In the U.S.—

In Canada—

Another commonly used name is CCNU.

• Antineoplastic

Lomustine ( loe-MUS-teen) belongs to the group of medicines known as alkylating agents. It is used to treat some kinds of cancer.

Lomustine interferes with the growth of cancer cells, which are eventually destroyed. Since the growth of normal body cells may also be affected by lomustine, other effects will also occur. Some of these may be serious and must be reported to your doctor. Other effects, like hair loss, may not be serious but may cause concern. Some effects may not occur for months or years after the medicine is used.

Before you begin treatment with lomustine, you and your doctor should talk about the good this medicine will do as well as the risks of using it.

Lomustine is available only with your doctor's prescription, in the following dosage form:

Oral
• Capsules (U.S. and Canada)

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For lomustine, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to lomustine.

Pregnancy—Tell your doctor if you are pregnant or if you intend to have children. There is a chance that this medicine may cause birth defects if either the male or female is taking it at the time of conception or if it is taken during pregnancy. Lomustine causes birth defects in rats and causes toxic or harmful effects in the fetus of rats and rabbits at doses about the same as the human dose. In addition, many cancer medicines may cause sterility which could be permanent. Sterility has been reported in animals and humans with this medicine.

Be sure that you have discussed this with your doctor before taking this medicine. It is best to use some kind of birth control while you are taking lomustine. Tell your doctor right away if you think you have become pregnant while taking lomustine.

Breast-feeding—Tell your doctor if you are breast-feeding or if you intend to breast-feed during treatment with this medicine. Because lomustine may cause serious side effects, breast-feeding is generally not recommended while you are receiving it.

Children—Although there is no specific information comparing use of lomustine in children with use in other age groups, this medicine is not expected to cause different side effects or problems in children than it does in adults.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of lomustine in the elderly with use in other age groups.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking lomustine, it is especially important that your health care professional know if you have ever been treated with x-rays or cancer medicines or if you are taking any of the following:

• Amphotericin B by injection (e.g., Fungizone) or
• Antithyroid agents (medicine for overactive thyroid) or
• Azathioprine (e.g., Imuran) or
• Chloramphenicol (e.g., Chloromycetin) or
• Colchicine or
• Flucytosine (e.g., Ancobon) or
• Ganciclovir (e.g., Cytovene) or
• Interferon (e.g., Intron A, Roferon-A) or
• Plicamycin (e.g., Mithracin) or
• Zidovudine (e.g., AZT, Retrovir)—Lomustine may increase the effects of these medicines or radiation therapy on the blood

• Chickenpox (including recent exposure) or
• Herpes zoster (shingles)—Risk of severe disease affecting other parts of the body

• Infection—Lomustine can decrease your body's ability to fight infection

• Kidney disease—Effects of lomustine may be increased because of slower removal from the body

• Lung disease—Risk of lung problems caused by lomustine may be increased

Take this medicine only as directed by your doctor. Do not take more or less of it than your doctor ordered. The exact amount of medicine you need has been carefully worked out. Taking too much may increase the chance of side effects, while taking too little may not improve your condition.

In order that you receive the proper dose of lomustine, there may be two or more different types of capsules in the container. This is not an error. It is important that you take all of the capsules in the container as one dose so that you receive the right dose of the medicine.

This medicine is sometimes given together with certain other medicines. If you are using a combination of medicines, make sure that you take each one at the right time and do not mix them. Ask your health care professional to help you plan a way to remember to take your medicines at the right times.

Nausea and vomiting occur often after lomustine is taken, but usually last less than 24 hours. Loss of appetite may last for several days. This medicine is best taken on an empty stomach at bedtime so that it will cause less stomach upset. Ask your health care professional for other ways to lessen these effects.

If you vomit shortly after taking a dose of lomustine, check with your doctor. You may be told to take the dose again.

Dosing—

The dose of lomustine will be different for different patients. The dose that is used may depend on a number of things, including what the medicine is being used for, the patient's size, and whether or not other medicines are also being taken. If you are taking lomustine at home, follow your doctor's orders or the directions on the label. If you have any questions about the proper dose of lomustine, ask your doctor.

It is important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to check for unwanted effects.

While you are being treated with lomustine, and after you stop treatment with it, do not have any immunizations (vaccinations) without your doctor's approval. Lomustine may lower your body's resistance and there is a chance you might get the infection the immunization is meant to prevent. In addition, other persons living in your household should not take oral polio vaccine since there is a chance they could pass the polio virus on to you. Also, avoid persons who have recently taken oral polio vaccine. Do not get close to them, and do not stay in the same room with them for very long. If you cannot take these precautions, you should consider wearing a protective face mask that covers the nose and mouth.

Lomustine can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

• If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
• Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in urine or stools; or pinpoint red spots on your skin.
• Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
• Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
• Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
• Avoid contact sports or other situations where bruising or injury could occur.

Along with their needed effects, medicines like lomustine can sometimes cause unwanted effects such as blood problems, loss of hair, and other side effects; these are described below. Also, because of the way these medicines act on the body, there is a chance that they might cause other unwanted effects that may not occur until months or years after the medicine is used. These delayed effects may include certain types of cancer, such as leukemia. Discuss these possible effects with your doctor.

Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

• Less common
  • Black, tarry stools;  blood in urine or stools;  cough or hoarseness;  fever or chills;  lower back or side pain;  painful or difficult urination;  pinpoint red spots on skin;  unusual bleeding or bruising 
  
  

Check with your doctor as soon as possible if any of the following side effects occur:

• Less common
  • Awkwardness;  confusion;  decrease in urination;  slurred speech ;  sores in mouth and on lips;  swelling of feet or lower legs;  unusual tiredness or weakness 
  
  

• Rare
  • Cough;  shortness of breath 
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

• More common
  • Loss of appetite;  nausea and vomiting (usually last less than 24 hours) 
  
  

• Less common
  • Darkening of skin;  diarrhea;  skin rash and itching 
  
  

This medicine may cause a temporary loss of hair in some people. After treatment with lomustine has ended, normal hair growth should return.

After you stop using this medicine, it may still produce some side effects that need attention. During this period of time, check with your doctor if you notice any of the following side effects:

• Black, tarry stools;  blood in urine or stools;  cough or hoarseness;  fever or chills;  lower back or side pain;  painful or difficult urination;  pinpoint red spots on skin;  unusual bleeding or bruising 

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.