Lomustine is an orally administered alkylating agent used alone and in combination with other antineoplastic agents in the treatment of several malignancies including Hodgkin’s disease, lymphoma, and brain cancer. Lomustine therapy is associated with minor transient serum enzyme elevations and has been linked to rare cases of clinically apparent acute liver injury.
Lomustine is a nitrosourea with antineoplastic activity. Lomustine alkylates and crosslinks DNA, thereby inhibiting DNA and RNA synthesis. This agent also carbamoylates DNA and proteins, resulting in the inhibition of DNA and RNA synthesis and disruption of RNA processing. Lomustine is lipophilic and crosses the blood-brain barrier. (NCI04)
Lomustine is an N-nitrosourea that is urea in which one of the nitrogens is substituted by a 2-chloroethyl group and by a nitroso group, while the other nitrogen is substituted by a cyclohexyl group. An alkylating antineoplastic agent, it is used in the treatment of brain tumors, lung cancer, malignant melanoma, and other solid tumors. It has a role as an alkylating agent and an antineoplastic agent. It is a member of N-nitrosoureas and an organochlorine compound.
Lomustine (INN); abbreviated as CCNU; original brand name CeeNU, now marketed as Gleostine) is an alkylating nitrosourea compound used in chemotherapy. It is closely related to semustine and is in the same family as streptozotocin. It is a highly lipid-soluble drug,[rx] thus it crosses the blood–brain barrier. This property makes it ideal for treating brain tumors, which is its primary use, although it is also used to treat Hodgkin lymphoma as a second-line option.[rx] Lomustine has a long time to nadir (the time when white blood cells reach their lowest number).
Mechanism of Action
Lomustine is a highly lipophilic nitrosourea compound that undergoes hydrolysis in vivo to form reactive metabolites. These metabolites cause alkylation and cross-linking of DNA (at the O6 position of guanine-containing bases) and RNA, thus inducing cytotoxicity. Other biologic effects include inhibition of DNA synthesis and some cell cycle phase specificity. Nitrosoureas generally lack cross-resistance with other alkylating agents. As lomustine is a nitrosourea, it may also inhibit several key processes such as carbamoylation and modification of cellular proteins. Although lomustine is believed to act by alkylation, the mechanism of action has not been completely elucidated, and other effects such as carbamoylation and modification of cellular proteins may be involved. The overall result is thought to be the inhibition of both DNA and RNA synthesis.
Lomustine is an alkylating agent of the nitrosourea type. Lomustine and its metabolites interfere with the function of DNA and RNA. It is cell cycle–phase nonspecific. Cancers form when some cells within the body multiply uncontrollably and abnormally. These cells then spread and destroy nearby tissues. Lomustine acts by slowing this process down. It kills cancer cells by damaging the DNA (the genetic material inside the cells) and stops them from dividing.
Indications
- For the treatment of primary and metastatic brain tumors as a component of combination chemotherapy in addition to appropriate surgical and/or radiotherapeutic procedures. Also used in combination with other agents as secondary therapy for the treatment of refractory or relapsed Hodgkin’s disease.
- Lomustine is an alkylating agent used as a part of chemotherapeutic regimens for the treatment of primary and metastatic brain tumors as well as refractory or relapsed Hodgkin’s disease in addition to surgical and/or radiotherapeutic treatments.
- Lomustine is an orally administered alkylating agent used alone and in combination with other antineoplastic agents in the treatment of several malignancies including Hodgkin’s disease, lymphoma, and brain cancer.
- CeeNU has been shown to be useful as a single agent in addition to other treatment modalities, or in established combination therapy with other approved chemotherapeutic agents in the following: Brain tumors-both primary and metastatic, in patients who have already received appropriate surgical and/or radiotherapeutic procedures. Hodgkin’s Disease-secondary therapy in combination with other approved drugs in patients who relapse while being treated with primary therapy, or who fail to respond to primary therapy.
- Antineoplastic agent. The compound has had limited use since the early 1970s in the treatment of Hodgkin’s disease and various solid tumors. These include primary and metastatic brain tumors, colorectal tumors, and certain pulmonary malignancies. It is usually used in conjunction with other antineoplastic drugs.
- Although lomustine is labeled for use in combination with other agents as secondary therapy for the treatment of refractory or relapsed Hodgkin’s disease, combination regimens containing other agents currently are preferred for this cancer.
- Metastatic Brain Tumors
- Primary Brain Neoplasm
- Refractory Hodgkin Lymphoma
Use in Cancer
Lomustine is approved to be used alone or with other drugs to treat:
- Brain tumors. It is used in patients who have already been treated with surgery or radiation therapy.
- Hodgkin lymphoma. It is used with chemotherapy in patients whose disease got worse after other types of treatment.
Lomustine is also being studied in the treatment of other types of cancer.
Contraindications
- decreased function of bone marrow
- decreased blood platelets
- low levels of white blood cells
- bleeding
- a condition where there is a formation of fibrous tissue in the lung called pulmonary fibrosis
- x-ray results showing lung tissue changes
- decreased kidney function
- the high amount of bilirubin in the blood
- abnormal liver function tests
- pregnancy
- a patient who is producing milk and breastfeeding
Dosage
Strengths: 10 mg; 40 mg; 100 mg; triphasic; 5 mg
Brain/Intracranial Tumor
As a single agent in previously untreated patients:
- 130 mg/m2 orally as a single dose every 6 weeks
As a single agent in patients with compromised bone marrow function:
- 100 mg/m2 orally as a single dose every 6 weeks
- The dose should be adjusted accordingly when this drug is used in combination with other myelosuppressive drugs.
- All doses of this drug should be rounded to the nearest 10 mg by the prescriber.
- Only a single dose of this drug should be dispensed.
As a single agent in addition to other treatment modalities, or in established combination therapy with other approved chemotherapeutic agents in the following:
- BRAIN TUMORS: both primary and metastatic tumors; in patients who have already received appropriate surgical and/or radiotherapeutic procedures.
- HODGKIN’S DISEASE: secondary therapy in combination with other approved drugs; in patients who relapse while being treated with primary therapy or who fail to respond to primary therapy.
Hodgkin’s Disease
As a single agent in previously untreated patients:
- 130 mg/m2 orally as a single dose every 6 weeks
As a single agent in patients with compromised bone marrow function:
- 100 mg/m2 orally as a single dose every 6 weeks
- The dose should be adjusted accordingly when this drug is used in combination with other myelosuppressive drugs.
- All doses of this drug should be rounded to the nearest 10 mg by the prescriber.
- Only a single dose of this drug should be dispensed.
As a single agent in addition to other treatment modalities, or in established combination therapy with other approved chemotherapeutic agents in the following:
- BRAIN TUMORS: both primary and metastatic tumors; in patients who have already received appropriate surgical and/or radiotherapeutic procedures.
