Temozolomide

Temozolomide is a prescription medication used to treat brain cancer tumors in adults. Temozolomide belongs to a group of drugs called alkylating agents, which slow or stop the growth of cancer cells.

This medication comes in capsule and injectable forms. The capsules are taken once daily, with or without food. Swallow temozolomide capsules whole, with a full glass of water. The injection is given directly into a vein (IV) by a healthcare provider.

Common side effects of temozolomide include nausea, headache, vomiting, and hair loss. 

Temozolomide is a prescription medicine used to treat adults with certain brain cancer tumors. Temozolomide may decrease the size of certain brain tumors in some patients.

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

Temozolomide may be found in some form under the following brand names:

• Temodar

Common side effects with temozolomide include:

• nausea and vomiting. Your doctor can prescribe medicines that may help reduce these symptoms.
• headache
• feeling tired
• loss of appetite
• hair loss
• constipation
• bruising
• rash
• paralysis on one side of the body
• diarrhea
• weakness
• fever
• dizziness
• coordination problems
• viral infection
• sleep problems
• memory loss
• pain, irritation, itching, warmth, swelling or redness at the site of infusion
• bruising or small red or purple spots under the skin

Tell your doctor about any side effect that bothers you or that does not go away.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take a medicine that contains valproic acid (Stavzor, Depakene).

Know the medicines you take. Keep a list of them and show it to your doctor and pharmacist when you get a new medicine.

Temozolomide can cause serious side effects.

• Decreased blood cells. Temozolomide affects cells that grow rapidly, including bone marrow cells. This can cause you to have a decrease in blood cells. Your doctor can monitor your blood for these effects.
• Decreased neutrophils. White blood cells are needed to fight infections. Neutrophils are a type of white blood cell that helps prevent bacterial infections. Decreased neutrophils can lead to serious infections that can lead to death. Other white blood cells called lymphocytes may also be decreased.
• Low platelet counts. Platelets are blood cells needed for normal blood clotting. Low platelet counts can lead to bleeding. Tell your doctor about any unusual bruising or bleeding.
• Pneumocystis carinii Pneumonia (PCP). PCP is an infection that people can get when their immune system is weak. Temozolomide decreases white blood cells, which makes your immune system weaker and can increase your risk of getting PCP. All patients taking temozolomide will be watched carefully by their doctor for this infection, especially patients who take steroids. Tell your doctor if you have any of the following signs and symptoms of PCP infection: shortness of breath and/or fever, chills, dry cough.
• Secondary cancers. Blood problems such as myelodysplastic syndrome and secondary cancers, such as a certain kind of leukemia, can happen in people who take temozolomide. Your doctor will watch you for this.
• Convulsions. Convulsions may be severe or life-threatening in people who take temozolomide.

Your doctor will check your blood regularly while you are taking temozolomide to see if these side effects are happening. Your doctor may need to change the dose of temozolomide or when you get it depending on your blood cell counts. People who are age 70 or older and women may be more likely to have their blood cells affected.

Do not take temozolomide if you:

• have had an allergic reaction to DTIC (dacarbazine), another cancer medicine.
• have had a red itchy rash, or a severe allergic reaction, such as trouble breathing, swelling of the face, throat, or tongue, or severe skin reaction to temozolomide or any of the ingredients in temozolomide. If you are not sure, ask your doctor.

Female patients and female partners of male patients should avoid becoming pregnant while taking temozolomide.

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of temozolomide, there are no specific foods that you must exclude from your diet when receiving temozolomide.

Tell your doctor about all your medical conditions, including if you:

• are allergic to DTIC (dacarbazine) or have had a severe allergic reaction to temozolomide
• have kidney problems
• have liver problems
• are pregnant
• are breastfeeding. It is not known whether temozolomide passes into breast milk. You and your doctor should decide if you will breastfeed or take temozolomide. You should not do both without talking with your doctor.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take a medicine that contains valproic acid (Stavzor, Depakene).

Know the medicines you take. Keep a list of them and show it to your doctor and pharmacist when you get a new medicine.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

This medication falls into category D. Temozolomide may cause birth defects. Male and female patients who take temozolomide should use effective birth control. Female patients and female partners of male patients should avoid becoming pregnant while taking temozolomide.

