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Lomustine

    Brands

    DEA Class; Rx

    Common Brand Names; Ifex

    • Antineoplastics, Alkylating

    Nitrosourea alkylating agent
    Used for the treatment of Hodgkin lymphoma and brain cancers
    Fatal myelosuppression has been reported; give only 1 lomustine dose at a time with a minimum interval of 6-weeks between doses

    Indicated for the treatment of Hodgkin lymphoma in patients who have progressive disease following initial chemotherapy, in combination with other chemotherapeutic agents.
    For the treatment of brain tumors, including malignant glioma, and brain metastases.
    For the treatment of non-Hodgkin’s lymphoma (NHL), in combination with other chemotherapy agents.

    Hypersensitivity

    • Nausea (54%)
    • Vomiting (54%)
    • Neurotoxicity
    • Myelosuppression (delayed 4-5 weeks)
    • Ataxia
    • Lethargy
    • Disorientation
    • Stomatitis
    • Mucositis
    • Pulmonary fibrosis (rare)
    • Pulmonary toxicity
    • Elevated LFTs
    • Leukemia
    • Renal toxicity
    • Hepatic toxicity
    • Infertility
    • Alopecia
    • Optic atrophy (rare)

    Causes myelosuppression that can result in fatal infections and bleeding; monitor blood counts for at least 6 weeks after each dose; do not give more frequently than q6wk due to delayed myelosuppression

    Avoid pregnancy; can cause fetal harm; advise males and females of reproductive potential of potential risk to fetus and to use effective contraception; advise males with female partners of reproductive potential to use effective contraception during treatment and for 3.5 months after the final dose; therapy may result in reduced fertility in males and females of reproductive potential

    Hepatotoxicity reported; increased levels of transaminases, alkaline phosphatase and bilirubin can occur; monitor liver function

    Can cause renal failure; monitor renal function

    Delayed pulmonary toxicity may occur; pulmonary infiltrates and/or fibrosis may occur; perform pulmonary function tests prior to treatment and repeat frequently; permanently discontinue therapy in patients diagnosed with pulmonary fibrosis

    Secondary malignancies reported; acute leukemia and myelodysplasia can occur with long-term use

    Pregnancy Category: D

    Lactation: Unknown if metabolites present in breast milk; avoid nursing during treatment and for 2 weeks after final dose

    Adults

    130 mg/m2 PO (repeated no sooner than every 6 weeks) is FDA approved; 200 mg/m2 PO has been studied off-label as induction therapy in AML patients 60 years and older in combination with other chemotherapy.

    Geriatric

    130 mg/m2 PO (repeated no sooner than every 6 weeks) is FDA approved; 200 mg/m2 PO has been studied off-label as induction therapy in AML patients 60 years and older in combination with other chemotherapy.

    Adolescents

    130 mg/m2 PO (repeated no sooner than every 6 weeks).

    Children

    130 mg/m2 PO (repeated no sooner than every 6 weeks).

    Infants

    130 mg/m2 PO (repeated no sooner than every 6 weeks).

    Lomustine 

    capsule

    • 5mg
    • 10mg
    • 40mg
    • 100mg