Lomustine is an alkylating agent that is prescribed, alone or in combination with other drugs, to treat certain brain tumors. It may also be prescribed along with other agents for the secondary treatment of Hodgkin's lymphoma.

Generic CeeNU


Moostin , Belustine, Lomoother

6, 10

Miracalus Pharma, Naprod, Medi Biotek India


40 mg



I. Introduction

Brief Overview of Lomustine

Lomustine is a type of chemotherapy drug mainly used to treat types of cancer. It works by targeting and inhibiting the growth of cancer cells using its properties.

Historical Context and Development

Lomustine, which was first developed in the 20th century has firmly established itself as a crucial weapon in the fight against cancer. Its introduction marked an advancement in the emerging field of oncological pharmacotherapy.

Scope and Importance in Medical Oncology

Lomustine has proven to be effective in treating types of cancers. It has not only benefited many patients but has also sparked significant academic discussions leading to advancements in the field of oncology. Its role is vital in malignancies and is also used for gliomas and metastatic brain tumors. Furthermore, it catalyzes research and development in this area.

II. What is Lomustine: Composition and Formulation

Chemical Composition

Lomustine contains a structure called chloroethyl cyclohexyl nitrosourea which gives it the ability to have toxic effects on cells.

Available Formulations

Lomustine is primarily found in the form of capsules, but there are ongoing research efforts to explore different ways of administering it, including through intravenous formulations.

Pharmacological Classification

Lomustine is classified as an alkylating agent belonging to the group of medications known as antineoplastics. Its primary function is to interfere with the replication of DNA in cells.

III. How Lomustine Works: Mechanism of Action

The Biochemical Pathway

When Lomustine is given, it goes through a process where it becomes activated and forms alkyl groups. These groups then attach themselves to the DNA bases, leading to programmed cell death (apoptosis) in cells.

Target Cells and Tissues

Lomustine has an affinity for cells that are rapidly dividing, which makes it highly effective, against cells found in different parts of the body like the blood and nervous system.

Effectiveness Against Specific Cancers

Clinical studies have shown that it is effective in treating types of cancer such as Hodgkin's lymphoma, glioblastoma multiforme, and small-cell lung cancer.

IV. Approved Uses of Lomustine

Primary Indications

Hodgkin's Lymphoma

Brain Tumors

Lung Cancer

Duration and Effectiveness

Clinical Studies Supporting Use

V. Off-Label Uses of Lomustine

Metastatic Melanoma

Although it hasn’t received approval Lomustine has been used to treat metastatic melanoma with some degree of success1Lomustine is not included in the current guidelines for systemic therapy of melanoma2, which recommend immunotherapy and targeted therapy as the main options for unresectable or metastatic disease23Lomustine may have some activity against melanoma cells that are resistant to other drugs, but more research is needed to confirm its efficacy and safety1.

1Lomustine in Treating Patients With Stage IV Melanoma - Full Text View … 2Systemic Therapy for Melanoma: ASCO Guideline 3New Therapies Available for Advanced Melanoma - NCI


Use in Veterinary Medicine

It’s quite interesting to note that Lomustine has found its use in medicine specifically in treating lymphoma, in dogs1234Lomustine can be used as a first-line or a rescue drug for canine lymphoma, with response rates ranging from 25% to 90% depending on the protocol and the stage of the disease124Lomustine can also treat other types of cancers in dogs, such as mast cell tumors, brain tumors, melanoma, and lung cancer34Lomustine is given orally in capsule form, but it can cause serious side effects such as bone marrow suppression, liver toxicity, and gastrointestinal upset34.

1Lomustine for dogs and cats: Uses, Dosage & Side Effects 2Efficacy and tolerability of a 12-week combination chemotherapy … 3Lomustine | VCA Animal Hospitals 4Lomustine – Pet Cancer Society

Doctors should exercise caution when considering the use of medications, for purposes that are not officially approved as there may be legal concerns to take into account.

VI. Dosage and Administration Guidelines

The recommended dosage is carefully determined, often considering factors like body surface area or weight. The specific dosage may vary depending on the type of cancer being treated.

Route of Administration

The standard way to take this medication is by swallowing it, and it's essential to follow the fasting instructions before you take it.

Dose Modifications (Renal Impairments, Liver Issues, etc.)

Patients who have issues with their liver or kidneys may require adjustments, to their dosage. Typically these adjustments are made based on monitoring liver function tests and renal panels.

