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What is this medication?

Antineoplastic Agent, Alkylating Agent (Nitrosourea)

Brand Name US: Gleostine
Canadian Equivalent: CeeNU

Lomustine is indicated for the treatment of various types of cancer, brain tumor; hodgkin lymphoma.

Bone marrow suppression:
Lomustine causes myelosuppression, including fatal myelosuppression. Myelosuppression is delayed, dose-related, and cumulative, occurring 4 to 6 weeks after drug administration and persisting for 1 to 2 weeks. Thrombocytopenia is generally more severe than leukopenia. Cumulative myelosuppression from lomustine is manifested by greater severity and longer duration of cytopenias. Monitor blood counts for at least 6 weeks after each dose. Do not give lomustine more frequently than every 6 weeks.

Medication error prevention:
Prescribe, dispense, and administer only enough capsules for one dose. Fatal toxicity occurs with overdosage of lomustine. Both health care provider and pharmacist should emphasize to the patient that only one dose of lomustine is taken every 6 weeks.

How does this medication work? 

GLEOSTINE/CEENU (Lomustine) inhibits DNA, RNA, and protein synthesis via alkylation and carbamylation of DNA and RNA but is cell cycle non-specific.

How should I take this medication? 

Oral: Take 130 mg/m2 as a single dose once every 6 weeks; reduce dose to 100 mg/m2 as a single dose once every 6 weeks in patients with compromised bone marrow function.

How to Take: Antiemetics are recommended to prevent nausea and vomiting, administering on an empty stomach may reduce the incidence of nausea and vomiting.  Varying strengths of capsules may be required to obtain necessary dose. Dispense only enough capsules for a single dose. Do not break capsules. If contact with skin occurs, immediately wash area (thoroughly). Avoid exposure to broken capsules.

What should I watch for while using this medication? 

Before starting GLEOSTINE/CEENU (Lomustine), make sure your physician is aware of any allergies or medications you currently take, if you have severe leukopenia, thrombocytopenia, are pregnant, or breastfeeding. Lomustine use has been associated with rare but serious adverse events such as bone marrow suppression, gastrointestinal toxicity, hepatotoxicity, pulmonary toxicity, renal toxicity, and risk of secondary malignancies.

What if I miss a dose?

If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.

How should I store this medication?

Keep out of the reach of children at all times. Store at room temperature, 59 to 86° F (15 to 30° C). Protect from light. Keep the container tightly closed. Properly dispose of any unused medication after the expiration date.

What are the possible side effects of using this medication?

Nausea and vomiting, leukopenia, bone marrow depression, thrombocytopenia.

Note this is not a complete list of side effects for GLEOSTINE/CEENU (Lomustine), only common ones.