Lomustine is a chemotherapy drug that is given as a treatment for some types of cancer. This information describes lomustine, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer, which give further information and advice.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

Lomustine is available as blue and clear capsules of 40mg.

The capsules should be swallowed whole with a large glass of water. Your doctor, nurse or pharmacist will explain exactly when you should take them.

Chemotherapy is usually given as a course of several sessions (or cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer for which you are being treated. Your nurse or doctor will discuss your treatment plan with you.

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given lomustine and may be different if you are having more than one chemotherapy drug.

We have outlined the most common side effects as well as rarer ones, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you.

If you notice any effects which you think may be due to the drug, but are not listed in this information, please discuss them with your doctor, chemotherapy nurse or pharmacist.

Feeling sick (nausea) and being sick (vomiting) If you do feel sick this may begin a few hours after the treatment is given and last for 2–3 days. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting. If the sickness is not controlled, or continues, tell your doctor; they can prescribe other anti-sickness drugs which may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Lowered resistance to infection Lomustine can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin three weeks after treatment has been given and your resistance to infection usually reaches its lowest point 4–6 weeks after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature)

You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Lomustine can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with lomustine you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these symptoms are a problem.

Tiredness and feeling weak It is important to allow yourself plenty of time to rest.

Sore mouth and ulcers Your mouth may become sore or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as special mouthwashes and medicine to prevent or clear any mouth infection can be prescribed.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Diarrhoea This can usually be easily controlled with medicine, but tell your doctor if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

Loss of appetite A dietitian or specialist nurse at your hospital can give advice and tips on boosting appetite, coping with eating difficulties and maintaining weight.

Your liver may be temporarily affected Lomustine may cause changes in the way that your liver works, though your liver will return to normal when the treatment is finished. This is very unlikely to cause you any harm, but your doctor will monitor you carefully. Samples of your blood will be taken from time to time to check your liver is working properly. If you notice that your skin or eyes become slightly yellow in colour let your doctor know.

Hair loss This is rare. If it happens, it usually begins about 3–4 weeks after starting treatment, although it may occur earlier. Hair may fall out completely or may just thin. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will regrow once the treatment ends.

Changes to the lungs Lomustine may cause some changes to the lung tissue. Tell your doctor if you notice any coughing or breathlessness.

Eyesight Lomustine may affect your eyesight, however this is very rare. Let your doctor know if you notice any change in your vision.

Confusion Rarely, lomustine can cause mild confusion and disorientation. Let your doctor know if you notice these side effects.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines Some medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking lomustine as it may harm the developing foetus. It is essential to use effective contraception whilst taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

• Store the capsules in their original packaging, in a cool, dry place.
• Keep the capsules in a safe place where children cannot reach them, as lomustine could harm them.
• It is important to take your capsules at the right times. You must take them as directed by your doctor.
• If you are sick just after taking the capsules let your doctor know as you may need to take another dose. Do not take more capsules without first telling your doctor.
• If your doctor decides to stop the treatment, return any remaining capsules to the pharmacist. Do not flush them down the toilet or throw them away.
• If you forget to take a capsule do not take a double dose. Tell your doctor and keep to your regular dose schedule.

This section is based on our Lomustine factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Medicines.org.uk website – www.medicines.org.uk (November 2007).
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott Williams and Wilkins, 2001.

For further references, please see general bibliography.