- HODGKIN’S DISEASE: secondary therapy in combination with other approved drugs; in patients who relapse while being treated with primary therapy or who fail to respond to primary therapy.
Pediatric Dose
Brain/Intracranial Tumor
As a single agent in previously untreated patients:
- 130 mg/m2 orally as a single dose every 6 weeks
As a single agent in patients with compromised bone marrow function:
- 100 mg/m2 orally as a single dose every 6 weeks
- The dose should be adjusted accordingly when this drug is used in combination with other myelosuppressive drugs.
- All doses of this drug should be rounded to the nearest 10 mg by the prescriber.
- Only a single dose of this drug should be dispensed.
As a single agent in addition to other treatment modalities, or in established combination therapy with other approved chemotherapeutic agents in the following:
- BRAIN TUMORS: both primary and metastatic tumors; in patients who have already received appropriate surgical and/or radiotherapeutic procedures.
- HODGKIN’S DISEASE: secondary therapy in combination with other approved drugs; in patients who relapse while being treated with primary therapy or who fail to respond to primary therapy.
Hodgkin’s Disease
As a single agent in previously untreated patients:
- 130 mg/m2 orally as a single dose every 6 weeks
As a single agent in patients with compromised bone marrow function:
- 100 mg/m2 orally as a single dose every 6 weeks
- The dose should be adjusted accordingly when this drug is used in combination with other myelosuppressive drugs.
- All doses of this drug should be rounded to the nearest 10 mg by the prescriber.
- Only a single dose of this drug should be dispensed.
As a single agent in addition to other treatment modalities, or in established combination therapy with other approved chemotherapeutic agents in the following:
- BRAIN TUMORS: both primary and metastatic tumors; in patients who have already received appropriate surgical and/or radiotherapeutic procedures.
- HODGKIN’S DISEASE: secondary therapy in combination with other approved drugs; in patients who relapse while being treated with primary therapy or who fail to respond to primary therapy.
Dose Adjustments
Doses subsequent to the initial dose should be adjusted according to the hematologic response of the patient to the preceding dose:
NADIR AFTER PRIOR DOSE:
- 4000/mm3 or greater leukocytes; 100,000/mm3 or greater platelets: 100% of prior dose to be given
- 3000 to 3999/mm3 leukocytes; 75,000 to 99,999/mm3 platelets: 100% of prior dose to be given
- 2000 to 2999/mm3 leukocytes; 25,000 to 74,999/mm3 platelets: 70% of prior dose to be given
- Less than 2000/mm3 leukocytes; less than 25,000/mm3 platelets: 50% of prior dose to be given
- A repeat course should not be given until circulating blood elements have returned to acceptable levels (leukocytes above 4000/mm3; platelets above 100,000/mm3).
- Repeat courses should not be given before 6 weeks because the hematologic toxicity is delayed and cumulative.
- An adequate number of neutrophils should be present on a peripheral blood smear; blood counts should be monitored weekly.
Administration Advice:
- Administering of this drug on an empty stomach may reduce the incidence of nausea and vomiting.
- Rubber or latex gloves should be worn when handling containers and capsules of this drug.
- Areas that come into contact with broken capsules should be washed immediately and thoroughly with soap and water.
- Handling and disposal of this drug should be performed in a manner consistent with safe procedures for cytotoxic agents.
- In order to provide the proper dose of this drug, the prescribed dose may be made up of 2 or more different strengths and colors of capsules; only the appropriate number of drug capsules required for a single dose should be dispensed and different capsule strengths should be dispensed separately.
- Cross-resistance with other nitrosoureas is usual (cross-resistance between this drug and carmustine has occurred), but cross-resistance with conventional alkylating agents is unusual.
- Overdosage: Accidental overdose has been associated with bone marrow suppression, abdominal pain, diarrhea, vomiting, anorexia, lethargy, dizziness, abnormal hepatic function, cough, and shortness of breath. No proven antidotes have been established; treat overdosage immediately with gastric lavage and appropriate supportive measures.
Side Effects
The Most Common
- nausea
- vomiting
- loss of appetite
- sores in the mouth and throat
- unusual tiredness or weakness
- pale skin
- fainting
- hair loss
- unsteady walk
- slurred speech
- difficulty breathing
- shortness of breath
- dry cough
- chest pain
- wheezing
- decreased urination;
- swelling of the face, arms, hands, feet, ankles, or lower legs.
- yellowing or eyes and skin
- confusion
- sudden change or loss of vision
More common
- Bleeding gums
- chest pain
- shortness of breath
- sore throat
- sores, ulcers, or white spots on the lips or in the mouth
- unusual bleeding or bruising
- unusual tiredness or weakness
- Awkwardness
- black, tarry stools
- blood in the urine or stools
- confusion
- cough or hoarseness
- decrease in urination
- fever or chills
- lower back or side pain
- painful or difficult urination
- pale skin
- pinpoint red spots on the skin
- slurred speech
- swelling of the feet or lower legs
- troubled breathing with exertion
- unusual bleeding or bruising
- unusual tiredness or weakness
Rare
- Abdominal or stomach pain or tenderness
- bone pain
- change in frequency of urination or amount of urine
- clay colored stools
- dark urine
- decreased appetite
- dizziness
- drowsiness
- dry mouth
- headache
- increased blood pressure
- increased thirst
- itching
- loss of appetite
- nausea or vomiting
- skin rash
- weight gain
- yellow eyes or skin
- Darkening of the skin
- diarrhea
- Blurred vision
- changes in patterns and rhythms of speech
- confusion about identity, place, and time
- decreased vision
- eye pain
- hair loss or thinning of the hair
- shakiness and unsteady walk
- swelling or inflammation of the mouth
- trouble with speaking
- unsteadiness, trembling, or other problems with muscle control or coordination
- unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
Drug Interaction
| DRUG | INTERACTION |
|---|---|
| Abatacept | The risk or severity of adverse effects can be increased when Lomustine is combined with Abatacept. |
| Abciximab | The risk or severity of bleeding can be increased when Abciximab is combined with Lomustine. |
| Acenocoumarol | The risk or severity of bleeding can be increased when Acenocoumarol is combined with Lomustine. |
| Acetylsalicylic acid | The risk or severity of bleeding can be increased when Acetylsalicylic acid is combined with Lomustine. |
| Adalimumab | The risk or severity of adverse effects can be increased when Adalimumab is combined with Lomustine. |
| Adenovirus type | The risk or severity of infection can be increased when Adenovirus type 7 vaccine live is combined with Lomustine. |
| Aldesleukin | The risk or severity of adverse effects can be increased when Aldesleukin is combined with Lomustine. |
| Alefacept | The risk or severity of adverse effects can be increased when Alefacept is combined with Lomustine. |
| Alemtuzumab | The risk or severity of adverse effects can be increased when Alemtuzumab is combined with Lomustine. |
| Allogeneic processed | The therapeutic efficacy of Allogeneic processed thymus tissue can be decreased when used in combination with Lomustine. |
| Allopurinol | The risk or severity of adverse effects can be increased when Allopurinol is combined with Lomustine. |
