Lomustine is a medicine used to treat certain types of cancer.
How is it given?
Lomustine is given by mouth in the form of a capsule.
What are the side effects of lomustine?
Nausea and vomiting
Taking lomustine with food will help this side effect. If this is not helpful, anti-sickness medicines can be given to reduce or prevent these symptoms.
Loss of appetite
It is possible that your child may ‘go off’ food and their appetite may reduce while having treatment. The dietitians may be able to suggest ways of making food more attractive to your child.
Bone marrow suppression
There will be a temporary reduction in how well your child’s bone marrow works. This means your child may become anaemic, bruise or bleed more easily than usual, and have a higher risk of infection. Your child’s blood counts will be checked regularly to see how the bone marrow is working. Please tell your doctor if your child seems unusually tired, has bruising or bleeding, or any signs of infection, especially a high temperature.
Your child may lose some or all of his or her hair, including eyebrows and eyelashes. This is temporary and the hair will grow back once the treatment is finished.
Mouth sores and ulcers
You will be given advice about appropriate mouth care including a copy of our mouth care leaflet. If your child complains of having a sore mouth, please tell your doctor or nurse.
Temporary effect on liver function
Lomustine can cause some mild changes to your child’s liver function. This should return to normal when the treatment is finished. Blood tests may be taken to monitor your child’s liver function (LFTs).
Lomustine and interactions with other medicines
Some medicines can react with lomustine, altering how well it works. Always check with your doctor or pharmacist before giving your child any other medicine, including medicines on prescription from your family doctor (GP), medicines bought from a pharmacy (chemist) or any herbal or complementary medicines.
Important information you should know about lomustine
- Keep all medicines in a safe place where children cannot reach them.
- Lomustine should be kept in a cool, dry place away from direct sunlight or heat.
- You should handle these medicines with care, avoiding touching them where possible. If you are pregnant or think you could be pregnant, please discuss handling instructions with your doctor, nurse or pharmacist. Please see our Special handling requirements information sheet for further details.
- If your child vomits straight after taking the dose, inform your local doctor or nurse, as your child may need to take another one. Do not give them another dose without informing the doctor or nurse.
- If you forget to give your child a dose, do not give a double dose. Inform your doctor or nurse and keep to your child’s regular schedule.
- If your child cannot swallow capsules, they can be made into a mixture to be given by mouth as follows:
- You will need a pair of rubber gloves, a small container such as a medicine pot, and a spoon or oral syringe to prepare the mixture. ‘Duck’ masks are available from Day Care. Use a new mask for each use.
- Put on your gloves and mask.
- Put a little milk into the small container or put some yoghurt, fromage frais or ice cream onto the spoon.
- Empty the contents of the required number of capsules into the milk or onto the food and mix carefully.
- DO NOT mix the capsule contents with water or juice as this can cause stomach irritation.
- If mixed with food, give the dose directly to your child using the spoon. If mixed with milk, draw the dose into the oral syringe and give to your child.
- Wash the container and spoon or oral syringe in warm, soapy water and do not use for any other purpose.
- If you accidentally spill the tablets or mixture, wash the area thoroughly with plenty of water.
- If the mixture accidentally gets into your eyes, wash with plenty of running water for five to 10 minutes.
- Used paper towels, masks, vomit and dirty disposable nappies should be placed inside two rubbish bags and disposed of along with your normal rubbish.
- If your doctor decides to stop treatment with lomustine or the medicine passes its expiry date, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
Please read this information sheet from GOSH alongside the patient information leaflet (PIL) provided by the manufacturer. If you do not have a copy of the manufacturer’s patient information leaflet please talk to your pharmacist. A few products do not have a marketing authorisation (licence) as a medicine and therefore there is no PIL.
For children in particular, there may be conflicts of information between the manufacturer’s patient information leaflet (PIL) and guidance provided by GOSH and other healthcare providers. For example, some manufacturers may recommend, in the patient information leaflet, that a medicine is not given to children aged under 12 years. In most cases, this is because the manufacturer will recruit adults to clinical trials in the first instance and therefore the initial marketing authorisation (licence) only covers adults and older children.
For new medicines, the manufacturer then has to recruit children and newborns into trials (unless the medicine is not going to be used in children and newborns) and subsequently amend the PIL with the approved information. Older medicines may have been used effectively for many years in children without problems but the manufacturer has not been required to collect data and amend the licence. This does not mean that it is unsafe for children and young people to be prescribed such a medicine ‘off-licence/off-label’. However, if you are concerned about any conflicts of information, please discuss with your doctor, nurse or pharmacist.