Lomustine
Alkylating agents
Alkylating agentsHigh alert
An error with this medicine can cause serious harm: double checks and protocols are used.
An oral nitrosourea for brain tumours. One dose covers a long cycle: dispensing errors have caused fatal overdoses, and myelosuppression comes late.
Also called: CCNU
Quick facts
- Group
- Alkylating agents
- Target
- DNA and RNA, alkylated; proteins carbamoylated
- Used for
- Primary and metastatic brain tumours
- Key effects
- Nausea · Hair loss · Delayed myelosuppression
- Monitor
- Pulmonary function tests before
- ATC
- L01AD02
No doses: the clinician sets them by the current guideline.
Mechanism of action
Lomustine is a lipid-soluble nitrosourea. Like carmustine it breaks down into a chloroethyl group that alkylates and cross-links DNA (and alkylates RNA) and an isocyanate that carbamoylates proteins, possibly inhibiting DNA repair. It crosses the blood–brain barrier.
- Lomustine breaks down into reactive pieces
- It alkylates and cross-links DNA
- It carbamoylates proteins
- It crosses into the brain
Indications
- Primary and metastatic brain tumours, after surgery and/or radiotherapy.
- Hodgkin lymphoma that progressed after initial chemotherapy, in combination. Hodgkin lymphoma →
Adverse effects
Common
- Nausea, vomiting, mouth sores
- Hair loss
- Delayed myelosuppression (thrombocytopenia more than leukopenia)
- Liver enzyme rises
Contraindications
- The label lists no contraindications; it is avoided after previous hypersensitivity
Key interactions
- Other myelosuppressive drugs and radiotherapy
- Additive, delayed bone marrow suppression.
What is monitored
- Blood counts weekly for several weeks after each dose
- Pulmonary function tests before and during treatment
- Liver and kidney function
Administration and safety
- Only enough capsules for a single dose are prescribed and dispensed, and the patient is told clearly that it is one dose per cycle.
- Capsules are swallowed whole and not opened; hazardous drug handled with gloves.
- A new cycle waits for blood counts to recover.
Pregnancy and breastfeeding
Can cause fetal harm; effective contraception is advised for women and men.
Nursing care
- Double-check the number of capsules dispensed against the single dose prescribed.
- Teach that the low blood counts come weeks later; report bleeding, bruising or fever.
- Ask about cough or breathlessness at each visit.
- Teaching: effective contraception for women and men.
Pharmacokinetics
- Absorption
- Oral capsules.
- Distribution
- Crosses the blood–brain barrier.
- Elimination
- Degradation products mostly in the urine.
Test yourself
Think of the answer, then tap the question to see it.
What is the major dispensing risk with lomustine?
Overdose: only enough capsules for one dose per cycle should be dispensed, because extra doses have been fatal.
Why is lomustine useful for brain tumours?
It is lipid-soluble and crosses the blood–brain barrier.
When does lomustine's myelosuppression appear?
Late, weeks after the dose, and it is cumulative.
Connections
← Back to the class: Alkylating agents
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - LOMUSTINE capsule (DailyMed (U.S. National Library of Medicine), 2026); Lomustine: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.