Lomustine Capsules: Dosage, Side Effects & Interactions Guide
Comprehensive guide to lomustine capsules: uses, dosage, side effects, and patient advice for brain tumors and Hodgkin's disease treatment.
About Lomustine Capsules and how to take them correctly, including possible side effects.
About lomustine capsules
Lomustine is a chemotherapy medication classified as an alkylating agent, specifically a nitrosourea. It works by damaging the DNA in cancer cells, preventing them from dividing and growing, which ultimately leads to cell death. This makes it effective against certain aggressive cancers.
Lomustine capsules are primarily indicated for treating brain tumors, both primary and metastatic, in adults and children following appropriate surgical and/or radiotherapeutic procedures. It is also used as secondary therapy for Hodgkin’s disease in patients who have relapsed during primary therapy or failed to respond to it, often in combination with other approved drugs.
The drug crosses the blood-brain barrier effectively, making it particularly suitable for brain tumors. It is administered orally as capsules available in strengths such as 10 mg, 40 mg, and 100 mg. Inactive ingredients include magnesium stearate, mannitol, and various capsule shell components like gelatin, titanium dioxide, FD&C blue #1, and iron oxides.
Key facts
- Lomustine is taken as a single dose every 6 weeks.
- It causes delayed bone marrow suppression (myelosuppression), peaking 4-6 weeks after dosing.
- Common side effects include nausea, vomiting, and loss of appetite.
- Fatal risks include severe thrombocytopenia, infections, bleeding, and pulmonary fibrosis.
- Dose is based on body surface area: typically 130 mg/m², rounded to nearest 5 mg.
When to take lomustine capsules
Lomustine is given as a single oral dose every 6 weeks, never more frequently, to allow recovery from myelosuppression. Blood counts must be monitored weekly for at least 6 weeks post-dose, with platelets >100,000/mm³ and leukocytes >4,000/mm³ required before repeating.
Take on an empty stomach, ideally at bedtime, 1 hour before or 2 hours after meals. First, take anti-sickness medication, wait 1 hour, then swallow capsules whole with water. Avoid food, drink, or other meds for 1 hour after.
Your dose may include multiple capsule colors/sizes to achieve the exact amount—take all at once. Pharmacists dispense only enough for one dose to prevent overdose.
How to take lomustine capsules
Follow your doctor’s instructions precisely. The recommended dose for adults and children is 130 mg/m² as a single oral dose every 6 weeks, rounded to the nearest 5 mg. Reduce to 100 mg/m² if bone marrow function is compromised or with other myelosuppressive drugs.
- Take antiemetics (e.g., against nausea) 1 hour before lomustine.
- Swallow capsules whole with water on an empty stomach.
- Do not crush, chew, or open capsules.
- Wait at least 1 hour before eating or drinking (small sips of water okay).
- Store at room temperature, away from moisture and heat.
If you miss a dose, contact your doctor—do not double up. Overdose can be fatal due to enhanced toxicity.
Common questions about lomustine capsules
How long does lomustine take to work?
Lomustine starts affecting cancer cells soon after absorption, but full effects on tumors may take weeks to months, assessed via scans and symptoms. Myelosuppression delays 4-6 weeks.
How long do you take lomustine for?
Treatment continues every 6 weeks as long as tolerated and effective, based on blood counts, scans, and response. Cumulative toxicity may limit duration.
Is lomustine a strong chemotherapy?
Yes, lomustine is potent due to its alkylating action and delayed, cumulative myelosuppression, requiring strict monitoring.
Can you drink alcohol while taking lomustine?
Avoid alcohol, as it may worsen nausea, liver effects, and interact with liver enzymes processing the drug.
Cautions – things to know before taking lomustine
Lomustine carries black box warnings for fatal myelosuppression and overdose risk. Administer under specialist supervision.
- Contraindications: Hypersensitivity to lomustine.
- Pregnancy/breastfeeding: Highly toxic—use contraception; do not breastfeed.
- Liver/kidney impairment: Dose adjustments needed.
- Prior chemotherapy: Increases myelosuppression risk.
- Pulmonary function <70% FVC/DLCO: Higher fibrosis risk.
Inform your doctor of all medications to avoid interactions with myelosuppressives.
