Temozolomide (Temodar)

Temozolomide (pronounced [te moe ZOE loe mide]) is also known by the brand name Temodar. Temozolomide is an antineoplastic (anti-cancer) drug that belongs to a class called alkylating agents. It is a type of chemotherapy that prevents cancer cells from multiplying and slows down their growth.

What Is Chemotherapy?

Chemotherapy is a cancer treatment in which certain drugs are used to kill cancerous cells. These drugs are usually cytotoxic chemical substances that are toxic to the cells, restrict their growth, prevent their division, and ultimately kill the cells. 

Protection From Chemotherapy

Temozolomide is considered to be a hazardous agent, and normally, the pills are covered by a thin coating of material, but if this coating is damaged, removed, melted, or if the pill is broken into pieces, the chemical inside the pill can cause damage to your skin if you touch it. Therefore, it is important to take appropriate precautions for receiving, handling, storing, administering, and disposing of this medication. It is highly recommended to wear gloves if touching this medication or avoid touching it entirely by using the cap of the bottle to scoop up the capsule and put it directly into the mouth. 

For the injectable solution, avoid inhalation or contact with skin if damaged or accidentally opened. 

How Is Temzolomide Used?

Temozolomide has been approved by the Food and Drug Administration (FDA) to treat glioblastoma or anaplastic astrocytoma (brain cancer), and many other cancers for off-label use.

Available Formulations

Temozolomide is available in the form of oral capsules and as a solution for intravenous infusion. The capsules are available in six different strengths: 5 mg, 20 mg, 100 mg, 140 mg, 180 mg, and 250 mg. The intravenous solution is available in 100 mg strength and contains a polysorbate 80 ingredient. 

Directions for Use

Food may decrease the absorption of temozolomide. Therefore, it is preferable to take this medication on an empty stomach. If experiencing nausea or vomiting, it may be best to administer on an empty stomach or at bedtime. It should be taken at the same time each day. If taking temozolomide with concurrent radiation therapy, the medication may need to be taken in a fasted state one hour prior to radiotherapy, but verify the correct dose and frequency with your provider. The dose should not be more or less than what is prescribed. 

While taking the capsule, swallow it whole; do not open, break, crush, chew, or allow it to be dissolved in your mouth. Swallow the capsules with a full glass of water. If vomiting occurs, do not readminister the dose again and wait until the next scheduled dose. If the capsules are opened or damaged, avoid inhalation or contact with the skin or mucous membranes.

For the intravenous solution, the goal is to infuse over 90 minutes. Flush the line before and after administration. Temozolomide may be administered through the same IV line as normal saline. Do not administer other solutions or medications through the same IV line.

Missed Dose

This medicine needs to be administered on a fixed schedule. If you miss a dose, contact your physician for instructions. If you vomit right after you take the medicine, do not repeat the dose. Wait until your next scheduled dose and continue therapy as normal. 

Storage

Store capsules in a cool, dry place at room temperature and ensure the bottle is tightly closed. Store vials for injection in their original containers in the refrigerator. Bring vials to room temperature prior to reconstitution. Vials should be swirled gently and not shaken. Once reconstituted, it must be administered within 14 hours and can be stored at room temperature during that time.

What To Avoid While Taking Temozolomide?

While taking temozolomide therapy, you must follow some precautions. Always tell your physician about any medications you are already taking. Do not take any drug or medicine (even herbals, vitamins, or over-the-counter medications) without prior consent from your physician or pharmacist. They may have some significant interactions with temozolomide.

Pregnancy and Temozolomide

Pregnancy status must be checked prior to starting temozolomide therapy in women of childbearing age, and effective contraception must be used during treatment and for 6 months after the last dose. Males with female partners of reproductive potential should use effective contraception during treatment and for 3 months after the last dose. Temozolomide may cause fetal harm and is therefore not recommended for women who are breastfeeding during therapy. Breastfeeding should also be avoided for at least 1 week after the last dose. 

