Lomustine

Lomustine is used in the treatment of different kinds of cancers. It may be also used to treat other conditions, as determined by the doctor. Lomustine should be taken on an empty stomach, but try to take it at the same time every day. Your doctor will decide what dose is necessary and how often you need to take it. This will depend on what you are being treated for and may change from time to time. You should take it exactly as your doctor has advised. Taking it in the wrong way or taking too much can cause very serious side effects. It may take several weeks or months for you to see or feel the benefits but do not stop taking it unless your doctor tells you to. The most common side effects of this medicine include nausea and vomiting. This medicine may reduce the number of blood cells in your blood thereby, increasing the susceptibility to infections. Regular blood tests are required to check your blood cells along with kidney, liver and heart function during treatment with this medicine. Inform your doctor if you observe signs of infections such as fever, chills, body ache or if you have unusual bruising or bleeding. Before taking it, tell your doctor if you have liver, or kidney problems or are taking any medicines to treat infections. Many other medicines can affect, or be affected by, this medicine so let your doctor know all medications you are using. This medicine is not recommended during pregnancy or while breastfeeding. The use of effective contraception by both males and females during treatment is important to avoid pregnancy. Lomustine is an anti-cancer medication. It works by damaging the genetic material (DNA and RNA) of the cancer cells. This stops their growth and multiplication.

• Brain tumor • Lung cancer • Hodgkin’s disease • Malignant melanoma

Lomustine inhibits the synthesis of DNA and RNA via alkylation although carbamoylation and modification of cellular proteins may also be involved.

Adult Dose: Oral Brain tumours; Hodgkin's disease, resistant or relapsed; Malignant melanoma; Lung cancer Adult: 100-130 mg/m2 as a single dose every 6 wk. Adjust dose according to platelet and leukocyte counts. Compromised marrow function: 100 mg/m2 as a single dose every 6 wk. Child Dose: Oral Brain tumours; Hodgkin's disease, resistant or relapsed; Malignant melanoma; Lung cancer Child: 75-150 mg/m2 as a single dose every 6 wk. Readjust dose according to platelet and leukocyte counts. Renal Dose: Renal impairment: CrCl (ml/min) Dosage Recommendation 10-50 Admin 75% of normal dose. <10 Admin 25-50% of normal dose.

Take this medicine in the dose and duration as advised by your doctor. Do not chew, crush or break it. Lomustine is to be taken empty stomach.

If you miss a dose of Lomustine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.

Common: • Nausea • Vomiting • Stomatitis (Inflammation of the mouth) • Hair loss • Decreased white blood cell count

[CONSULT YOUR DOCTOR] It is not known whether Lomustine alters the ability to drive. Do not drive if you experience any symptoms that affect your ability to concentrate and react. Take lomustine as recommended by your doctor preferably on empty stomach. Take precautions as lomustine is known to lower the white blood cells and platelets in blood that will make you more prone to infections or you may bleed easily/excessively. Seek immediate medical attention if you observe signs of infections such as fever, chills, body ache or if you have unusual bruising or bleeding. Do not receive any live vaccines [for eg. measles, mumps, MMR (Rubella), rotavirus, typhoid, yellow fever, chickenpox, zoster and influenza vaccine] while on lomustine treatment. Use disposable gloves while handling lomustine capsule to avoid direct contact with medicine. Use appropriate contraceptive measures while on lomustine treatment. Men are advised not to father children during treatment with lomustine and for up to 6 months afterwards, and should seek advice regarding sperm conservation before the start of treatment with lomustine, as there is a chance that lomustine may cause permanent infertility in men. You may need to undergo frequent blood tests and kidney/lung/liver function tests to evaluate drugs effect on your body. Contact your doctor if you observe severe side effects such as chest discomfort, difficulty breathing, rapid heart rate, dry cough, wheezing, reduced/no urination, yellowing of skin and eyes (jaundice), pale skin, inability to concentrate.

Pregnancy and lactation.

Increased levels/effects with CYP2D6 inhibitors.

[UNSAFE] It is unsafe to consume alcohol with Lomustine.

[CONSULT YOUR DOCTOR] Lomustine is unsafe to use during pregnancy as there is definite evidence of risk to the developing baby. However, the doctor may rarely prescribe it in some life-threatening situations if the benefits are more than the potential risks. Please consult your doctor.

[CONSULT YOUR DOCTOR] Information regarding the use of Lomustine during breastfeeding is not available. Please consult your doctor.

[CAUTION] Lomustine should be used with caution in patients with kidney disease. Dose adjustment of Lomustine may be needed. Please consult your doctor. Regular monitoring of kidney function tests is advised while you are taking this medicine. Use of Lomustine is not recommended in patients with severe kidney disease. [CONSULT YOUR DOCTOR] There is limited information available on the use of Lomustine in patients with liver disease. Please consult your doctor. However, regular monitoring of liver function tests is advised while you are taking this medicine.

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