Lomustine can cause a severe decrease in the number of blood cells in your bone marrow. A decrease in the number of blood cells in your body may cause certain symptoms and may increase the risk that you will develop a serious infection or bleeding. If you experience any of the following symptoms, call your doctor immediately: fever, sore throat, ongoing cough and congestion, or other signs of infection; unusual bleeding or bruising, bloody or black, tarry stools; bloody vomit; or vomiting blood or brown material that resembles coffee grounds.

Taking too much lomustine or taking it too often can cause serious, life-threatening problems. Take only one dose of lomustine every six weeks.

Keep all appointments with your doctor and the laboratory. Your doctor will order laboratory tests before, during, and after your treatment to check your body’s response to lomustine to see if your blood cells, liver, kidneys, and lungs are affected by this medication.

Lomustine is used to treat certain types of brain tumors. Lomustine is also used with other medications to treat Hodgkin’s lymphoma (Hodgkin’s disease) that has not improved or that has worsened after treatment with other medications. Lomustine is in a class of medications called alkylating agents. It works by slowing or stopping the growth of cancer cells in your body.

Lomustine comes as a capsule to take by mouth. It is usually taken once every 6 weeks on an empty stomach. Your full dose may contain two or more different types and colors of capsules. You will receive only enough capsules for one dose. Take all of the capsules given to you in the prescription bottle at the same time. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take lomustine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

You should wear rubber or latex gloves when you handle the capsules so that your skin does not come into contact with the capsules. If the capsule contents touch your skin, wash the area well with soap and water right away.

Swallow the capsules whole; do not split, chew, or crush them.

Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking lomustine,

• tell your doctor and pharmacist if you are allergic to lomustine, any other medications, or any of the ingredients in lomustine capsules. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.
• you should know that lomustine may decrease fertility in men and women. However, you should not assume that you or your partner cannot become pregnant. Tell your doctor if you are pregnant or plan to become pregnant. If you are female, you should use birth control to prevent pregnancy during your treatment with lomustine and for at least 2 weeks after your final dose. If you are male, you and your female partner should use birth control during your treatment with lomustine and continue for 4 months after your final dose. If you or your partner become pregnant while taking lomustine, call your doctor. Lomustine may harm the fetus.
• tell your doctor if you are breast-feeding or plan to breast-feed. You should not breast-feed while taking lomustine and for 2 weeks after your final dose.

Unless your doctor tells you otherwise, continue your normal diet.

Take the missed dose as soon as you remember it. Tell your doctor if you take your dose on a different day from what was scheduled.

Lomustine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• vomiting
• loss of appetite
• sores in the mouth and throat
• unusual tiredness or weakness
• pale skin
• fainting
• hair loss
• unsteady walk
• slurred speech

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, stop taking lomustine and call your doctor immediately or get emergency medical treatment:

• difficulty breathing
• shortness of breath
• dry cough
• chest pain
• wheezing
• decreased urination;
• swelling of the face, arms, hands, feet, ankles, or lower legs.
• yellowing or eyes and skin
• confusion
• sudden change or loss of vision

Lomustine may increase the risk that you will develop other cancers. Talk to your doctor about the risks of taking lomustine.

Lomustine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• black, tarry stools
• red urine
• unusual bruising or bleeding
• unusual tiredness or weakness
• sore throat, cough, fever, or other signs of infection
• dizziness
• shortness of breath
• diarrhea
• vomiting
• stomach pain
• sores in the mouth and throat

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

• Gleostine^® (formerly available as CeeNu^®)

• CCNU