[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Alkylating agents](https://durgical.com/en/pharmacology/classes/alkylating-agents/) › Lomustine

# Lomustine

## Alkylating agents?

Alkylating agents

## High 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.

Updated Nov 1, 2026

Also called: CCNU

## Quick facts

**Group**
[Alkylating agents](https://durgical.com/en/pharmacology/classes/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.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Clinical What the labels mean

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## 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 →](https://durgical.com/en/conditions/hodgkin-lymphoma/)

## Adverse effects

### Common

- Nausea, vomiting, mouth sores
- Hair loss
- Delayed myelosuppression (thrombocytopenia more than leukopenia)
- Liver enzyme rises

### Serious (rare, important)

- Fatal myelosuppression, which is delayed, dose-related and cumulative
- Fatal toxicity after accidental overdose from dispensing or taking extra capsules
- Pulmonary infiltrates and fibrosis
- Kidney failure; second cancers (acute leukaemia, myelodysplasia)

## 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.

## Memory aid

«LOMustine: one LOnely dose per cycle»: an oral nitrosourea for the brain; counts fall late, lungs can scar.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/lomustine/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## What the labels mean

**High alert**
An error with this medicine can cause serious harm: double checks and protocols are used.

## Connections

## Related drugs 3

- [Carmustine](https://durgical.com/en/pharmacology/carmustine/)
- [Temozolomide](https://durgical.com/en/pharmacology/temozolomide/)
- [Procarbazine](https://durgical.com/en/pharmacology/procarbazine/)

## Related conditions 1

- [Hodgkin lymphoma](https://durgical.com/en/conditions/hodgkin-lymphoma/)

[← Back to the class: Alkylating agents](https://durgical.com/en/pharmacology/classes/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](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=916dfac8-da11-40e4-9e44-a909e29a6b5f) (DailyMed (U.S. National Library of Medicine), 2026); [Lomustine: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a682207.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=L01AD02) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/lomustine/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/lomustine/