Temozolomide Side Effects

As with any other medication, you may encounter side effects while taking temozolomide. A few things to remember are:

• You may not have all the side effects listed below. Many people may experience little to no side effects.
• The severity of side effects may vary from person to person, so don’t compare your side effects with other people’s experiences.
• Most of the side effects will improve when therapy is discontinued.
• These side effects are easily manageable most of the time, either by readjusting the dose of temozolomide or using additional medications to treat the symptoms. Consult with your physician or pharmacist to explore available options.
• Do not hide any symptoms; if you feel any discomfort, do not hesitate to tell your physician or pharmacist about it.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions. 

Some of the more serious side effects of temozolomide are listed below:

Vomiting

Temozolomide is associated with a high potential for vomiting. For the prevention of nausea and vomiting, the use of antiemetic therapy is highly recommended with this therapy. Consult with your physician to see available options. 

Hair Loss

One of the most conspicuous side effects of chemotherapy encountered is hair loss. This happens because most chemotherapies, including temozolomide, act on rapidly dividing cancerous cells as well as healthy cells of the body like hair cells. However, the hair usually grows back once the chemotherapy is stopped. 

Liver Complications

In certain cases, temozolomide can affect the liver and cause liver damage. The condition of the liver is monitored through blood tests that are able to detect liver function. Contact your physician immediately if you experience liver problems like dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or yellow skin or eyes. These may be indications of liver complications. 

Pneumocystis Pneumonia (PCP)

PCP is a serious infection caused by a fungus that is very typical in patients who have a weakened immune system. Temozolomide lowers white blood cells, which weakens the immune system and increases the risk of PCP. The risk of PCP is increased in those receiving corticosteroids alongside temozolomide. Due to the high risk for infection, it is highly likely that concurrent PCP prophylaxis (antibiotics that prevent PCP infection before it occurs) would be prescribed. During therapy, if you experience difficulty breathing, fever, chills, or dry cough, contact your physician immediately. 

Secondary Malignancies

It is possible that temozolomide can give rise to a secondary type of cancer during treatments, including myeloid leukemia. Continuous monitoring during treatment for new malignancies may be necessary. 

Bone Marrow Suppression

It is essential to keep up with regular blood tests, especially the complete blood count test (CBC). The CBC blood test is capable of detecting potential side effects of temozolomide, including leukopenia (low white blood cells level), thrombocytopenia (low platelet count), and anemia (low red blood cells), all of which are potential side effects from the use of temozolomide. Patients over 70 years of age should take extra precautions with temozolomide use as they may have a higher risk for bone marrow suppression. 

Allergic Reactions

Allergic reactions are another rare side effect of temozolomide. A mild allergic reaction can include a rash on the skin, skin becoming itchy, etc. Severe side effects may include swelling under the eyes, lips, or hands and swelling of the throat or tongue with disturbed breathing. Immediately contact your physician if any signs of an allergic reaction are present. 

Other common side effects may include:

• Diarrhea or constipation
• Dizziness or fatigue
• Change in appetite
• Muscle or joint pain
• Insomnia
• Change in taste
• Dry skin
• Nausea or vomiting

Precautions

Unless approved by your physician, temozolomide is generally not recommended in patients who have an allergy to temozolomide. Allergic reactions can cause a rash over the whole body, shortness of breath, wheezing, dizziness, swelling around your mouth or eyes, fast heart rate, trouble breathing, and sweating. If you have any of these symptoms, stop using temozolomide and call your doctor or get emergency help right away.

FAQs

Is temozolomide a chemo agent?

Chemo drugs are those that are used in the management of various cancers. Temozolomide kills the cancer cells. Thus, it is a chemo agent that is advised as a treatment option for various cancer patients. 

How should temozolomide be taken?

It is best to take temozolomide at the same time each day and on an empty stomach. When taking the capsule, swallow it whole; do not open, break, crush, chew, or allow it to be dissolved in your mouth. Swallow the capsules with a glass of water. 

Infuse the IV solution over 90 minutes. Flush the line before and after administration. Do not administer other solutions (other than normal saline) or medications through the same IV line.

Can you lose your hair with temozolomide?

Like other chemotherapeutic agents, temozolomide has the potential to cause hair loss. 

Can you touch temozolomide?

As stated earlier, chemo drugs contain chemicals that are hazardous to your health, and therefore, you should avoid touching them. It is recommended to wear gloves or pour the drug directly into the mouth using the cap of the container to avoid and minimize direct contact.