Lomustine
Mechanism :
Lomustine alkylates DNA and RNA, it is not cross resistant with other alkylators. As with other nitrosoureas, it may also inhibit several key enzymatic processes by carbamoylation of amino acids in proteins.
Indication :
- Brain tumors
- Hodgkin’s Lymphoma
Contraindications :
Should not be given to individuals who have demonstrated a previous hypersensitivity to it.
Dosing :
130 mg/m² as a single oral dose once every 6 weeks. Round off the dose to nearest 5 mg.
Compromised bone marrow:
100 mg/m² orally once every 6 weeks.
Adverse Effect :
Delayed myelosuppression, anemia, thrombocytopenia, leukopenia, acute leukemia, bone marrow dysplasia, nausea and vomiting, progressive azotemia, decrease in kidney size and renal failure have been reported in patients who received large cumulative doses after prolonged therapy, disorientation, lethargy, ataxia, and dysarthria.
Interaction :
Contraindicated:
Adenovirus vaccine, live, BCG live intravesical, Influenza nasal vaccine live, Measles/mumps/rubella vaccine live, Rotavirus vaccine live, Smallpox vaccine (live vaccinia virus), Typhoid vaccine live, Varicella vaccine live, Yellow fever vaccine live, Zoster vaccine live.
Avoid/Use Alternative:
Alefacept, Deferiprone, Natalizumab, Palifermin, Radium Ra 223 dichloride, Sipuleucel-T, Thiotepa.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 45-60 | 75% of dose |
| 30-45 | 50–70% of dose |
| <30 | Not recommended. |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unlikely to be dialysed. Avoid |
| HD | Not dialysed. Avoid. |
| HDF/High flux | Unknown dialysability. Avoid. |
| CAV/VVHD | Unlikely to be dialysed. Avoid. |
Hepatic Dose :
No dose adjustments are recommended.