression; monitor blood counts weekly for 6 wk after a dose. Monitor liver and renal function periodically.
  • Conduct baseline pulmonary function studies during treatment. Patients with a baseline < 70% of the predicted Forced Vital Capacity (FVC) or Carbon Monoxide Diffusing Capacity (DLCO) are particularly at risk.
  • Nausea and vomiting may occur 3 to 6 hr after an oral dose and usually lasts < 24 hr. Antiemetics prior to dosing may diminish and sometimes prevent these effects. May also be reduced by administration to fasting patients.

Drug Storage/Management ::

 Administration/Storage

  • Store in well-closed containers at room temperature. Lomustine capsules are stable for ³ 2 yr when stored properly. Avoid excessive heat (> 40°C).
  • Adminster orally. Take lomustine on an empty stomach; avoid alcohol on that day.
  • Follow procedures for proper handling and disposal of anticancer drugs. Wear gloves and avoid skin exposure and inhalation of fumes.

Drug Notes ::

 Patient/Family Education

  • Notify physician if fever, chills, sore throat, unusual bleeding or bruising, shortness of breath, dry cough, swelling of feet or lower legs, yellowing of eyes and skin, confusion, sores on the mouth or lips, or unusual tiredness occurs.
  • Medication may cause loss of appetite; nausea; vomiting; hair loss; skin rash or itching (infrequent); notify health care provider if these reactions become pronounced.
  • Take on an empty stomach to reduce nausea.
  • Avoid alcohol for short periods after taking a dose of lomustine.
  • Contraceptive measures are recommended during therapy.

Medicscientist Drug Facts

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