سعر لوموستين-ميداك 40مجم 20 كبسولة 2024

Lomustine-medac (medac, distributed in Egypt by the Egyptian Pharmaceutical Trading Company): lomustine (CCNU) 40 mg hard capsules, pack of 20; an oral nitrosourea alkylating cytotoxic agent used in brain tumours, Hodgkin lymphoma and other cancers.

• Palliative or supplementary treatment, usually combined with radiotherapy and/or surgery in multi-drug regimens, in brain tumours (primary or metastatic), lung tumours (especially oat-cell carcinoma), Hodgkin's disease resistant to conventional combination chemotherapy and metastatic malignant melanoma.electronic medicines compendium (emc)
• May be of value as second-line treatment in non-Hodgkin's lymphoma, myelomatosis, gastrointestinal tumours and carcinoma of the kidney, testis, ovary, cervix uteri and breast.electronic medicines compendium (emc)
• Primary and metastatic brain tumours after appropriate surgery and/or radiotherapy; component of combination chemotherapy for Hodgkin's lymphoma that progressed after initial chemotherapy.DailyMed (U.S. National Library of Medicine)

• Very common: myelosuppression (thrombocytopenia, leukopenia, neutropenia, anaemia, pancytopenia), nausea, vomiting and decreased appetite. Common: infection, immunosuppression, neurological effects (ataxia, disorientation, lethargy, dysarthria), stomatitis, diarrhoea, abnormal liver function and raised liver enzymes, fever, chills and swelling. Rare: interstitial lung disease/pulmonary fibrosis, cholestatic jaundice, hepatic failure, alopecia. Uncommon: renal failure.International label, same product · electronic medicines compendium (emc)

• Hypersensitivity to lomustine, other nitrosoureas or any excipient; previous failure of the tumour to respond to other nitrosoureas; severe bone marrow depression; severe renal impairment; pregnancy and breast-feeding; wheat allergy; concomitant yellow fever vaccine or other live vaccines in immunosuppressed patients.International label, same product · electronic medicines compendium (emc)
• US label lists no contraindications.International label, same formulation · DailyMed (U.S. National Library of Medicine)

• Delayed, cumulative bone marrow suppression (notably thrombocytopenia and leukopenia, 4-6 weeks after a dose) is the most common and severe toxicity and may contribute to bleeding and overwhelming infection; treatment should be supervised by physicians experienced in cancer therapy.International label, same product · electronic medicines compendium (emc)
• Patients must be strictly instructed not to take higher doses than prescribed: lomustine is a single dose (or divided over 3 days) not repeated for at least 6 weeks.International label, same product · electronic medicines compendium (emc)
• Boxed warning (US): fatal toxicity occurs with overdosage; prescribe, dispense and administer only enough capsules for one dose, and emphasise that only one dose is taken every 6 weeks.International label, same formulation · DailyMed (U.S. National Library of Medicine)

• Theophylline; cimetidineUse with theophylline or the H2-receptor antagonist cimetidine may potentiate bone marrow toxicity.electronic medicines compendium (emc)
• Phenobarbital and other enzyme-inducing antiepilepticsPre-treatment with phenobarbital can reduce the antitumour effect of lomustine through accelerated elimination (hepatic microsomal enzyme induction).electronic medicines compendium (emc)
• Other cytostatics; radiotherapyConcomitant cytostatic or radiation therapy can increase bone marrow depression.electronic medicines compendium (emc)

• Contraindicated during pregnancy; safe use not established and animal studies show reproductive toxicity (embryotoxic and teratogenic in rats). Women of childbearing potential should use effective contraception during treatment and for 7 months afterwards; men should use effective contraception and not father a child during treatment and for 4 months afterwards.International label, same product · electronic medicines compendium (emc)
• US label: based on animal data and mechanism of action, can cause fetal harm; no human pregnancy data; advise pregnant women of the potential risk to a fetus.International label, same formulation · DailyMed (U.S. National Library of Medicine)
• Contraindicated during breast-feeding; lomustine is lipophilic and likely to be excreted in human milk.International label, same product · electronic medicines compendium (emc)

• Lomustine: Believed to act partly as an alkylating agent and partly by inhibiting several steps of nucleic acid synthesis and the repair of single-strand DNA breaks (UK SmPC); the US label adds that it alkylates DNA and RNA and may carbamoylate proteins.