Nurses Compass
Drug Guide
Lomustine
Classification
Therapeutic: Antineoplastic agent
Pharmacological: Alkylating agent, Nitrosourea
FDA Approved Indications
- Treatment of Hodgkin's disease, brain tumors, and other cancers
Mechanism of Action
Lomustine alkylates DNA and RNA, leading to cross-linking and ultimately cell death, especially in rapidly dividing cells like cancer cells.
Dosage and Administration
Adult: Typically 60-100 mg/m² orally every 6 weeks, but dosing varies based on condition and response.
Pediatric: Dosing is individualized; consult specific protocols.
Geriatric: Use cautiously; assess organ function and comorbidities.
Renal Impairment: Adjust dosage based on renal function.
Hepatic Impairment: Use with caution; no specific dose adjustment established.
Pharmacokinetics
Absorption: Well absorbed orally.
Distribution: Widely distributed, crosses blood-brain barrier.
Metabolism: Metabolized in the liver.
Excretion: Excreted in urine and feces.
Half Life: Approx. 1.5-2 hours, but effects last longer due to DNA alkylation.
Contraindications
- Hypersensitivity to lomustine or other nitrosoureas.
- Bone marrow suppression.
Precautions
- Monitor blood counts closely.
- Use cautiously in pregnancy and lactation; teratogenic effects possible.
Adverse Reactions - Common
- Myelosuppression (Common)
- Nausea and vomiting (Common)
- Hepatotoxicity (Less common)
Adverse Reactions - Serious
- Severe myelosuppression leading to risk of infection, bleeding (Serious)
- Pulmonary toxicity (pneumonitis, fibrosis) (Rare)
- Secondary malignancies (Rare)
Drug-Drug Interactions
- CNS depressants, other immunosuppressants
Drug-Food Interactions
- Increased toxicity with concomitant alcohol intake.
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood counts (CBC), liver and lung function, renal function.
Diagnoses:
- Risk for infection related to myelosuppression.
- Risk for bleeding.
Implementation: Administer as prescribed, monitor labs, and educate patient on infection and bleeding precautions.
Evaluation: Assess blood counts regularly, monitor for signs of toxicity.
Patient/Family Teaching
- Report signs of infection, bleeding, or unusual fatigue.
- Follow-up blood tests as scheduled.
- Avoid live vaccines during treatment.
Special Considerations
Black Box Warnings:
- Myelosuppression can be severe and life-threatening.
- Secondary leukemias and cancers have been reported.
Genetic Factors: DNA repair deficiencies may influence toxicity.
Lab Test Interference: May cause false positives in certain urine tests.
Overdose Management
Signs/Symptoms: Bone marrow suppression, gastrointestinal upset, neurological symptoms.
Treatment: Supportive care, hematopoietic growth factors, blood transfusions as needed.
Storage and Handling
Storage: Store at controlled room temperature, away from moisture and light.
Stability: Stable for specified period as per manufacturer guidelines.