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Temozolomide

(tem-uh-zo-luh-mide)

Trade/other name(s): Temodar

Why would this drug be used?

Temozolomide is used to treat brain cancers such as anaplastic astrocytoma and glioblastoma multiforme (GBM). Temozolomide may also be used to treat other types of cancer.

How does this drug work?

Temozolomide belongs to a group of chemotherapy drugs called alkylating agents. Unlike many other chemotherapy drugs, it can reach the brain from the bloodstream. It slows or stops the growth of cancer cells, which causes them to die.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you had a severe reaction to the drug dacarbazine (DTIC). Both temozolomide and dacarbazine form the same substance when broken down by the body, so having a problem with one of these drugs means you are at risk for having a problem with the other one.
  • If you have any medical conditions such as kidney 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 are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. 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 if 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 can cause infertility in some people. 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

Valproic acid (Depakote, Depakene) may have a small effect on the level of temozolomide in the body. If you are taking this drug, be sure to talk to your doctor or nurse.

Temozolomide can lower platelet counts and increase the risk of bleeding. Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding further during treatment with temozolomide. 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)
  • Dabigatran (Pradaxa)
  • Rivaroxaban (Xarelto)
  • Apixaban (Eliquis)
  • Any type of heparin injections, such as enoxaparin (Lovenox), dalteparin (Fragmin), and tinzaparin (Innohep)

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

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

No serious interactions with food are known at this time, although it is recommended that the capsule form of this medicine be taken on an empty stomach or at bedtime to reduce the chance of nausea. Check with your pharmacist, doctor, or nurse for more information.

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

How is this drug taken or given?

Temozolomide can be taken as capsules or given by an injection into a vein. As an injection, temozolomide is given into a vein (IV) over about 90 minutes. As a capsule, temozolomide comes in 6 sizes: 250 mg, 180 mg, 140 mg, 100 mg, 20 mg, and 5 mg. Your dose depends on your height and weight, whether you have taken chemotherapy before, and your blood counts. Your dose may change from one cycle to the next.

For treatment of anaplastic astrocytoma, the drug is usually taken or given once a day for 5 days every 4 weeks.

For treatment of glioblastoma multiforme, the drug is usually taken or given each day for 6 weeks while radiation therapy is being given. Following a short rest period, the drug is then taken once a day for 5 days every 4 weeks, over a total of about 6 months.

Be sure of the exact dose and schedule of medicine before you start taking it. The capsules should be taken with a full glass of water on an empty stomach or at bedtime. Try to take the capsules at the same time each day. If your doctor gives you medicine to prevent nausea, take it about half an hour before the temozolomide.

Swallow capsules whole; do not crush, open, or dissolve the capsule. If a capsule is opened, keep its contents away from your skin, eyes, nose, and mouth, being careful not to let them be inhaled. If you do get the capsule contents on your skin, mouth, eyes, or nose, flush the area with water.

Keep the medicine in a tightly closed container away from heat and moisture and out of the reach of children and pets.

Precautions

Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs. 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. Keep all your appointments for lab tests and doctor visits.

Temozolomide 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, shortness of breath, pain when passing urine, dry cough, or bringing up sputum.

When this drug is given along with radiation, it increases the risk of a certain kind of pneumonia (called Pneumocystis). If you are being treated with this treatment combination, your doctor will likely have you take an antibiotic to help prevent this kind of pneumonia.

This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Talk 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.

Temozolomide can cause liver damage that can be life-threatening. Your doctor will check blood tests of liver function before you start on this drug to be sure it is safe. These tests will be repeated during and after treatment to look for signs of liver damage. If these tests show signs of liver damage, your dose may need to be decreased or your treatment may need to be stopped. Call your doctor right away if you notice any yellowing of the skin or eyes, pain in the upper right part of the stomach, or any darkening of the urine.

This drug can cause skin reactions which can become life-threatening. Tell your nurse or doctor right away if you notice fever or skin blistering, or if you have severe rash or itching.

Men and women should avoid conceiving a child (starting a pregnancy) during treatment and for at least 6 months after taking this drug.

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
  • Constipation
  • Headache
  • Loss of appetite
  • Tiredness (fatigue)
  • Weakness
  • Hair loss or thinning, which may include face and body hair
  • Low white blood cell count with increased risk of infection*
  • Low platelet count with increased risk of bleeding*
  • Pain, itching, warmth, swelling, or redness at the injection site

Less common

  • Diarrhea
  • Mouth sores
  • Rash
  • Itching
  • Tiredness
  • Trouble sleeping
  • Memory loss
  • Trouble moving on one side of the body
  • Infection*
  • Seizures (may be severe or life-threatening)

Rare

  • Low red blood cell count (anemia) with tiredness and other symptoms
  • Trouble walking or other problem with coordination
  • Dizziness
  • Allergic reaction, which can be severe
  • Infertility, which may be short-term or permanent
  • Birth defects or fetal harm if a child is conceived during or soon after treatment
  • A second type of cancer, which can happen years after this drug is taken*
  • Liver damage* or problems with liver function, including hepatitis
  • Serious skin rash or blistering*
  • Lung infection (pneumonia, pneumonitis, and others)
  • Lung damage or scarring
  • Death due to bone marrow shutdown, infection, liver failure, or other cause

*See the "Precautions" section for more detailed information.

There are 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 in 1999

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: 08/06/2014
Last Revised: 08/06/2014