Side effects – taking lomustine capsules
Lomustine causes significant side effects, primarily delayed myelosuppression: thrombocytopenia (platelets drop more severely than leukocytes), occurring 4-6 weeks post-dose, lasting 1-2 weeks, and worsening cumulatively.
Serious side effects
| Side Effect | Symptoms | Action |
|---|---|---|
| Myelosuppression | Fever, chills, sore throat, bleeding, bruising, fatigue | Contact doctor immediately; monitor blood weekly |
| Pulmonary toxicity | Shortness of breath, cough, infiltrates/fibrosis (after >1100 mg/m²) | Seek urgent care; baseline lung tests |
| Secondary cancers | Acute leukemia, bone marrow dysplasia (long-term) | Long-term monitoring |
| Liver toxicity | Jaundice, abdominal pain | Blood tests |
Other side effects
- Gastrointestinal: Nausea/vomiting (3-6 hours post-dose, lasts <24h), loss of appetite, stomatitis.
- Neurological: Confusion, vision changes (rare).
- Skin: Rash, alopecia.
- Manage nausea with premedication; report persistent symptoms.
Precautions during low blood counts: Avoid infections (hand hygiene, crowds), bleeding (no razors, contact sports), live vaccines.
Interactions – taking lomustine capsules with other medicines
Lomustine interacts with myelosuppressive drugs (e.g., other chemotherapies), increasing toxicity—dose reduce.
- Antiemetics: Use as premed.
- CYP3A4 inducers/inhibitors: May alter levels.
- Vaccines: Avoid live ones due to immunosuppression.
- Alcohol/NSAIDs: Heighten GI/bleeding risks.
Provide full medication list to your oncologist.
Other medicines, food and drink with lomustine capsules
Take on empty stomach; avoid food/drink 1h before/after. No grapefruit (CYP interactions). Limit alcohol. Stay hydrated but follow timing.
Common questions about lomustine capsules
Can you drive or ride a bike when taking lomustine?
Possible dizziness/fatigue—avoid until effects known. Nausea may impair.
Can you fly with lomustine?
Carry prescription; inform airline if needed. Single-dose packaging aids.
Can you take paracetamol or ibuprofen with lomustine?
Paracetamol okay for fever (check doctor); avoid ibuprofen if platelets low due to bleeding risk.
Pregnancy, breastfeeding and fertility while taking lomustine capsules
Teratogenic: Avoid pregnancy—use effective contraception during and 6 months after (mutagenic).
Fertility: May cause infertility; discuss preservation.
Breastfeeding: Contraindicated—passes into milk.
What happens if you take too much lomustine?
Overdose risks fatal myelosuppression, hepatotoxicity. Only one dose dispensed. Seek emergency care; supportive measures only—no antidote.
Analogs
Other nitrosoureas like carmustine (BCNU); alkylators like cyclophosphamide. Not direct substitutes—physician choice.
Frequently Asked Questions (FAQs)
How often is lomustine given?
Every 6 weeks as a single dose, after blood count recovery.
Does lomustine cause hair loss?
Yes, mild to moderate alopecia possible.
How to manage nausea from lomustine?
Premedicate with antiemetics; take at bedtime on empty stomach.
What blood tests are needed?
Weekly CBC for 6 weeks: platelets, WBC, neutrophils.
Can lomustine cure brain tumors?
Palliative; extends survival, not always curative.
References
- LOMUSTINE capsule – DailyMed – NIH — National Library of Medicine. 2023. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=916dfac8-da11-40e4-9e44-a909e29a6b5f
- Lomustine: MedlinePlus Drug Information — MedlinePlus. 2024-01-15. https://medlineplus.gov/druginfo/meds/a682207.html
- Lomustine Capsules Label — FDA. 2013-05-01. https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/017588s039lbl.pdf
- Lomustine (oral route) – Mayo Clinic — Mayo Clinic. 2024. https://www.mayoclinic.org/drugs-supplements/lomustine-oral-route/description/drg-20064559
- Lomustine (CCNU) – The Clatterbridge Cancer Centre — Clatterbridge Cancer Centre. 2023. https://www.clatterbridgecc.nhs.uk/patients-and-visitors/treatment-and-care/patient-information/lomustine-ccnu
- Lomustine (CCNU, Gleostine®) for Brain Cancer – ChemoExperts — ChemoExperts. 2024. https://www.chemoexperts.com/lomustine-ccnu-gleostine.html
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