Adalimumab
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Drug reference
Lomustine
Alkylating Agent · Antineoplastic
Also known as CCNU
Alkylating AgentAntineoplastic
CDSCO approvedSchedule H
EXCRETION
—
not curated
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
—
not curated
Top interactionssee all 12 →
- AdalimumabSevereDatabaseDDInter
- BaricitinibSevereDatabaseDDInter
- CertolizumabSevereDatabaseDDInter
- CimetidineSevereDatabaseDDInter
Mechanism
Lomustine, a nitrosourea, exerts its cytotoxicity through spontaneous breakdown to the 2-chloroethyl diazonium ion, an alkylating intermediate. This strong electrophile alkylates guanine, cytidine, and adenine bases, leading to interstrand or intrastrand cross-linking of DNA. It also causes carbamylation of DNA, thereby inhibiting DNA synthesis.
Indications
CNS tumorslymphomaHodgkin diseasebrain tumorsgliomas (as part of PVC regimen)Meningeal leukaemiasBrain cancer
Dosing
- Adult
- counts must be checked before each treatment, and doses should be reduced or therapy delayed if bone-marrow has not recovered. Cytotoxic drugs may be contra-indicated in patients with acute infection; any infection should be treated before, or when starting, cytotoxic drugs.…
Pharmacokinetics
Onset
not specified
Peak effect
not specified
Bioavailability
orally bioavailable
Protein binding
not specified
Metabolism
Undergoes spontaneous breakdown to an alkylating intermediate, the 2-chloroethyl diazonium ion.
Contraindications
- Acute infection
Side effects
Common
Bone-marrow suppressionAlopeciaStomatitisprofound and delayed myelosuppression (recovery 4-6 weeks after single dose)NauseaVomitingCNS effects
Serious
- Pulmonary fibrosis
- Carcinogenic effects
- renal failure (especially semustine, with long-term treatment courses)
- pulmonary dysfunction (with repeated treatment courses)
- prolonged bone marrow toxicity (with repeated treatment courses)
- highly carcinogenic
- mutagenic
- Delayed bone marrow depression
- Visceral fibrosis
- Renal damage
Drug interactions
Baricitinib
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Certolizumab
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Cimetidine
Severe
Database
Drug interaction classified as: synergy, metabolism
Source: DDInter
Cladribine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Clozapine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Deferiprone
Severe
Database
Clinical effect not specified
Source: DDInter
Etanercept
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Fingolimod
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Golimumab
Severe
Database
Clinical effect not specified
Source: DDInter
Infliximab
Severe
Database
Clinical effect not specified
Source: DDInter
Leflunomide
Severe
Database
Clinical effect not specified
Source: DDInter
Related guidelines
Other Alkylating Agent drugs
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Sources: KD Tripathi 7e, Goodman & Gilman 14e, BNF·Verified: 2026-05-13 · House clinical team