An oral chemotherapy for brain tumours and Hodgkin lymphoma
Lomustine
An oral chemotherapy capsule used for some brain tumours and Hodgkin lymphoma, taken as a single dose every several weeks.
What is Lomustine?
Lomustine is an oral chemotherapy medicine, a nitrosourea, used to treat certain brain tumours and Hodgkin lymphoma. A crucial and unusual feature is that it is taken as a single dose only once every several weeks, not daily, and taking it more often than prescribed can be extremely dangerous. Its main risk is bone-marrow suppression, which lowers blood cells and is delayed, prolonged and builds up over repeated courses. It can also affect the lungs and kidneys with longer use. It is a specialist medicine given under close supervision, with careful checks to prevent dosing errors.
Education and reference only. This is a plain-language guide to Lomustine — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Lomustine is a chemotherapy medicine belonging to a group called nitrosoureas. It is used to treat some types of brain tumour and Hodgkin lymphoma, often as part of a wider treatment plan. Unlike many medicines, it is taken by mouth as capsules as a single dose given only once every several weeks. It is a specialist cancer medicine prescribed and supervised by an oncology team. Because of how powerful it is and how unusual its dosing schedule is, it carries important safety warnings to make sure it is never taken too often.
How it works
Lomustine is an alkylating agent, which means it damages the DNA inside cells so they can no longer divide and grow. Cancer cells, which divide rapidly, are particularly affected, which is how it helps shrink or control tumours. Because it can cross into the brain, it is useful for certain brain tumours. The same action also affects healthy fast-dividing cells, especially those in the bone marrow that make blood cells, which is why its main side effect is a fall in blood counts. Its effect on the marrow is delayed and long-lasting, which is why it is given so infrequently.
Company & origin
Originated / developed by: Specialist manufacturers.
A specialist oral chemotherapy used in the UK to treat certain brain tumours and Hodgkin lymphoma.
Practical use
How to take Lomustine
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it only as a single dose on the day your oncology team tells you, never daily and never more often than prescribed.
- Make sure you understand exactly how many capsules make up your single dose, as taking too many is very dangerous.
- Take any anti-sickness medicine you are given, as nausea and vomiting are common around the dose.
- Attend all your blood tests, as the medicine lowers blood counts in a delayed and prolonged way.
- Report any breathlessness, cough, fever, bruising or signs of infection to your team promptly.
Weighing it up
Advantages & disadvantages of Lomustine
Advantages
- An effective chemotherapy for certain brain tumours and Hodgkin lymphoma.
- Taken by mouth, so it does not need a drip for each dose.
- Able to reach the brain, which is useful for some brain tumours.
Disadvantages
- Causes delayed, prolonged and cumulative bone-marrow suppression, lowering blood counts.
- Its unusual single-dose-every-few-weeks schedule means dosing errors can be very dangerous.
- With longer use it can affect the lungs and kidneys, and it commonly causes nausea.
Practical use
Good to know
The most important safety point with lomustine is its dosing: it is taken as a single dose only once every several weeks, and taking it daily or more often by mistake can cause severe, potentially fatal harm. Because of this, the capsules are dispensed carefully and patients are counted and counselled to avoid dosing errors. Its main effect is bone-marrow suppression, which lowers white cells, red cells and platelets; importantly this is delayed, can be prolonged, and builds up over repeated courses, so blood counts are checked closely and doses are spaced out to allow recovery. With longer use it can also affect the lungs (causing breathing problems) and the kidneys. Nausea and vomiting are common around the time it is taken, and anti-sickness medicine is usually given. It is handled and supervised entirely by a specialist team.
Who should not take it / use with caution
- People who have had a serious allergic reaction to lomustine should not take it.
- It is not used in pregnancy, as it can harm an unborn baby; effective contraception is important.
- It is used with great care, or avoided, in people with very low blood counts or significant lung or kidney problems.
Monitoring
- Regular and ongoing blood tests to check blood counts, given the delayed and cumulative marrow effect.
- Checking lung and kidney function over time with repeated courses.
- Reviewing how the tumour responds and watching for signs of infection or bleeding.
Side effects
- A fall in blood counts that is delayed and prolonged, raising the risk of infection, bleeding and anaemia.
- Nausea and vomiting around the time the dose is taken.
- With longer use, lung problems (such as breathlessness or cough) and kidney problems.
Key interactions
- It adds to the effects of other medicines or treatments that lower blood counts, such as other chemotherapy or radiotherapy.
- Live vaccines are generally avoided during treatment, as the immune system is weakened.
- Tell your team about all your medicines, including anything bought over the counter.
Available as: Capsules taken by mouth as a single dose every several weeks.
Answers
Lomustine: frequently asked questions
What is lomustine used for?
It is an oral chemotherapy used to treat certain brain tumours and Hodgkin lymphoma, usually as part of a wider treatment plan.
How often do I take it?
It is taken as a single dose only once every several weeks, not daily; taking it more often than prescribed can be extremely dangerous, so follow your team's instructions exactly.
What is its main side effect?
Its main effect is a fall in blood counts (bone-marrow suppression), which is delayed, can last a while, and builds up over repeated courses, so blood tests are checked closely.
Why are there so many warnings about the dose?
Because of its unusual single-dose schedule, taking it daily or taking too many capsules by mistake can cause severe harm, so the capsules are dispensed and counted very carefully.
Can it affect my lungs or kidneys?
With longer use it can affect the lungs and kidneys, so these are monitored, and you should report any new breathlessness or cough to your team.
The wider class
About Nitrosourea alkylating chemotherapy (oral)
Lomustine belongs to the nitrosourea alkylating chemotherapy (oral) class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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