WARNING

Lomustine, also known as CCNU, is a chemotherapy drug primarily used to treat certain types of cancer, including brain tumors and Hodgkin’s disease. Like many chemotherapy medications, it carries several risks and potential side effects:

• Bone marrow suppression: Lomustine can reduce the production of blood cells in the bone marrow, leading to anemia, increased susceptibility to infections, and easy bruising or bleeding.
• Gastrointestinal effects: Nausea, vomiting, and diarrhea are common side effects. These can range from mild to severe and may require medical management.
• Liver toxicity: Lomustine can cause liver damage, which may manifest as elevated liver enzymes or more severe liver dysfunction.
• Pulmonary toxicity: Rarely, lomustine can cause lung damage, which may lead to symptoms such as cough, shortness of breath, or even pulmonary fibrosis.
• Delayed side effects: Some side effects, such as bone marrow suppression or lung toxicity, may not become apparent until weeks or months after treatment.
• Allergic reactions: While uncommon, allergic reactions to lomustine can occur, ranging from mild skin reactions to more severe symptoms like difficulty breathing or anaphylaxis.
• Secondary malignancies: There is a slight risk of developing secondary cancers, particularly leukemia, years after treatment with lomustine.
• Reproductive risks: Lomustine can harm developing fetuses, so it should not be used during pregnancy. It may also impair fertility in both men and women.
• Neurological effects: Some patients may experience neurological side effects such as confusion, dizziness, or seizures.
• Kidney toxicity: In some cases, lomustine can affect kidney function, leading to elevated creatinine levels or other signs of renal impairment.

These risks underscore the importance of careful monitoring and management by healthcare professionals when using lomustine, balancing potential benefits with potential adverse effects.

Why is this medication prescribed?

Lomustine, also known as CCNU, is prescribed primarily for the treatment of certain types of cancer, particularly:

• Brain Tumors: Lomustine is commonly used in the treatment of primary brain tumors, including glioblastoma multiforme and anaplastic astrocytoma.
• Hodgkin’s Disease: It may also be used in combination with other chemotherapy drugs to treat Hodgkin’s disease (a type of lymphoma).

How should this medicine be used?

Lomustine is typically administered orally in the form of capsules. Here are key points regarding its usage:

• Dosage: The dosage of lomustine depends on factors such as the type of cancer being treated, the patient’s overall health, and other medications they may be taking. It is usually prescribed as a single dose taken once every 6 to 8 weeks.
• Administration: The capsules should be swallowed whole with a full glass of water, usually on an empty stomach at least one hour before or two hours after a meal.
• Medical Supervision: Lomustine is a potent chemotherapy drug, and its use requires careful monitoring by healthcare professionals. Blood tests to monitor blood cell counts, liver function, and kidney function are typically conducted before each dose and periodically during treatment.
• Duration of Treatment: Treatment duration with lomustine varies depending on the specific cancer being treated, the response to treatment, and any adverse effects experienced by the patient. It may be used as part of a multi-drug regimen for several cycles.
• Handling and Safety: Due to its cytotoxic nature, precautions should be taken when handling lomustine capsules to avoid exposure, such as wearing gloves. Patients are advised to follow strict instructions regarding its use and disposal.
• Side Effects Management: Patients should be aware of potential side effects and report any new or worsening symptoms to their healthcare provider promptly. Supportive care, such as anti-nausea medications, may be prescribed to manage side effects.
• Contraindications: Lomustine is contraindicated in pregnant women due to potential harm to the fetus. It should not be used in patients with severe bone marrow suppression or severe liver dysfunction.

In summary, lomustine is prescribed for its effectiveness in treating specific types of cancer, but its use requires careful management and monitoring to minimize risks and optimize therapeutic outcomes.

Other uses for this medicine

• Melanoma: In some cases, lomustine has been studied or used off-label for the treatment of melanoma, particularly when other treatments have not been effective.
• Multiple Myeloma: There is limited evidence suggesting lomustine may have some activity in multiple myeloma, although it is not a standard treatment for this cancer.
• Metastatic Colorectal Cancer: Lomustine has been investigated in combination with other drugs for the treatment of metastatic colorectal cancer in certain clinical trials.

What special precautions should I follow?

When using lomustine, it’s crucial to follow specific precautions to ensure safe and effective treatment. Here are important precautions to consider:

