Temozolomide (Temodar) treats adults with certain types of brain cancer, like glioblastoma (GBM). It’s a type of chemotherapy called an alkylating agent. Temozolomide (Temodar) usually comes as a capsule you swallow whole once a day. But it’s also available as an injection that’s given through the vein by a healthcare professional at a medical office or infusion clinic. Temozolomide (Temodar) can cause side effects like tiredness, nausea, and hair loss. It also has risks like low blood cell counts and liver problems.
Newly-diagnosed glioblastoma (GBM), first with radiation and then by itself as maintenance therapy
Newly-diagnosed or refractory anaplastic astrocytoma (grade 3 astrocytoma)
Temozolomide (Temodar) is a type of traditional chemotherapy. It’s known as an alkylating agent.
Once temozolomide (Temodar) gets inside a cancer cell, it attaches to the cell’s DNA. This damages the DNA, which usually causes the cancer cell to die. As a result, the cancer cell can’t make copies of itself so the cancer can’t grow.
Source: DailyMed
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common or rare
Amnesia
black, tarry stools
blood in the urine or stools
convulsions
cough or hoarseness
fever or chills
lower back or side pain
muscle weakness or paralysis on one or both sides of the body
painful or difficult urination
pinpoint red spots on the skin
swelling of the feet or lower legs
unusual bleeding or bruising
Incidence not known
Abdominal or stomach pain or tenderness
blistering, peeling, or loosening of the skin
clay colored stools
decreased appetite
difficulty with swallowing
dizziness
fast heartbeat
headache
joint or muscle pain
nausea or vomiting
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
red skin lesions, often with a purple center
red, irritated eyes
sores, ulcers, or white spots in the mouth or on the lips
tightness in the chest
troubled breathing
unusual tiredness or weakness
yellow skin or eyes
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Less common or rare
blurred or double vision
breast pain (in females)
burning or prickling feeling on the skin
confusion
difficulty with speaking
drowsiness
increased urge to urinate
loss of appetite
loss of muscle coordination
mental depression
runny or stuffy nose
trouble sleeping
unusual weight gain
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Available as a capsule that’s taken by mouth
Recommended treatment option for certain types of brain cancer
Commonly causes nausea and hair loss
Can have a low white blood cell count, which puts you at risk of infection
You might need to take an antibiotic like Bactrim (sulfamethoxazole / trimethoprim) during treatment. This helps prevent you from getting a lung infection. You’re more likely to need it if you're taking temozolomide (Temodar) with radiation or if your white blood cell count is low.
Temozolomide (Temodar) can cause nausea and vomiting. Your oncologist might give you antiemetics like ondansetron (Zofran) or prochlorperazine to help. They might tell you to take them before each temozolomide (Temodar) dose. You can also take them between doses if you feel nauseous. If this side effect bothers you too much, talk to your care team.
Temozolomide (Temodar) can put you at risk of getting sick. So, take your temperature often, like once a day. Call your care team right away if it’s 100.4ºF or higher — this means you have a fever. It can sometimes be the only sign that you’re sick, so it’s important to let your oncologist know as soon as possible.
Tips for temozolomide (Temodar) capsules:
Take temozolomide (Temodar) at the same time each day so it works the best it can for you. It also helps you remember to take your medication by making it a part of your daily routine.
You can take temozolomide (Temodar) with or without food. But it’s a good idea to take it on an empty stomach or at bedtime. This helps reduce nausea and vomiting.
Swallow temozolomide (Temodar) capsules whole with water. Don’t crush, open, or chew them because the powder inside can be irritating and harmful.
If a temozolomide (Temodar) capsule gets damaged, avoid getting the powder on your skin, in your eyes, or in your nose. Wash the area with water right away if this happens though.
Ask your oncologist if you’re not sure about your temozolomide (Temodar) dose. This includes which capsule strength to take and how many to take. Temozolomide (Temodar) capsules come in different strengths, and you might need to take more than one at a time. Your dose might change during treatment depending on how you tolerate the medication.
Ask your oncology team about the best way to handle and throw away temozolomide (Temodar) safely. Anticancer medications can be harmful to people who handle or come in contact with them. Keep the medication in a safe place away from children and pets.
Tips for temozolomide (Temodar) IV infusion:
Plan ahead for some time at the medical center or infusion center for your temozolomide (Temodar) IV infusion. The infusion itself lasts about an hour and a half. But you might need some extra time to do paperwork or get situated. Bring something to do, like a book to read or an electronic device, to help pass the time.