It is not known if temozolomide crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using temozolomide.

• Temozolomide may be taken by mouth as a capsule at home, or you may receive temozolomide by injection into a vein (intravenous). Your doctor will decide the best way for you to take temozolomide.

There are two common dosing schedules for taking temozolomide.

• Some people take temozolomide for 42 days in a row (possibly 49 days depending on side effects) with radiation treatment. This is one cycle of treatment. After this, you may have "maintenance" treatment. Your doctor may prescribe 6 more cycles of temozolomide. For each of these cycles, you take temozolomide one time each day for 5 days in a row and then you stop taking it for the next 23 days. This is a 28-day maintenance treatment cycle.
• Another way to take temozolomide is to take it one time each day for 5 days in a row only, and then you stop taking it for the next 23 days. This is one cycle of treatment (28 days). Your doctor will watch your progress on temozolomide and decide how long you should take it. You might take temozolomide until your tumor gets worse or for possibly up to 2 years.
• Your dose is based on your height and weight, and the number of treatment cycles will depend on how you respond to and tolerate this treatment.
• Your doctor may modify your schedule based on how you tolerate the treatment.
• If your doctor prescribes a treatment regimen that is different from the information provided here, make sure you follow the specific instructions given to you by your doctor.

Oral:

• Take temozolomide capsules exactly as prescribed.
• Temozolomide capsules come in different strengths. Each strength has a different color cap. Your doctor may prescribe more than one strength of temozolomide capsules for you, so it is important that you understand how to take your medicine the right way. Be sure that you understand exactly how many capsules you need to take on each day of your treatment, and what strengths to take. This may be different whenever you start a new cycle.
• Talk to your doctor before you take your dose if you are not sure how much to take. This will help to prevent taking too much temozolomide and decrease your chances of getting serious side effects.
• Take each day's dose of temozolomide capsules at one time, with a full glass of water.
• Swallow temozolomide capsules whole. Do not chew, open, or split the capsules.
• If temozolomide capsules are accidentally opened or damaged, be careful not to breathe in (inhale) the powder from the capsules or get the powder on your skin or mucous membranes (for example, in your nose or mouth). If contact with any of these areas happens, flush the area with water.
• If you vomit temozolomide capsules, do not take any more capsules. Wait and take your next planned dose.
• The medicine is used best by your body if you take it at the same time every day in relation to a meal.
• To lessen nausea, try to take temozolomide on an empty stomach or at bedtime. Your doctor may prescribe medicine to prevent or treat nausea, or other medicines to lessen side effects with temozolomide.
• See your doctor regularly to check your progress. Your doctor will check you for side effects that you might not notice.
• If you miss a dose of temozolomide, talk with your doctor for instructions about when to take your next dose of temozolomide.
• Call your doctor right away if you take more than the prescribed amount of temozolomide. It is important that you do not take more than the amount of temozolomide prescribed for you.

Injectable

• You will receive temozolomide as an infusion directly into your vein. Your treatment will take about 90 minutes.
• Your doctor may prescribe medicine to prevent or treat nausea, or other medicines to relieve side effects with temozolomide.

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully. The dose your doctor recommends may be based on the following:

• the condition being treated
• other medical conditions you have
• other medications you are taking
• how you respond to this medication
• your weight
• your height
• your age
• your gender

Newly diagnosed glioblastoma multiforme: 75 mg/m² for 42 days along with radiotherapy followed by starting maintenance dose of 150 mg/m² once daily for Days 1–5 of a 28-day cycle of temozolomide for 6 cycles.

Refractory anaplastic astrocytoma: Starting dose of 150 mg/m² once daily for 5 consecutive days per 28-day treatment cycle.

If you take too much temozolomide, call your local Poison Control Center or seek emergency medical attention right away.

• Store temozolomide capsules at 77°F (controlled room temperature). Storage at 59° to 86°F (15° to 30°C) is permitted occasionally.
• Store temozolomide injection under refrigeration at 2–8°C (36–46°F). After reconstitution, store reconstituted product at room temperature (25°C or 77°F).
• Keep temozolomide capsules out of the reach of children and pets.