| Alteplase | The risk or severity of bleeding can be increased when Alteplase is combined with Lomustine. |
| Altretamine | The risk or severity of adverse effects can be increased when Altretamine is combined with Lomustine. |
| Amsacrine | The risk or severity of adverse effects can be increased when Amsacrine is combined with Lomustine. |
| Anagrelide | The risk or severity of bleeding can be increased when Anagrelide is combined with Lomustine. |
| Anakinra | The risk or severity of adverse effects can be increased when Anakinra is combined with Lomustine. |
| Ancrod | The risk or severity of bleeding can be increased when Ancrod is combined with Lomustine. |
| Anifrolumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Anifrolumab. |
| Anistreplase | The risk or severity of bleeding can be increased when Anistreplase is combined with Lomustine. |
| Anthrax immune | The therapeutic efficacy of Anthrax immune globulin human can be decreased when used in combination with Lomustine. |
| Anthrax vaccine | The risk or severity of infection can be increased when Anthrax vaccine is combined with Lomustine. |
| Antilymphocyte i | The risk or severity of adverse effects can be increased when Lomustine is combined with Antilymphocyte immunoglobulin (horse). |
| Antithrombin Alfa | The risk or severity of bleeding can be increased when Antithrombin Alfa is combined with Lomustine. |
| Antithrombin III | The risk or severity of bleeding can be increased when Antithrombin III human is combined with Lomustine. |
| Antithymocyte i | The risk or severity of adverse effects can be increased when Antithymocyte immunoglobulin (rabbit) is combined with Lomustine. |
| Apixaban | The risk or severity of bleeding can be increased when Apixaban is combined with Lomustine. |
| Apremilast | The risk or severity of adverse effects can be increased when Lomustine is combined with Apremilast. |
| Ardeparin | The risk or severity of bleeding can be increased when Ardeparin is combined with Lomustine. |
| Argatroban | The risk or severity of bleeding can be increased when Argatroban is combined with Lomustine. |
| Arsenic trioxide | The risk or severity of adverse effects can be increased when Arsenic trioxide is combined with Lomustine. |
| Articaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Articaine. |
| AstraZeneca | The therapeutic efficacy of AstraZeneca COVID-19 Vaccine can be decreased when used in combination with Lomustine. |
| Azacitidine | The risk or severity of adverse effects can be increased when Azacitidine is combined with Lomustine. |
| Azathioprine | The risk or severity of adverse effects can be increased when Azathioprine is combined with Lomustine. |
| Bacillus | The risk or severity of infection can be increased when Bacillus calmette-guerin substrain connaught live antigen is combined with Lomustine. |
| Bacillus calmette | The therapeutic efficacy of Bacillus calmette-guerin substrain russian BCG-I live antigen can be decreased when used in combination with Lomustine. |
| Bacillus calm | The risk or severity of infection can be increased when Bacillus calmette-guerin substrain tice live antigen is combined with Lomustine. |
| Baricitinib | The risk or severity of adverse effects can be increased when Lomustine is combined with Baricitinib. |
| Basiliximab | The risk or severity of adverse effects can be increased when Basiliximab is combined with Lomustine. |
| BCG vaccine | The risk or severity of infection can be increased when BCG vaccine is combined with Lomustine. |
| Beclomethasone | The risk or severity of adverse effects can be increased when Beclomethasone dipropionate is combined with Lomustine. |
| Belatacept | The risk or severity of adverse effects can be increased when Lomustine is combined with Belatacept. |
| Belimumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Belimumab. |
| Belinostat | The risk or severity of adverse effects can be increased when Lomustine is combined with Belinostat. |
| Belumosudil | The risk or severity of adverse effects can be increased when Lomustine is combined with Belumosudil. |
| Bemiparin | The risk or severity of bleeding can be increased when Bemiparin is combined with Lomustine. |
| Bendamustine | The risk or severity of adverse effects can be increased when Lomustine is combined with Bendamustine. |
| Bendroflumethiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Bendroflumethiazide is combined with Lomustine. |
| Benzocaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Benzocaine. |
| Benzthiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Benzthiazide is combined with Lomustine. |
| Benzyl alcohol | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Benzyl alcohol. |
| Betamethasone | The risk or severity of adverse effects can be increased when Betamethasone is combined with Lomustine. |
| Betrixaban | The risk or severity of bleeding can be increased when Betrixaban is combined with Lomustine. |
| Bexarotene | The risk or severity of adverse effects can be increased when Bexarotene is combined with Lomustine. |
| Bimekizumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Bimekizumab. |
| Bivalirudin | The risk or severity of bleeding can be increased when Bivalirudin is combined with Lomustine. |
| Bleomycin | The risk or severity of adverse effects can be increased when Bleomycin is combined with Lomustine. |
| Blinatumomab | The risk or severity of adverse effects can be increased when Lomustine is combined with Blinatumomab. |
| Bordetella per | The therapeutic efficacy of Bordetella pertussis toxoid antigen (formaldehyde, glutaraldehyde inactivated) can be decreased when used in combination with Lomustine. |
| Bortezomib | The risk or severity of adverse effects can be increased when Bortezomib is combined with Lomustine. |
| Bosutinib | The risk or severity of adverse effects can be increased when Lomustine is combined with Bosutinib. |
| Brentuximab ved | The risk or severity of adverse effects can be increased when Lomustine is combined with Brentuximab vedotin. |
| Brodalumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Brodalumab. |
| Budesonide | The risk or severity of adverse effects can be increased when Lomustine is combined with Budesonide. |
| Bupivacaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Bupivacaine. |
| Busulfan | The risk or severity of adverse effects can be increased when Busulfan is combined with Lomustine. |
| Butacaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Butacaine. |
| Butamben | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Butamben. |
| Cabazitaxel | The risk or severity of adverse effects can be increased when Lomustine is combined with Cabazitaxel. |
| Canakinumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Canakinumab. |
| Cangrelor | The risk or severity of bleeding can be increased when Cangrelor is combined with Lomustine. |
| Capecitabine | The risk or severity of adverse effects can be increased when Capecitabine is combined with Lomustine. |
| Caplacizumab | The risk or severity of bleeding can be increased when Caplacizumab is combined with Lomustine. |
| Capsaicin | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Capsaicin. |
| Carbamazepine | The risk or severity of adverse effects can be increased when Carbamazepine is combined with Lomustine. |
| Carboplatin | The risk or severity of adverse effects can be increased when Carboplatin is combined with Lomustine. |
| Carfilzomib | The risk or severity of adverse effects can be increased when Lomustine is combined with Carfilzomib. |
