Names and pronunciation
(tem-oh-zole′oh-mide) Temodar, Temodal
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Individual generic drug information
Extracted information for temozolomide only.
(tem-oh-zole′oh-mide) Temodar, Temodal
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Func. class.: Antineoplastic-alkylating agent
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Chem. class.: Imidazotetrazine derivative
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ACTION: Prodrug that undergoes conversion to MTIC; MTIC action prevents DNA transcription
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USES: Anaplastic astrocytoma with relapse, glioblastoma multiforme, malignant glioma
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Unlabeled uses: Metastatic malignant melanoma
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Extracted information for temozolomide only.
CONTRAINDICATIONS: Preg- nancy, breastfeeding; hypersensitivity to this product, carbazine, or gelatin Precautions: Geriatric patients, radiation therapy, renal/hepatic disease, bone marrow suppression, infection, myelosuppression
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SIDE EFFECTS CNS: Seizures, hemiparesis, dizziness, poor coordination, amnesia, insomnia, paresthesia, somnolence, paresis, ataxia, anxiety, dysphagia, depression, confusion GI: Nausea, anorexia, vomiting, abdominal pain, constipation GU: Urinary incontinence, UTI, frequency HEMA: Thrombocytopenia, leukopenia, anemia, myelosuppression, neutropenia INTEG: Rash, pruritus MISC: Headache, fatigue, asthenia, fever, edema, back pain, weight increase, diplopia RESP: URI, pharyngitis, sinusitis, coughing SYST: Anaphylaxis, secondary malignancy
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INTERACTIONS Increase: myelosuppression—radiation, other antineoplastics Increase: bleeding risk—NSAIDs, antico- agulants, platelet inhibitors, thrombolytics Decrease: antibody reaction—live virus vaccines, toxoids Decrease: action of digoxin Drug/Food Decrease: drug absorption Drug/Lab Test Decrease: HB, platelets, WBC, neutrophils
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Extracted information for temozolomide only.
DOSAGE AND ROUTES Glioblastoma multiforme • Adult: PO/IV 75 mg/m2/day × 42 days with focal radiotherapy, then main- tenance of 6 cycles; maintenance dose: 150 mg/m2 on days 1-5 of a 28-day cycle Refractory anaplastic astrocytoma • Adult: PO 150 mg/day × 5 days, re- peated q28days; IV 150 mg/m2/day over 90 min on days 1-5 q28days, may in- crease to 200 mg/m2/day on days 1-5 T q28days if hematologic parameters per- mit
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Available forms: Caps 5, 20, 100, 140, 180, 250 mg; powder for inj 100 mg/vial
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Administer: PO route • Do not break, crush, chew, open caps • Antiemetic 30-60 min before product to prevent vomiting • Caps 1 at a time with 8 oz of water at same time of day • Fluids IV or PO before chemotherapy to hydrate patient • If caps accidentally damaged, do not allow contact with skin or inhale • Use proper procedures for handling/ disposing of chemotherapy products • Give on empty stomach at bedtime to prevent nausea/vomiting • Store in light-resistant container in a dry area IV route • Bring vial to room temperature; dis- card if cloudy • Inject 41 mL sterile water for inj into vial (2.5 mg/mL) • Gently swirl; do not shake Intermittent IV INFUSION route • Withdraw up to 40 mL from each vial to make total dose; transfer to empty 250-mL PVC infusion bag; flush before and after infusion • Run over 90 min • Use reconstituted sol within 14 hr, in- cluding infusion time • Do not admix
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Extracted information for temozolomide only.
Assess: • CBC on day 22 (21 days after 1st dose), CBC weekly until recovery if ANC is <1.5 × 109/L and platelets <100 × 109/L; do not administer to patients who do not tolerate 100 mg/m2; myelosuppression usually occurs late during the treatment cycle • Seizures throughout treatment; mental status • Tumor response during treatment • Monitor temperature; may indicate be- ginning infection • Hepatic studies before, during therapy (bilirubin, AST, ALT, LDH), as needed or monthly • Bleeding: hematuria, guaiac, bruising, petechiae, mucosa or orifices • Pregnancy/breastfeeding: do not use in pregnancy, breastfeeding
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Evaluate: • Therapeutic response: decreased tu- mor size, spread of malignancy
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report signs of infection: fever, sore throat, flulike symptoms • To report signs of anemia: fatigue, headache, faintness, SOB, irritability • To report bleeding; to avoid use of ra- zors, commercial mouthwash • To notify prescriber if pregnancy is planned or suspected; not to breastfeed HIGH ALERT
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Extracted information for temozolomide only.
PHARMACOKINETICS Absorption complete, rapid; crosses blood-brain barrier; excreted in urine, feces; half-life 1.8 hr; peak 1 hr
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Filter the extracted dose blocks for this individual drug.
Glioblastoma multiforme
• Adult: PO/IV 75 mg/m2/day × 42 days with focal radiotherapy, then main- tenance of 6 cycles; maintenance dose: 150 mg/m2 on days 1-5 of a 28-day cycle Refractory anaplastic astrocytoma
Candidate age grouping · source page 1267
Glioblastoma multiforme
• Adult: PO 150 mg/day × 5 days, re- peated q28days; IV 150 mg/m2/day over 90 min on days 1-5 q28days, may in- crease to 200 mg/m2/day on days 1-5 T q28days if hematologic parameters per- mit
Candidate age grouping · source page 1267