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Lomustine

(low-mus-teen)

Trade/other name(s): CCNU, CeeNU

Why would this drug be used?

Lomustine is used to treat brain cancer, Hodgkin disease, and other conditions.

How does this drug work?

Lomustine is a member of the general group of chemotherapy drugs known as alkylating agents. These drugs work by stopping the growth of cancer cells in the body.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any medical conditions such as kidney disease, lung disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.
  • If you have ever been treated with chemotherapy. This may affect the dose of lomustine your doctor can prescribe.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. If either the male or female is taking lomustine at the time of conception or during pregnancy, there's a chance it may cause birth defects. Check with your doctor about what kinds of birth control can be used with this medicine.
  • If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it could harm the baby.
  • If you think you might want to have children in the future. This drug may affect fertility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with lomustine. These include:

  • vitamin E
  • non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others
  • warfarin (Coumadin)
  • ticlopidine (Ticlid)
  • clopidogrel (Plavix)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren't sure what is in the medicines you take.

No other serious interactions are known at this time. But this does not necessarily mean that none exist. Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

This medicine should be taken on an empty stomach to reduce nausea. Check with your pharmacist, doctor, or nurse.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Lomustine is available in capsule form. Your dose may include capsules of different colors or types, but they are taken by mouth all at once on an empty stomach at bedtime. Wear disposable gloves when you handle the capsules, and do not break open capsules. If you accidentally touch the drug to your skin, wash thoroughly right away.

Lomustine can cause nausea and vomiting, so you should take some type of anti-nausea medicine 1 hour before the lomustine. The capsules are usually taken once every 6 weeks. The dose depends on several factors: your weight, whether you are taking other chemotherapy drugs with it, and how well your kidneys are working.

Take this drug exactly as prescribed by your doctor. If you have any questions or are uncertain of the instructions, ask your doctor or nurse. Store the medicine in a tightly closed container away from heat and moisture and out of the reach of children and pets.

Precautions

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. Lomustine may affect your immune system. This could make vaccinations ineffective, or could even lead to serious infections if you get a live virus vaccine during or soon after treatment. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine.

Your doctor will likely test your blood before, during, and after your treatment. These tests look for possible effects of the drug on blood counts (described below) or on other body organs such as the liver or kidneys. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it completely.

This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Check with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

You may have nausea and vomiting a few hours after taking lomustine. It is usually gone within 24 hours. Your doctor may give you a prescription for an anti-nausea medicine that you can take at home before and after the lomustine. It is important to have these medicines on hand and to take them as prescribed by your doctor.

Lomustine can rarely cause lung damage (scarring or fibrosis) that can restrict breathing. Your doctor will test your breathing before and during treatment with this drug. Even after you have finished taking lomustine, it is important to let your doctor know right away if you notice cough, trouble breathing, shortness of breath, or chest pain. Lung damage can show up months or even years after receiving the drug. It is more common when the drug is used in children.

Call your doctor if you notice yellowing of your skin or eyes, or dark colored urine. This may mean the drug is affecting your liver.

Because of the way this drug acts on cells in the body, it may increase your long-term risk of getting a second type of cancer, such as leukemia. This is rare, but if it does occur it would likely be years after the drug is used. If you are getting this drug, your doctor feels this risk is outweighed by the risk of what might happen if you do not get this drug. You may want to discuss these risks with your doctor.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • nausea*
  • vomiting*
  • low white blood cell count with increased risk of infection*
  • low platelet count with increased risk of bleeding*
  • fetal changes if pregnancy occurs while taking lomustine

Less common

  • loss of appetite
  • weight loss
  • weakness
  • low red blood cell count (anemia) with tiredness and other symptoms
  • kidney damage, especially with prolonged use of high doses
  • hair loss (can also affect face and body hair; usually grows back after treatment)
  • dry, darkened skin

Rare

  • diarrhea
  • confusion
  • feeling sleepy or drowsy
  • stumbling or trouble walking
  • blurred vision. blindness, or other changes in vision
  • liver damage, which usually gets better after treatment*
  • second type of cancer, which may happen years after treatment*
  • scarring of the lungs (fibrosis), which may happen months or years after treatment*
  • death due to lung damage or other causes

*See "Precautions" section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved before 1984 (FDA cannot verify dates of drugs approved before 1984).

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.

Last Medical Review: 01/08/2010
Last Revised: 01/08/2010