II. Indications

III. Mechanism

  1. See Alkylating Agent
  2. Antineoplastic nitrosourea
    1. Alkylating Agent that cross-links DNA during all cell cycle phases
    2. Carbamoylates Proteins, including DNA repair Proteins, resulting in further cytotoxic effects

IV. Medications

  1. Oral Lomustine: 5, 10, 40 and 100 mg capsules
    1. Dispensed as single doses

V. Dosing

  1. See other references for disease specific dosing protocols
  2. Typically taken every 6 weeks during treatment

VI. Pharmacokinetics

  1. Lipophilic
  2. Easily crosses the blood brain barrier
  3. Narrow therapeutic range
    1. Fatalities have occurred with overdosage (dispense one dose at a time)

VII. Adverse Effects

  1. Alopecia
  2. Severe Bone Marror Suppression
  3. Hepatotoxicity
  4. Impaired future fertility
  5. Nephrotoxicity
  6. Pulmonary Fibrosis
  7. Secondary Malignancy

VIII. Safety

  1. Avoid in Lactation
  2. Pregnancy Category D
    1. Avoid in Pregnancy (all trimesters)
    2. Use reliable Contraception
  3. Monitoring
    1. Complete Blood Count (CBC)
    2. Liver Function Tests
    3. Renal Function tests
    4. Pulmonary Function Tests

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