| Carmustine | The risk or severity of adverse effects can be increased when Carmustine is combined with Lomustine. |
| Certolizumab pegol | The risk or severity of adverse effects can be increased when Lomustine is combined with Certolizumab pegol. |
| Chlorambucil | The risk or severity of adverse effects can be increased when Chlorambucil is combined with Lomustine. |
| Chloramphenicol | The risk or severity of adverse effects can be increased when Chloramphenicol is combined with Lomustine. |
| Chloroprocaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Chloroprocaine. |
| Chlorothiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Chlorothiazide is combined with Lomustine. |
| Ciclesonide | The risk or severity of adverse effects can be increased when Lomustine is combined with Ciclesonide. |
| Cilostazol | The risk or severity of bleeding can be increased when Cilostazol is combined with Lomustine. |
| Cinchocaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Cinchocaine. |
| Cisplatin | The risk or severity of adverse effects can be increased when Cisplatin is combined with Lomustine. |
| Cladribine | The risk or severity of adverse effects can be increased when Cladribine is combined with Lomustine. |
| Clobetasol propionate | The risk or severity of adverse effects can be increased when Clobetasol propionate is combined with Lomustine. |
| Clofarabine | The risk or severity of adverse effects can be increased when Clofarabine is combined with Lomustine. |
| Clopidogrel | The risk or severity of bleeding can be increased when Clopidogrel is combined with Lomustine. |
| Clostridium tetani | The therapeutic efficacy of Clostridium tetani toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Lomustine. |
| Clozapine | The risk or severity of neutropenia can be increased when Lomustine is combined with Clozapine. |
| Cocaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Cocaine. |
| Corticotropin | The risk or severity of adverse effects can be increased when Lomustine is combined with Corticotropin. |
| Cortisone acetate | The risk or severity of adverse effects can be increased when Lomustine is combined with Cortisone acetate. |
| Corynebacterium | The therapeutic efficacy of Corynebacterium diphtheriae toxoid antigen (formaldehyde inactivated) can be decreased when used in combination with Lomustine. |
| Cyanocobalamin | The therapeutic efficacy of Cyanocobalamin can be decreased when used in combination with Lomustine. |
| Cyclopenthiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Cyclopenthiazide is combined with Lomustine. |
| Cyclophosphamide | The risk or severity of adverse effects can be increased when Cyclophosphamide is combined with Lomustine. |
| Cyclosporine | Lomustine may increase the immunosuppressive activities of Cyclosporine. |
| Cyclothiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Cyclothiazide is combined with Lomustine. |
| Cytarabine | The risk or severity of adverse effects can be increased when Cytarabine is combined with Lomustine. |
| Dabigatran | The risk or severity of bleeding can be increased when Dabigatran is combined with Lomustine. |
| Dabigatran etexi | The risk or severity of bleeding can be increased when Dabigatran etexilate is combined with Lomustine. |
| Dacarbazine | The risk or severity of adverse effects can be increased when Dacarbazine is combined with Lomustine. |
| Dactinomycin | The risk or severity of adverse effects can be increased when Dactinomycin is combined with Lomustine. |
| Dalteparin | The risk or severity of bleeding can be increased when Dalteparin is combined with Lomustine. |
| Danaparoid | The risk or severity of bleeding can be increased when Danaparoid is combined with Lomustine. |
| Darbepoetin a | The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Lomustine. |
| Dasatinib | The risk or severity of adverse effects can be increased when Lomustine is combined with Dasatinib. |
| Daunorubicin | The risk or severity of adverse effects can be increased when Daunorubicin is combined with Lomustine. |
| Decitabine | The risk or severity of adverse effects can be increased when Lomustine is combined with Decitabine. |
| Defibrotide | The risk or severity of bleeding can be increased when Defibrotide is combined with Lomustine. |
| Deflazacort | The risk or severity of adverse effects can be increased when Lomustine is combined with Deflazacort. |
| Denosumab | The risk or severity of adverse effects can be increased when Denosumab is combined with Lomustine. |
| Desirudin | The risk or severity of bleeding can be increased when Desirudin is combined with Lomustine. |
| Desoximetasone | The risk or severity of adverse effects can be increased when Desoximetasone is combined with Lomustine. |
| Deucravacitinib | The risk or severity of adverse effects can be increased when Lomustine is combined with Deucravacitinib. |
| Dexamethasone | The risk or severity of adverse effects can be increased when Lomustine is combined with Dexamethasone. |
| Dexrazoxane | The risk or severity of adverse effects can be increased when Dexrazoxane is combined with Lomustine. |
| Dextran | The risk or severity of bleeding can be increased when Dextran is combined with Lomustine. |
| Dicoumarol | The risk or severity of bleeding can be increased when Dicoumarol is combined with Lomustine. |
| Difluocortolone | The risk or severity of adverse effects can be increased when Lomustine is combined with Difluocortolone. |
| Dimethyl fumarate | The risk or severity of adverse effects can be increased when Lomustine is combined with Dimethyl fumarate. |
| Dinutuximab | The risk or severity of adverse effects can be increased when Lomustine is combined with Dinutuximab. |
| Diphenhydramine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Diphenhydramine. |
| Dipyridamole | The risk or severity of bleeding can be increased when Dipyridamole is combined with Lomustine. |
| Diroximel fumarate | The risk or severity of adverse effects can be increased when Lomustine is combined with Diroximel fumarate. |
| Docetaxel | The risk or severity of adverse effects can be increased when Lomustine is combined with Docetaxel. |
| Doxorubicin | The risk or severity of adverse effects can be increased when Doxorubicin is combined with Lomustine. |
| Drotrecogin alfa | The risk or severity of bleeding can be increased when Drotrecogin alfa is combined with Lomustine. |
| Dyclonine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Dyclonine. |
| Ebola Zaire vacc | The therapeutic efficacy of Ebola Zaire vaccine (live, attenuated) can be decreased when used in combination with Lomustine. |
| Eculizumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Eculizumab. |
| Edetic acid | The risk or severity of bleeding can be increased when Edetic acid is combined with Lomustine. |
| Edoxaban | The risk or severity of bleeding can be increased when Edoxaban is combined with Lomustine. |
| Efalizumab | The risk or severity of adverse effects can be increased when Efalizumab is combined with Lomustine. |
| Emapalumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Emapalumab. |
| Enoxaparin | The risk or severity of bleeding can be increased when Enoxaparin is combined with Lomustine. |
| Epirubicin | The risk or severity of adverse effects can be increased when Epirubicin is combined with Lomustine. |
| Epoprostenol | The risk or severity of bleeding can be increased when Epoprostenol is combined with Lomustine. |
| Eptifibatide | The risk or severity of bleeding can be increased when Eptifibatide is combined with Lomustine. |
| Eribulin | The risk or severity of adverse effects can be increased when Lomustine is combined with Eribulin. |