VII. Common Side Effects of Lomustine

Mild Side Effects

The medication may cause some side effects, such as feeling nauseous, experiencing fatigue, or temporary hair loss. However, these symptoms can usually be managed with treatment and are not long-lasting.

Severe Side Effects

Lomustine may lead to side effects, like reduced bone marrow function and liver damage. It is essential to monitor for these complications and potentially discontinue the medication if needed. Potential side effects include Reduced bone marrow function and Liver damage.

VIII. Drug Interactions and Warnings

Potential Drug Interactions

When Lomustine is taken together with medications, it may affect how it works and its safety. These medications can include alcohol and other chemotherapy agents.


Drinking alcohol at the time, such as taking Lomustine, can worsen liver toxicity. Alcohol can affect how the drug is broken down and removed from the body by changing how liver enzymes work.

Other Chemotherapy Agents

Using Lomustine with other drugs to treat cancer may increase the risk of myelosuppression, a condition where the bone marrow's ability to function properly is compromised.

Important Warnings

Both healthcare professionals and individuals seeking treatment need to be aware of essential safety precautions related to the use of Lomustine. These precautions include box warnings and considerations, for genetic predispositions.

Black Box Warnings

Lomustine is accompanied by warning labels that emphasize the potential for bone marrow suppression, which requires regular monitoring of blood-related factors.

Genetic Predispositions

Some specific genetic differences might make people more likely to experience increased toxicity or reduced effectiveness when using Lomustine.

IX. Contraindications and Special Precautions

Existing Health Conditions

Individuals with existing kidney or liver problems should usually avoid undergoing Lomustine treatment unless the potential advantages significantly outweigh any risks.

Allergic Reactions

Patients with a known allergy or sensitivity to Lomustine or its components, should not use the medication.

Lifestyle Choices: Smoking and Alcohol Consumption

Excessive consumption of alcohol and tobacco smoking can amplify the effects of Lomustine, which may require adjustments in the treatment approach.

X. Special Administration Considerations

Administration to Elderly Patients

Dose Adjustments

As patients get older, they might need to lower their medication dosage because their kidneys may not work as efficiently as before and they become more vulnerable, to potential side effects.

Monitoring Parameters

Elderly individuals need to be monitored, especially regarding their kidney and liver function, to minimize the chances of any negative consequences.

Administration to Pregnant Women and Nursing Mothers

Teratogenic Effects

Lomustine has been found to affect fetal development, so it is advisable to avoid its use during pregnancy unless necessary.

Alternative Treatments

If it is necessary to undergo treatment, it is advisable to explore chemotherapy options with a better safety record, for pregnant women.

Administration to Children

Pediatric Dosage

Pediatric dosing schedules must be customized for each individual and are typically calculated based on milligrams per meter (mg/m2).

Clinical Studies on Pediatric Use

There is empirical evidence regarding the effectiveness and safety of Lomustine in treating pediatric malignancies. Therefore, it is essential to be cautious when considering its use.

XI. Overdosage and Handling Precautions

Signs and Symptoms of Overdosage

Overdosing, whether accidentally or intentionally, primarily shows symptoms of increased suppression of bone marrow function and gastrointestinal issues such, as vomiting and diarrhea.

Immediate Treatment Protocols

It is crucial to provide vital care to stabilize patients' blood flow and manage their symptoms in overdose cases.

Safe Handling and Disposal Guidelines

Healthcare professionals must follow the recommended medication management protocols to prevent contamination and ensure proper disposal.

XII. Storage Recommendations

Optimal Storage Conditions

It is crucial to store Lomustine capsules in a place at room temperature to ensure their effectiveness is preserved.

Shelf Life and Expiry

The expiration dates mentioned on the packaging should be strictly followed to ensure the therapeutic effects are not compromised.

Signs of Compromised Product Integrity

If you notice any changes in color, unpleasant smell, or abnormalities, in the appearance of the capsules, it is important to dispose of them and report the issue.

XIII. Conclusion

Summary of Key Points

Lomustine is a used chemotherapy drug that effectively treats various types of cancer. However, it comes with essential factors to consider, including potential interactions with other drugs and specific instructions, for administration.

Importance of Consulting Healthcare Providers

It's crucial for patients to seek guidance, from healthcare professionals when it comes to treatment plans and careful monitoring. This way, they can optimize the effectiveness of their therapies. Minimize any potential adverse effects.

Future Research and Developments in Lomustine Therapies

Ongoing and future research endeavors are focused on broadening the applications of Lomustine, enhancing its safety profile, and creating new formulations. These efforts hold promise for the future of this long-standing anticancer drug.

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