LOMUSTINE

LOMUSTINE
(loe-mus'teen)
CeeNU, CCNU
Classifications: antineoplastic; alkylating agent;
Therapeutic: antineoplastic

Prototype: Cyclophosphamide
Pregnancy Category: D

Availability

10 mg, 40 mg, 100 mg capsules

Action

Lipid-soluble alkylating nitrosourea with actions like those of carmustine (e.g., cell-cycle-nonspecific activity against rapidly proliferating cell populations). Inhibits synthesis of both DNA and RNA.

Therapeutic Effect

Has antineoplastic and myelosuppressive effect.

Uses

Palliative therapy in addition to other modalities or with other chemotherapeutic agents in primary and metastatic brain tumors and as secondary therapy in Hodgkin's disease.

Unlabeled Uses

GI, lung, and renal carcinomas, non-Hodgkin's lymphomas, malignant melanoma, and multiple myelomas.

Contraindications

Immunization with live virus vaccines, viral infections; severe bone marrow suppression; active infection; pregnancy (category D), lactation.

Cautious Use

Patients with decreased circulating platelets, leukocytes, or erythrocytes; kidney or liver function impairment; previous cytotoxic or radiation therapy; pulmonary disease.

Route & Dosage

Palliative Therapy
Adult: PO 130 mg/m2 as single dose, repeated in 6 wk; subsequent doses based on hematologic response (WBC >4000/mm3, platelets >100,000/mm3)
Child: PO 75–150 mg/m2 q6wk

Administration

Oral
  • Give on an empty stomach to reduce possibility of nausea, may also give an antiemetic before drug to prevent nausea.
  • Store capsules away from excessive heat (over 40° C).

Adverse Effects (≥1%)

CNS: Lethargy, ataxia, disorientation. GI: Anorexia, nausea, vomiting, stomatitis, transient elevations of LFTs. Hematologic: Delayed (cumulative) myelosuppression: (thrombocytopenia, leukopenia); anemia. Skin: Alopecia, skin rash, itching. Urogenital: Nephrotoxicity. Respiratory: Pulmonary toxicity (rare).

Interactions

Drug: Cimetidine can increase bone marrow toxicity; anticoagulants, nsaids, salicylates increase risk of bleeding.

Pharmacokinetics

Absorption: Readily absorbed from GI tract. Peak: 1–6 h. Distribution: Readily crosses blood–brain barrier; crosses placenta; distributed into breast milk. Metabolism: In liver to several active metabolites. Elimination: In urine. Half-Life: 16–48 h.

Nursing Implications

Assessment & Drug Effects

  • Lab tests: Monitor blood counts weekly for at least 6 wk after last dose. Liver and kidney function tests should be performed periodically.
  • A repeat course is not given until platelets have returned to above 100,000/mm3 and leukocytes to above 4000/mm3.
  • Avoid invasive procedures during nadir of platelets.
  • Thrombocytopenia occurs about 4 wk and leukopenia about 6 wk after a dose, persisting 1–2 wk.
  • Inspect oral cavity daily for S&S of superinfections (see Appendix F) and stomatitis or xerostomia.

Patient & Family Education

  • Nausea and vomiting may occur 3–5 h after drug administration, usually lasting less than 24 h.
  • Anorexia may persist for 2 or 3 d after a dose.
  • Notify physician of signs of sore throat, cough, fever. Also report unexplained bleeding or easy bruising.
  • Use reliable contraceptive measures during therapy.
  • Be aware of the possibility of hair loss while taking this drug.
  • A given dose may include capsules of different colors; the pharmacist prepares prescribed dose by combining various capsule strengths.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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