| Erythropoietin | The risk or severity of Thrombosis can be increased when Erythropoietin is combined with Lomustine. |
| Estramustine | The risk or severity of adverse effects can be increased when Estramustine is combined with Lomustine. |
| Etanercept | The risk or severity of adverse effects can be increased when Etanercept is combined with Lomustine. |
| Ethyl chloride | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Ethyl chloride. |
| Etidocaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Etidocaine. |
| Etoposide | The risk or severity of adverse effects can be increased when Etoposide is combined with Lomustine. |
| Everolimus | The risk or severity of adverse effects can be increased when Lomustine is combined with Everolimus. |
| Famtozinameran | The therapeutic efficacy of Famtozinameran can be decreased when used in combination with Lomustine. |
| Filgotinib | The risk or severity of adverse effects can be increased when Lomustine is combined with Filgotinib. |
| Fingolimod | Lomustine may increase the immunosuppressive activities of Fingolimod. |
| Floxuridine | The risk or severity of adverse effects can be increased when Floxuridine is combined with Lomustine. |
| Flucytosine | The risk or severity of adverse effects can be increased when Flucytosine is combined with Lomustine. |
| Fludarabine | The risk or severity of adverse effects can be increased when Fludarabine is combined with Lomustine. |
| Fludrocortisone | The risk or severity of adverse effects can be increased when Fludrocortisone is combined with Lomustine. |
| Fluindione | The risk or severity of bleeding can be increased when Fluindione is combined with Lomustine. |
| Flunisolide | The risk or severity of adverse effects can be increased when Flunisolide is combined with Lomustine. |
| Fluocinolone ac | The risk or severity of adverse effects can be increased when Fluocinolone acetonide is combined with Lomustine. |
| Fluocinonide | The risk or severity of adverse effects can be increased when Fluocinonide is combined with Lomustine. |
| Fluocortolone | The risk or severity of adverse effects can be increased when Lomustine is combined with Fluocortolone. |
| Fluorometholone | The risk or severity of adverse effects can be increased when Fluorometholone is combined with Lomustine. |
| Fluorouracil | The risk or severity of adverse effects can be increased when Fluorouracil is combined with Lomustine. |
| Flupentixol | The risk or severity of myelosuppression can be increased when Flupentixol is combined with Lomustine. |
| Fluprednisolone | The risk or severity of adverse effects can be increased when Lomustine is combined with Fluprednisolone. |
| Fluticasone | The risk or severity of adverse effects can be increased when Lomustine is combined with Fluticasone. |
| Fluticasone furoate | The risk or severity of adverse effects can be increased when Lomustine is combined with Fluticasone furoate. |
| Fluticasone propionate | The risk or severity of adverse effects can be increased when Fluticasone propionate is combined with Lomustine. |
| Fondaparinux | The risk or severity of bleeding can be increased when Fondaparinux is combined with Lomustine. |
| Gallium nitrate | The risk or severity of adverse effects can be increased when Lomustine is combined with Gallium nitrate. |
| Gemcitabine | The risk or severity of adverse effects can be increased when Gemcitabine is combined with Lomustine. |
| Gemtuzumab oz | The risk or severity of adverse effects can be increased when Gemtuzumab ozogamicin is combined with Lomustine. |
| Glatiramer | The risk or severity of adverse effects can be increased when Lomustine is combined with Glatiramer. |
| Golimumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Golimumab. |
| Guselkumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Guselkumab. |
| Haemophilus | The therapeutic efficacy of Haemophilus influenzae type B strain 20752 capsular polysaccharide tetanus toxoid conjugate antigen can be decreased when used in combination with Lomustine. |
| Heparin | The risk or severity of bleeding can be increased when Heparin is combined with Lomustine. |
| Hepatitis A Vaccine | The therapeutic efficacy of Hepatitis A Vaccine can be decreased when used in combination with Lomustine. |
| Hepatitis B Vacci | The therapeutic efficacy of Hepatitis B Vaccine (Recombinant) can be decreased when used in combination with Lomustine. |
| Human adenovi | The risk or severity of infection can be increased when Human adenovirus e serotype 4 strain cl-68578 antigen is combined with Lomustine. |
| Hydrochlorothiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Hydrochlorothiazide is combined with Lomustine. |
| Hydrocortisone | The risk or severity of adverse effects can be increased when Lomustine is combined with Hydrocortisone acetate. |
| Hydrocortisone | The risk or severity of adverse effects can be increased when Lomustine is combined with Hydrocortisone butyrate. |
| Hydrocortisone s | The risk or severity of adverse effects can be increased when Lomustine is combined with Hydrocortisone succinate. |
| Hydroflumethiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Hydroflumethiazide is combined with Lomustine. |
| Hydroxychloroquine | The risk or severity of adverse effects can be increased when Lomustine is combined with Hydroxychloroquine. |
| Hydroxyurea | The risk or severity of adverse effects can be increased when Hydroxyurea is combined with Lomustine. |
| Ibritumomab tiu | The risk or severity of adverse effects can be increased when Ibritumomab tiuxetan is combined with Lomustine. |
| Ibrutinib | The risk or severity of adverse effects can be increased when Lomustine is combined with Ibrutinib. |
| Icosapent ethyl | The risk or severity of bleeding can be increased when Icosapent ethyl is combined with Lomustine. |
| Idarubicin | The risk or severity of adverse effects can be increased when Idarubicin is combined with Lomustine. |
| Idelalisib | The risk or severity of adverse effects can be increased when Lomustine is combined with Idelalisib. |
| Ifosfamide | The risk or severity of adverse effects can be increased when Ifosfamide is combined with Lomustine. |
| Iloprost | The risk or severity of bleeding can be increased when Iloprost is combined with Lomustine. |
| Imatinib | The risk or severity of adverse effects can be increased when Imatinib is combined with Lomustine. |
| Indomethacin | The risk or severity of adverse effects can be increased when Indomethacin is combined with Lomustine. |
| Inebilizumab | The risk or severity of infection can be increased when Lomustine is combined with Inebilizumab. |
| Infliximab | The risk or severity of adverse effects can be increased when Infliximab is combined with Lomustine. |
| Leflunomide | The risk or severity of adverse effects can be increased when Lomustine is combined with Leflunomide. |
| Lenalidomide | The risk or severity of adverse effects can be increased when Lenalidomide is combined with Lomustine. |
| Lepirudin | The risk or severity of bleeding can be increased when Lepirudin is combined with Lomustine. |
| Levobupivacaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Levobupivacaine. |
| Lidocaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Lidocaine. |
| Linezolid | The risk or severity of adverse effects can be increased when Linezolid is combined with Lomustine. |
| Lipegfilgrastim | Lomustine may increase the myelosuppressive activities of Lipegfilgrastim. |
| Lopinavir | The serum concentration of Lomustine can be increased when it is combined with Lopinavir. |
