Home Drug Guide Lomustine

Drug Guide

Generic Name

Lomustine

Brand Names Gleostine

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/A

Nursing 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.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.