• Pregnancy and Contraception: Lomustine can cause harm to developing fetuses. It is essential that both men and women receiving lomustine use effective contraception during treatment and for several months afterward. Pregnant women should not handle lomustine capsules due to the risk of harm to the fetus.
• Liver Function: Lomustine can cause liver toxicity. Liver function tests should be monitored before starting treatment and regularly during treatment. Patients with pre-existing liver disease or impairment may require dose adjustments or careful monitoring.
• Bone Marrow Suppression: Lomustine can suppress bone marrow function, leading to decreased blood cell production. Blood counts (white blood cells, red blood cells, and platelets) should be monitored before each dose and periodically during treatment. This helps to detect and manage potential complications such as infections, anemia, or bleeding.
• Renal Function: Lomustine can affect kidney function. Renal function tests should be assessed periodically, especially in patients with pre-existing kidney disease.
• Neurological Effects: Some patients may experience neurological side effects such as dizziness, confusion, or seizures. Patients should report any new or worsening neurological symptoms to their healthcare provider.
• Secondary Malignancies: There is a risk of developing secondary cancers, particularly leukemia, after treatment with lomustine. Patients should be monitored for signs of secondary malignancies during and after treatment.
• Handling and Administration: Lomustine capsules should be handled with care, using gloves to prevent skin contact. They should be swallowed whole with plenty of water and taken on an empty stomach as directed.
• Drug Interactions: Inform your healthcare provider about all medications, supplements, and herbal products you are taking, as lomustine can interact with other drugs, potentially affecting their efficacy or increasing the risk of side effects.
• Follow-Up Care: Regular follow-up appointments with your healthcare provider are essential to monitor treatment response, manage side effects, and adjust treatment as necessary.

By following these precautions and guidelines, healthcare providers aim to maximize the benefits of lomustine treatment while minimizing potential risks and complications for patients.

What special dietary instructions should I follow?

There are no specific dietary restrictions for lomustine. However, it’s generally recommended to maintain a healthy and balanced diet during chemotherapy treatment.

What should I do if I forget a dose?

If you miss a dose of lomustine, take it as soon as you remember unless it is almost time for your next scheduled dose. In that case, skip the missed dose and continue with your regular dosing schedule. Do not take extra capsules to make up for a missed dose unless instructed to do so by your healthcare provider.

What side effects can this medication cause?

Lomustine, also known by its brand name CCNU, is a chemotherapy medication used primarily in the treatment of certain types of cancer. Like many chemotherapy drugs, it can cause a range of side effects. Some common side effects of Lomustine include:

• Bone marrow suppression: This can lead to low blood cell counts (leukopenia, thrombocytopenia, and anemia), which may increase the risk of infection, bleeding, and fatigue.
• Nausea and vomiting: Gastrointestinal symptoms like nausea and vomiting are common. These symptoms can usually be managed with anti-nausea medications.
• Hair loss: Temporary hair loss (alopecia) is a common side effect of many chemotherapy drugs, including Lomustine.
• Liver toxicity: Lomustine can affect liver function, causing elevated liver enzymes and liver damage in some cases.
• Pulmonary toxicity: Rarely, Lomustine can cause lung damage, leading to shortness of breath, cough, and other respiratory symptoms.
• Kidney toxicity: There can be kidney function impairment associated with Lomustine use.
• Neurological effects: Lomustine can sometimes cause neurological symptoms such as confusion, dizziness, and rarely, seizures.
• Delayed effects: Some side effects may not appear until weeks to months after treatment, such as delayed bone marrow suppression or delayed pulmonary toxicity.

It’s important to note that not everyone experiences all of these side effects, and the severity can vary from person to person. The medical team prescribing Lomustine will monitor for these potential side effects and provide supportive care as needed.

What should I know about storage and disposal of this medication?

Storage and Disposal of Lomustine:

• Storage:
  • Store lomustine capsules at room temperature, away from moisture and heat.
  • Keep them in their original container or packaging, tightly closed.
  • Store out of reach of children and pets.
• Disposal:
  • Dispose of any unused lomustine capsules properly according to local regulations or guidelines.
  • Do not flush lomustine down the toilet or pour it into a drain unless instructed to do so.
  • Consult with your pharmacist or healthcare provider on the proper disposal method. They may provide specific instructions or direct you to a disposal facility.

In case of emergency/overdose

• Seek Immediate Medical Attention: Contact emergency services or go to the nearest emergency room immediately.
• Symptoms of Overdose: Symptoms of lomustine overdose may include severe nausea, vomiting, diarrhea, severe dizziness, confusion, seizures, or signs of bone marrow suppression (e.g., severe weakness, unusual bruising or bleeding).
• What to Tell Healthcare Providers: Provide healthcare providers with as much information as possible, including the amount of lomustine ingested, when it was taken, and any symptoms experienced.

What other information should I know?

• Follow-Up Care: Regular follow-up appointments with your healthcare provider are essential to monitor your response to treatment, manage side effects, and adjust your treatment plan as needed.
• Blood Tests: You will likely need frequent blood tests to monitor your blood cell counts, liver function, and kidney function during treatment with lomustine.
• Contraception: If you are of childbearing potential, use effective contraception during treatment with lomustine and for a period after treatment ends, as advised by your healthcare provider.
• Handling Precautions: Wear gloves when handling lomustine capsules to prevent skin contact. Wash hands thoroughly after handling the capsules.
• Sun Exposure: Lomustine may increase sensitivity to sunlight. Use sunscreen, wear protective clothing, and avoid prolonged sun exposure to reduce the risk of sunburn.
• Patient Education: Educate yourself about the potential side effects of lomustine and how to manage them. Report any new or worsening symptoms to your healthcare provider promptly.
• Support System: Build a support system of family, friends, or support groups to help you cope with the emotional and physical challenges of cancer treatment.

By understanding these aspects of lomustine treatment and following appropriate precautions, you can help ensure safe and effective use of this medication as part of your cancer therapy.