| Magnesium | The serum concentration of Magnesium can be decreased when it is combined with Lomustine. |
| Measles virus v | The therapeutic efficacy of Measles virus vaccine live attenuated can be decreased when used in combination with Lomustine. |
| Mechlorethamine | The risk or severity of adverse effects can be increased when Mechlorethamine is combined with Lomustine. |
| Meloxicam | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Meloxicam. |
| Melphalan | The risk or severity of adverse effects can be increased when Melphalan is combined with Lomustine. |
| Meningococcal | The therapeutic efficacy of Meningococcal (groups A, C, Y and W-135) oligosaccharide diphtheria CRM197 conjugate vaccine can be decreased when used in combination with Lomustine. |
| Mepivacaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Mepivacaine. |
| Mepolizumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Mepolizumab. |
| Meprednisone | The risk or severity of adverse effects can be increased when Lomustine is combined with Meprednisone. |
| Mercaptopurine | The risk or severity of adverse effects can be increased when Mercaptopurine is combined with Lomustine. |
| Metamizole | The risk or severity of myelosuppression can be increased when Metamizole is combined with Lomustine. |
| Methimazole | The risk or severity of adverse effects can be increased when Methimazole is combined with Lomustine. |
| Methotrexate | The risk or severity of adverse effects can be increased when Methotrexate is combined with Lomustine. |
| Methoxy po | The risk or severity of Thrombosis can be increased when Methoxy polyethylene glycol-epoetin beta is combined with Lomustine. |
| Methylprednisolone | The risk or severity of adverse effects can be increased when Methylprednisolone is combined with Lomustine. |
| Mitomycin | The risk or severity of adverse effects can be increased when Mitomycin is combined with Lomustine. |
| Mitoxantrone | The risk or severity of adverse effects can be increased when Mitoxantrone is combined with Lomustine. |
| COVID-19 Vaccine | The therapeutic efficacy of Moderna COVID-19 Vaccine can be decreased when used in combination with Lomustine. |
| m vaccinia ankara | The therapeutic efficacy of Modified vaccinia ankara can be decreased when used in combination with Lomustine. |
| Mometasone furoate | The risk or severity of adverse effects can be increased when Lomustine is combined with Mometasone furoate. |
| Monomethyl fumara | The risk or severity of adverse effects can be increased when Lomustine is combined with Monomethyl fumarate. |
| Mosunetuzumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Mosunetuzumab. |
| Mumps virus | The therapeutic efficacy of Mumps virus strain B level jeryl lynn live antigen can be decreased when used in combination with Lomustine. |
| Muromonab | The risk or severity of adverse effects can be increased when Muromonab is combined with Lomustine. |
| Mycophenolate m | The risk or severity of adverse effects can be increased when Mycophenolate mofetil is combined with Lomustine. |
| Mycophenolic acid | The risk or severity of adverse effects can be increased when Mycophenolic acid is combined with Lomustine. |
| Nadroparin | The risk or severity of bleeding can be increased when Nadroparin is combined with Lomustine. |
| Natalizumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Natalizumab. |
| Nelarabine | The risk or severity of adverse effects can be increased when Lomustine is combined with Nelarabine. |
| Nilotinib | The risk or severity of adverse effects can be increased when Lomustine is combined with Nilotinib. |
| Nimesulide | The risk or severity of bleeding can be increased when Nimesulide is combined with Lomustine. |
| Nuvaxovid | The therapeutic efficacy of Nuvaxovid can be decreased when used in combination with Lomustine. |
| Obinutuzumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Obinutuzumab. |
| Ocrelizumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Ocrelizumab. |
| Ofatumumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Ofatumumab. |
| Olaparib | The risk or severity of adverse effects can be increased when Lomustine is combined with Olaparib. |
| Oxaliplatin | The risk or severity of adverse effects can be increased when Oxaliplatin is combined with Lomustine. |
| Oxetacaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Oxetacaine. |
| Oxybuprocaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Oxybuprocaine. |
| Ozanimod | The risk or severity of adverse effects can be increased when Lomustine is combined with Ozanimod. |
| Paclitaxel | The risk or severity of adverse effects can be increased when Lomustine is combined with Paclitaxel. |
| Palbociclib | The risk or severity of adverse effects can be increased when Lomustine is combined with Palbociclib. |
| Palifermin | The therapeutic efficacy of Palifermin can be decreased when used in combination with Lomustine. |
| Panobinostat | The risk or severity of adverse effects can be increased when Lomustine is combined with Panobinostat. |
| Parnaparin | The risk or severity of bleeding can be increased when Parnaparin is combined with Lomustine. |
| Pazopanib | The risk or severity of adverse effects can be increased when Lomustine is combined with Pazopanib. |
| Pegaspargase | The risk or severity of adverse effects can be increased when Pegaspargase is combined with Lomustine. |
| Pegcetacoplan | The risk or severity of adverse effects can be increased when Lomustine is combined with Pegcetacoplan. |
| Peginesatide | The risk or severity of Thrombosis can be increased when Peginesatide is combined with Lomustine. |
| Peginterferon | The risk or severity of adverse effects can be increased when Peginterferon alfa-2a is combined with Lomustine. |
| Peginterferon a | The risk or severity of adverse effects can be increased when Peginterferon alfa-2b is combined with Lomustine. |
| Peginterferon | The risk or severity of adverse effects can be increased when Lomustine is combined with Peginterferon beta-1a. |
| Pemetrexed | The risk or severity of adverse effects can be increased when Pemetrexed is combined with Lomustine. |
| Penicillamine | The risk or severity of adverse effects can be increased when Penicillamine is combined with Lomustine. |
| Pentosan polysu | The risk or severity of bleeding can be increased when Pentosan polysulfate is combined with Lomustine. |
| Pentostatin | The risk or severity of adverse effects can be increased when Pentostatin is combined with Lomustine. |
| Pentoxifylline | The risk or severity of bleeding can be increased when Pentoxifylline is combined with Lomustine. |
| Pertussis vaccine | The therapeutic efficacy of Pertussis vaccine can be decreased when used in combination with Lomustine. |
| Phenindione | The risk or severity of bleeding can be increased when Phenindione is combined with Lomustine. |
| Phenol | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Phenol. |
| Phenprocoumon | The risk or severity of bleeding can be increased when Phenprocoumon is combined with Lomustine. |
| Phenylalanine | The risk or severity of adverse effects can be increased when Phenylalanine is combined with Lomustine. |
| Pimecrolimus | The risk or severity of adverse effects can be increased when Pimecrolimus is combined with Lomustine. |
| Pirfenidone | The risk or severity of adverse effects can be increased when Lomustine is combined with Pirfenidone. |
| Pirtobrutinib | The risk or severity of adverse effects can be increased when Lomustine is combined with Pirtobrutinib. |
| Polythiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Polythiazide is combined with Lomustine. |