You might have a reaction where you get your temozolomide (Temodar) IV infusion. You might feel pain, irritation, itchiness, and warmth around the area. There also could be swelling, redness, and bruising. Tell your nurse or oncology team if this happens and it bothers you. They can help manage these injection site reactions.
Temozolomide (Temodar) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factors: Older adults | Female
Taking temozolomide (Temodar) can cause your blood cell counts to drop. This can put you at higher risk for infections, anemia, and easy bleeding. Sometimes, it can be very serious.
Your oncologist will check your blood cell counts before each cycle and occasionally during treatment. If your blood cell count gets too low, your oncologist might lower your dose or pause your treatment until it goes back up.
During treatment, watch for signs of infection like fever, chills, or cough. Also look out for signs of anemia, such as feeling tired or having pale skin. And tell your care team if you bleed or bruise more easily than usual.
Risk factors: History of liver problems
Although uncommon, serious liver problems can happen in some people taking temozolomide (Temodar). Sometimes, it can be life-threatening.
Your oncologist will regularly check your liver health with lab tests. So, be sure to go to all the lab appointments your oncologist recommends. Tell your care team if you have belly pain, a swollen belly, yellow skin, or yellow eyes during treatment. These could be signs of liver damage.
Risk factors: Also taking corticosteroids | Taking temozolomide (Temodar) together with radiation | Taking temozolomide (Temodar) for a long time
Some people taking temozolomide (Temodar) have gotten a lung infection called Pneumocystis pneumonia (PCP). Your risk is higher if you’re also taking a corticosteroid like dexamethasone. It’s also higher if you’re getting radiation at the same time. Your oncologist might prescribe an antibiotic to help prevent this infection. A common one used is Bactrim (sulfamethoxazole / trimethoprim).
Tell your care team if you have a fever, cough, trouble breathing, chest pain, chills, or feel very tired while taking temozolomide (Temodar). These can be symptoms of PCP.
People taking temozolomide (Temodar) have a higher risk of developing new cancers later. This has included cancers including acute myeloid leukemia (AML). Your oncologist will monitor for this side effect with lab tests, even after you’ve stopped taking temozolomide (Temodar). Talk to your oncologist if you’re worried about this risk.
Risk factors: Pregnancy
Animal studies show that temozolomide (Temodar) might harm an unborn baby or cause pregnancy loss (miscarriage). If you can get pregnant, use reliable birth control while taking this medication and for 6 months after your last dose.
If you’re having sex with someone who can get pregnant, also use birth control like condoms during treatment and for 3 months after stopping. Because temozolomide (Temodar) might affect sperm, don’t donate semen during this time.
Tell your oncologist right away if you or your partner becomes pregnant while you’re taking temozolomide (Temodar).
Most people take temozolomide (Temodar) as a capsule that’s swallowed whole. There’s also an infusion that’s given through the vein (IV) over 90 minutes at a medical center.
The dose is the same whether you take the capsule or get the IV. Your oncologist will calculate your dose based on your body surface area (BSA). This takes into account your height and weight.
Glioblastoma
With radiation: The recommended dose is 75 mg/m2 of BSA once a day for 6 to 7 weeks. It’s taken together with radiation.
Maintenance therapy (starting 4 weeks after radiation)
Cycle 1: The recommended dose is 150 mg/m2 once a day on days 1 to 5 of the first 28-day cycle of treatment.
Cycles 2 to 6: The typical dose is either 150 mg/m2 or 200 mg/m2 once a day on days 1 to 5 of each 28-day cycle. The dose will depend on your lab results and if you have any serious side effects. The dose can be even lower if you have severe side effects.
Anaplastic astrocytoma
Cycle 1: The recommended dose is 150 mg/m2 once a day on days 1 to 5 of the first 28-day cycle of treatment.
Newly diagnosed
Cycles 2 to 12: The typical dose is either 150 mg/m2 or 200 mg/m2 once a day on days 1 to 5 of each 28-day cycle. Your oncologist will decide on your dose based on your lab results and if you have any serious side effects from the medication. The dose can be even lower if you have severe side effects.
Refractory
Cycles 2 and beyond: The typical dose is either 150 mg/m2 or 200 mg/m2 once a day on days 1 to 5 of each 28-day cycle. Your dose is based on your lab results and if you have any serious side effects from the medication.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Serious allergic reaction to temozolomide (Temodar)
Serious allergic reaction to another chemotherapy medication called dacarbazine
Newly-diagnosed glioblastoma (GBM), first with radiation and then by itself as maintenance therapy
Newly-diagnosed or refractory anaplastic astrocytoma (grade 3 astrocytoma)
Advanced Hodgkin’s lymphoma
Advanced Non-Hodgkin’s lymphoma
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