Adult: For treatment of primary and metastatic tumours following surgical and/or radiotherapeutic procedures: 120-130 mg/m2 as a single dose every 6-8 weeks. Patients with compromised bone marrow function: 100 mg/m2 as a single dose every 6 weeks. Dose reduction may be necessary when used in combination with other myelosuppressive agents. Repeat courses must only be given following adequate recovery of leucocytes (≥4,000/mm3) and platelets (≥100,000/mm3). Dose adjustment or discontinuation may be required according to haematological response. Dosage and treatment recommendations may vary among countries and between individual products (refer to detailed product guidelines). Child: Same as adult dose.
Oral Lung cancer, Metastatic malignant melanoma
Adult: 120-130 mg/m2 as a single dose every 6-8 weeks. Patients with compromised bone marrow function: 100 mg/m2 as a single dose every 6 weeks. Dose reduction may be necessary when used in combination with other myelosuppressive agents. Repeat courses must only be given following adequate recovery of leucocytes (≥4,000/mm3) and platelets (≥100,000/mm3). Dose adjustment or discontinuation may be required according to haematological response. Dosage and treatment recommendations may vary among countries and between individual products (refer to detailed product guidelines). Child: Same as adult dose.
Oral Hodgkin's lymphoma
Adult: As secondary treatment in combination with other chemotherapy agents in patients who have disease progression after initial chemotherapy: 120-130 mg/m2 as a single dose every 6-8 weeks. Patients with compromised bone marrow function: 100 mg/m2 as a single dose every 6 weeks. Dose reduction may be necessary when used in combination with other myelosuppressive agents. Repeat courses must only be given following adequate recovery of leucocytes (≥4,000/mm3) and platelets (≥100,000/mm3). Dose adjustment or discontinuation may be required according to haematological response. Dosage and treatment recommendations may vary among countries and between individual products (refer to detailed product guidelines). Child: Same as adult dose.
Administration
Lomustine Should be taken on an empty stomach.
Special Precautions
Patient with decreased platelets, leucocytes, or erythrocytes; baseline <70% of predicted forced vital capacity or carbon monoxide diffusing capacity (DLCO). Avoid concomitant use with live vaccines. Renal and hepatic impairment. Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Secondary malignancies, including acute leukaemia and myelodysplasia (prolonged use); pulmonary toxicity (e.g. pulmonary infiltrates, pulmonary fibrosis), hepatotoxicity (e.g. increased transaminases, alkaline phosphatase, and bilirubin levels), nephrotoxicity (e.g. decreased kidney size, progressive renal failure). Eye disorders: Blindness, optic atrophy, visual disturbances. Gastrointestinal disorders: Nausea, vomiting, stomatitis, diarrhoea. Metabolism and nutrition disorders: Decreased appetite. Nervous system disorders: Lethargy, ataxia, abnormal coordination, dysarthria. Psychiatric disorders: Confusion, disorientation. Renal and urinary disorders: Azotaemia. Skin and subcutaneous tissue disorders: Alopecia. Potentially Fatal: Delayed and dose-related bone marrow suppression (e.g. thrombocytopenia, leucopenia), which may lead to infections or bleeding.
PO: Z (Some manufacturers contraindicate lomustine use in pregnancy while others do not recommend its use unless benefits outweigh potential risks.)
Patient Counseling Information
Women of childbearing potential must use effective birth control methods during treatment and for at least 2 weeks after the final dose. Men with female partners of childbearing potential must use effective birth control methods during treatment and for 3.5 months after the final dose. Women should avoid breastfeeding during treatment and for 2 weeks after the last dose.
Monitoring Parameters
Obtain CBC with differential and platelet count weekly for at least 6 weeks after each dose. Monitor pulmonary function (at baseline and periodically); liver and kidney function (periodically). Assess for signs and symptoms of secondary malignancies.
Overdosage
Symptoms: Bone marrow suppression, dizziness, anorexia, abdominal pain, diarrhoea, nausea, vomiting, lethargy, abnormal hepatic function, cough, shortness of breath; multiple organ failure (in very severe cases).
Management: Symptomatic and supportive treatment. Perform gastric lavage immediately.
Drug Interactions
May potentiate bone marrow toxicity with theophylline and cimetidine. May reduce anti-tumour effect with phenobarbital. Potentially Fatal: Increased risk of systemic vaccine-associated disease with live vaccines (e.g. yellow fever vaccine).
Action
Description: Overview: Lomustine, a nitrosourea derivative, is an alkylating antineoplastic agent. Mechanism of Action: Lomustine inhibits the synthesis of deoxyribonucleic acid (DNA), ribonucleic acid (RNA), and protein via alkylation. It may also prevent several essential enzymatic processes via carbamoylation of amino acids in proteins. Pharmacokinetics: Absorption: Readily absorbed from the gastrointestinal tract. Time to peak plasma concentration: Approx 3 hours. Distribution: Highly concentrated in the CNS and crosses the blood-brain barrier. Metabolism: Metabolised in the liver to active metabolites. Excretion: Via urine (approx 50% as metabolites). Elimination half-life: 16-48 hours (metabolites).
Chemical Structure
Lomustine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 3950, Lomustine. https://pubchem.ncbi.nlm.nih.gov/compound/Lomustine. Accessed Nov. 26, 2025.
Storage
Store between 15-30°C. This is a cytotoxic drug. Follow applicable procedures for receiving, handling, administration, and disposal.
L01AD02 - lomustine ; Belongs to the class of alkylating agents, nitrosoureas. Used in the treatment of cancer.
References
Brayfield A, Cadart C (eds). Lomustine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 30/10/2025.Gleostine Capsule, Gelatin Coated (NextSource Biotechnology, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 30/10/2025.Joint Formulary Committee. Lomustine. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 30/10/2025.Link Pharmaceuticals Ltd. CeeNU 40 mg Capsules data sheet 16 May 2024. Medsafe. http://www.medsafe.govt.nz. Accessed 30/10/2025.Lomustine Medac 40 mg Capsule (Medac). MHRA. https://products.mhra.gov.uk. Accessed 30/10/2025.Lomustine, CCNU. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 05/11/2025.Lomustine. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 30/10/2025.Lomustine. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 30/10/2025.
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