| Pomalidomide | The risk or severity of adverse effects can be increased when Lomustine is combined with Pomalidomide. |
| Ponatinib | The risk or severity of adverse effects can be increased when Lomustine is combined with Ponatinib. |
| Ponesimod | The risk or severity of adverse effects can be increased when Lomustine is combined with Ponesimod. |
| Pralatrexate | The risk or severity of adverse effects can be increased when Lomustine is combined with Pralatrexate. |
| Pramocaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Pramocaine. |
| Prasugrel | The risk or severity of bleeding can be increased when Prasugrel is combined with Lomustine. |
| Prednisolone | The risk or severity of adverse effects can be increased when Prednisolone is combined with Lomustine. |
| Prednisone | The risk or severity of adverse effects can be increased when Prednisone is combined with Lomustine. |
| Prilocaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Prilocaine. |
| Procaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Procaine. |
| Procarbazine | The risk or severity of adverse effects can be increased when Procarbazine is combined with Lomustine. |
| Proparacaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Proparacaine. |
| Propoxycaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Propoxycaine. |
| Propylthiouracil | The risk or severity of adverse effects can be increased when Propylthiouracil is combined with Lomustine. |
| Protein C | The risk or severity of bleeding can be increased when Protein C is combined with Lomustine. |
| Protein S | The risk or severity of bleeding can be increased when Protein S human is combined with Lomustine. |
| Rabies immune | The therapeutic efficacy of Rabies immune globulin, human can be decreased when used in combination with Lomustine. |
| Rabies virus i | The therapeutic efficacy of Rabies virus inactivated antigen, A can be decreased when used in combination with Lomustine. |
| Rabies virus | The therapeutic efficacy of Rabies virus inactivated antigen, B can be decreased when used in combination with Lomustine. |
| Raltitrexed | The risk or severity of adverse effects can be increased when Raltitrexed is combined with Lomustine. |
| Ravulizumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Ravulizumab. |
| Reteplase | The risk or severity of bleeding can be increased when Reteplase is combined with Lomustine. |
| Reviparin | The risk or severity of bleeding can be increased when Reviparin is combined with Lomustine. |
| Rilonacept | The risk or severity of adverse effects can be increased when Lomustine is combined with Rilonacept. |
| Risankizumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Risankizumab. |
| Rituximab | The risk or severity of adverse effects can be increased when Rituximab is combined with Lomustine. |
| Rivaroxaban | The risk or severity of bleeding can be increased when Rivaroxaban is combined with Lomustine. |
| Roflumilast | Roflumilast may increase the immunosuppressive activities of Lomustine. |
| Ropeginterfer | The risk or severity of adverse effects can be increased when Lomustine is combined with Ropeginterferon alfa-2b. |
| Ropivacaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Ropivacaine. |
| Rotavirus vaccine | The therapeutic efficacy of Rotavirus vaccine can be decreased when used in combination with Lomustine. |
| Rubella virus | The risk or severity of infection can be increased when Rubella virus vaccine is combined with Lomustine. |
| Ruxolitinib | The risk or severity of adverse effects can be increased when Lomustine is combined with Ruxolitinib. |
| Sarilumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Sarilumab. |
| Satralizumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Satralizumab. |
| Secukinumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Secukinumab. |
| Siltuximab | The risk or severity of adverse effects can be increased when Lomustine is combined with Siltuximab. |
| Siponimod | The risk or severity of adverse effects can be increased when Lomustine is combined with Siponimod. |
| Sipuleucel-T | The therapeutic efficacy of Sipuleucel-T can be decreased when used in combination with Lomustine. |
| Sirolimus | The risk or severity of adverse effects can be increased when Sirolimus is combined with Lomustine. |
| Smallpox | The therapeutic efficacy of Smallpox (Vaccinia) Vaccine, Live can be decreased when used in combination with Lomustine. |
| Sodium citrate | The risk or severity of bleeding can be increased when Sodium citrate is combined with Lomustine. |
| Sorafenib | The risk or severity of adverse effects can be increased when Sorafenib is combined with Lomustine. |
| Spesolimab | The risk or severity of adverse effects can be increased when Lomustine is combined with Spesolimab. |
| Streptokinase | The risk or severity of bleeding can be increased when Streptokinase is combined with Lomustine. |
| Streptozocin | The risk or severity of adverse effects can be increased when Streptozocin is combined with Lomustine. |
| Sulfamethoxazole | The risk or severity of myelosuppression can be increased when Sulfamethoxazole is combined with Lomustine. |
| Sulfasalazine | The risk or severity of adverse effects can be increased when Sulfasalazine is combined with Lomustine. |
| Sulfinpyrazone | The risk or severity of bleeding can be increased when Sulfinpyrazone is combined with Lomustine. |
| Sulodexide | The risk or severity of bleeding can be increased when Sulodexide is combined with Lomustine. |
| Sunitinib | The risk or severity of adverse effects can be increased when Lomustine is combined with Sunitinib. |
| Sutimlimab | The risk or severity of adverse effects can be increased when Lomustine is combined with Sutimlimab. |
| Tacrolimus | Tacrolimus may increase the immunosuppressive activities of Lomustine. |
| Tedizolid phosp | The risk or severity of myelosuppression can be increased when Lomustine is combined with Tedizolid phosphate. |
| Temozolomide | The risk or severity of adverse effects can be increased when Temozolomide is combined with Lomustine. |
| Temsirolimus | The risk or severity of adverse effects can be increased when Lomustine is combined with Temsirolimus. |
| Tenecteplase | The risk or severity of bleeding can be increased when Tenecteplase is combined with Lomustine. |
| Teniposide | The risk or severity of adverse effects can be increased when Teniposide is combined with Lomustine. |
| Teprotumumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Teprotumumab. |
| Teriflunomide | The risk or severity of adverse effects can be increased when Lomustine is combined with Teriflunomide. |
| Tetracaine | The risk or severity of methemoglobinemia can be increased when Lomustine is combined with Tetracaine. |
| Thalidomide | The risk or severity of adverse effects can be increased when Thalidomide is combined with Lomustine. |
| Thiotepa | The risk or severity of adverse effects can be increased when Lomustine is combined with Thiotepa. |
| Ticagrelor | The risk or severity of bleeding can be increased when Ticagrelor is combined with Lomustine. |
| Tick-borne encep | The therapeutic efficacy of Tick-borne encephalitis vaccine (whole virus, inactivated) can be decreased when used in combination with Lomustine. |
| Ticlopidine | The risk or severity of bleeding can be increased when Ticlopidine is combined with Lomustine. |
| Tinzaparin | The risk or severity of bleeding can be increased when Tinzaparin is combined with Lomustine. |
| Tioguanine | The risk or severity of adverse effects can be increased when Tioguanine is combined with Lomustine. |
