Lomustine Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Brain/Intracranial Tumor

130 mg/m2 orally as a single dose every six weeks in previously untreated patients or 100 mg/m2 orally as a single dose every six weeks for patient with compromised bone marrow function.

Usual Adult Dose for Hodgkin's Disease

130 mg/m2 orally as a single dose every six weeks in previously untreated patients or 100 mg/m2 orally as a single dose every six weeks for patient with compromised bone marrow function.

Usual Pediatric Dose for Brain/Intracranial Tumor

75 to 130 mg/m2 orally as a single dose every six weeks.
Subsequent doses are readjusted after initial treatment according to platelet and leukocyte counts.

Usual Pediatric Dose for Hodgkin's Disease

75 to 130 mg/m2 orally as a single dose every six weeks.
Subsequent doses are readjusted after initial treatment according to platelet and leukocyte counts.

Renal Dose Adjustments

CrCl less than 10 mL/min: 65 mg/m2 orally one time, as a single agent in previously untreated patients or
50 mg/m2 orally one time, for patient with compromised bone marrow function.

CrCl 10 to 50 mL/min: 97.5 mg/m2 orally one time, as a single agent in previously untreated patients or
75 mg/m2 orally one time, for patient with compromised bone marrow function.

Liver Dose Adjustments

Data not available

Dose Adjustments

Courses of lomustine should not be given more often than every 6 weeks because hematologic toxicity is delayed and cumulative. Repeat courses should not be given until the platelet count is greater than 100,000/mm3 and the leukocyte count is greater than 4,000/mm3 (usually within 6 weeks). An adequate number of neutrophils should be present on a peripheral blood smear. The following guide to adjust dosage based on nadir levels from the previous dose may be appropriate:
Nadir level and Appropriate Dose:
Greater than 3000 leukocytes or 75,000 platelets, no adjustment is required.
2,000-2,999 leukocytes or 25,000-74,999 platelets, give 70% of normal dose
Less than 2,000 leukocytes or less than 25,000 platelets, give 50% of normal dose

Appropriate dosages may vary depending on the specific indication and choice of cytotoxic agents. Reference to specific protocols is recommended.

Precautions

Because lomustine is hepatically metabolized, extra caution is recommended if lomustine is to be used in patients with hepatic dysfunction.

Alcohol should be avoided for short periods after ingestion of a dose. The major toxicity is delayed bone marrow suppression. Blood counts should be monitored weekly for at least 6 weeks after a dose.

Dialysis

Lomustine is not removed by hemodialysis. A supplemental dose in not necessary.

Continuous ambulatory peritoneal dialysis: Administer 25% to 50% of dose.

Other Comments

Lomustine may be taken on an empty stomach to decrease nausea and vomiting that may occur. Prophylactic antiemetics may be administered concurrently.

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