| Tirofiban | The risk or severity of bleeding can be increased when Tirofiban is combined with Lomustine. |
| Tixocortol | The risk or severity of adverse effects can be increased when Lomustine is combined with Tixocortol. |
| Tocilizumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Tocilizumab. |
| Tofacitinib | Lomustine may increase the immunosuppressive activities of Tofacitinib. |
| Topotecan | The risk or severity of adverse effects can be increased when Topotecan is combined with Lomustine. |
| Tositumomab | The risk or severity of adverse effects can be increased when Tositumomab is combined with Lomustine. |
| Trabectedin | The risk or severity of adverse effects can be increased when Lomustine is combined with Trabectedin. |
| Trastuzumab | Trastuzumab may increase the neutropenic activities of Lomustine. |
| Trastuzumab e | The risk or severity of adverse effects can be increased when Lomustine is combined with Trastuzumab emtansine. |
| Tretinoin | The risk or severity of adverse effects can be increased when Tretinoin is combined with Lomustine. |
| Triamcinolone | The risk or severity of adverse effects can be increased when Triamcinolone is combined with Lomustine. |
| Trichlormethiazide | The risk or severity of neutropenia and thrombocytopenia can be increased when Trichlormethiazide is combined with Lomustine. |
| Trifluridine | The risk or severity of adverse effects can be increased when Trifluridine is combined with Lomustine. |
| Triflusal | The risk or severity of bleeding can be increased when Triflusal is combined with Lomustine. |
| Trilostane | The risk or severity of adverse effects can be increased when Trilostane is combined with Lomustine. |
| Typhoid vaccine | The therapeutic efficacy of Typhoid vaccine can be decreased when used in combination with Lomustine. |
| Typhoid Vaccine | The risk or severity of infection can be increased when Typhoid Vaccine Live is combined with Lomustine. |
| Typhoid Vi poly | The therapeutic efficacy of Typhoid Vi polysaccharide vaccine can be decreased when used in combination with Lomustine. |
| Ublituximab | The risk or severity of infection can be increased when Ublituximab is combined with Lomustine. |
| Upadacitinib | The risk or severity of adverse effects can be increased when Lomustine is combined with Upadacitinib. |
| Urokinase | The risk or severity of bleeding can be increased when Urokinase is combined with Lomustine. |
| Varicella zoster | The risk or severity of infection can be increased when Varicella zoster vaccine (live/attenuated) is combined with Lomustine. |
| Varicella zoster) | The therapeutic efficacy of Varicella zoster vaccine (recombinant) can be decreased when used in combination with Lomustine. |
| Vedolizumab | The risk or severity of adverse effects can be increased when Lomustine is combined with Vedolizumab. |
| Vibrio cholerae | The therapeutic efficacy of Vibrio cholerae CVD 103-HgR strain live antigen can be decreased when used in combination with Lomustine. |
| Vilanterol | The risk or severity of adverse effects can be increased when Lomustine is combined with Vilanterol. |
| Vinblastine | The risk or severity of adverse effects can be increased when Vinblastine is combined with Lomustine. |
| Vincristine | The risk or severity of adverse effects can be increased when Vincristine is combined with Lomustine. |
| Vindesine | The risk or severity of adverse effects can be increased when Vindesine is combined with Lomustine. |
| Vinorelbine | The risk or severity of adverse effects can be increased when Vinorelbine is combined with Lomustine. |
| Voclosporin | The risk or severity of adverse effects can be increased when Lomustine is combined with Voclosporin. |
| Vorapaxar | The risk or severity of bleeding can be increased when Vorapaxar is combined with Lomustine. |
| Vorinostat | The risk or severity of adverse effects can be increased when Lomustine is combined with Vorinostat. |
| Warfarin | The risk or severity of bleeding can be increased when Warfarin is combined with Lomustine. |
| Ximelagatran | The risk or severity of bleeding can be increased when Ximelagatran is combined with Lomustine. |
| Yellow fever vacci | The risk or severity of infection can be increased when Yellow fever vaccine is combined with Lomustine. |
| Zidovudine | The risk or severity of adverse effects can be increased when Zidovudine is combined with Lomustine. |
Pregnancy and Lactation
AU TGA pregnancy category: D
US FDA pregnancy category: D
Pregnancy
Based on animal data and its mechanism of action, Gleostine can cause fetal harm when administered to a pregnant woman. There are no available data on Gleostine exposure in pregnant women. Lomustine was teratogenic in rats and embryotoxic in rabbits at total dose levels
approximately two to four times the total human dose of 130 mg/m2 over 6 weeks (0.18 to 0.27 times the single human dose of 130 mg/m2
) based on BSA [see Data]. Advise pregnant women of the potential risk to a fetus. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.
Lactation
There is no information on the presence of lomustine or its metabolites in human milk, its effects on the breastfed infant, or its effects on milk production. Because of the potential for serious adverse reactions in breastfed infants from Gleostine.
Why is this medication prescribed?
Lomustine is used to treat certain types of brain tumors. Lomustine is also used with other medications to treat Hodgkin’s lymphoma (Hodgkin’s disease) that has not improved or that has worsened after treatment with other medications. Lomustine is in a class of medications called alkylating agents. It works by slowing or stopping the growth of cancer cells in your body.
How should this medicine be used?
Lomustine comes as a capsule to take by mouth. It is usually taken once every 6 weeks on an empty stomach. Your full dose may contain two or more different types and colors of capsules. You will receive only enough capsules for one dose. Take all of the capsules given to you in the prescription bottle at the same time. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take lomustine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
You should wear rubber or latex gloves when you handle the capsules so that your skin does not come into contact with the capsules. If the capsule contents touch your skin, wash the area well with soap and water right away. Swallow the capsules whole; do not split, chew, or crush them. Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.
What special precautions should I follow?
Before taking lomustine,
- tell your doctor and pharmacist if you are allergic to lomustine, any other medications, or any of the ingredients in lomustine capsules. Ask your pharmacist for a list of the ingredients.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.
- you should know that lomustine may decrease fertility in men and women. However, you should not assume that you or your partner cannot become pregnant. Tell your doctor if you are pregnant or plan to become pregnant. If you are female, you should use birth control to prevent pregnancy during your treatment with lomustine and for at least 2 weeks after your final dose. If you are male, you and your female partner should use birth control during your treatment with lomustine and continue for 4 months after your final dose. If you or your partner become pregnant while taking lomustine, call your doctor. Lomustine may harm the fetus.
- tell your doctor if you are breastfeeding or plan to breastfeed. You should not breastfeed while taking lomustine and for 2 weeks after your final dose.
