Temozolomide

Uses

Precaution

Side Effects

Handling

For more information

Uses

What is Temozolomide for?

Temozolomide is used to treat certain brain cancer conditions such as glioblastoma multiforme and anaplastic astrocytoma. It may be used in combination with radiotherapy which uses high-energy radiation beams to destroy cancer cells.
Temozolomide works by damaging the DNA inside cells, and this stops cancer cells from multiplying and growing.

How should I take or use Temozolomide?

Take Temozolomide once a day on an empty stomach, 1 hour before food. Take at the same time every day.
- Temozolomide may be taken every day for 6 to 7 weeks with radiotherapy, or every day for 5 days of a 28-day treatment cycle without radiotherapy.
Swallow the capsule whole with a full glass of water.
- Do not open, chew or crush the capsule.
- Inform your doctor or pharmacist if you have difficulty swallowing.
  - If you are not able to swallow the capsule whole, Temozolomide may be opened and dissolved in acidic juice (such as orange juice or apple juice) or applesauce. Wash the glass and spoon after each use and keep them separate from other kitchen utensils.
- Special handling of the medication is needed.
  - Try not to touch the medication with your bare hands. Use the medication cup provided. Wash your hands after handling the medication.
Temozolomide capsules come in different strengths. Your doctor may prescribe more than one strength for you. It is important to follow the instructions on the number of capsules of each strength to be taken.

What should I do if I forget to take or use Temozolomide?

If you forget to take a dose, skip the missed dose and take it at the next scheduled time. Do not take two doses to make up for the missed dose.
If you vomit out a dose of Temozolomide, do not take another dose to make up for it. Take your next dose at the usual time.

Precaution

What precautions should I take when taking or using Temozolomide?

Inform your healthcare professional if:
You are allergic to this medication or dacarbazine, or any of the other ingredients of this medication.
- You are taking any other medications, including supplements, traditional medications and herbal remedies.
- You have any other medical conditions.
- You are going to receive any vaccination or surgery, including dental surgery.
- You have any plans to start a family in the future.
  - Temozolomide may have an anti-fertility effect, which could be irreversible. You should discuss fertility preservation options with your doctor before starting treatment.
You should not become pregnant during treatment. You should use an effective birth control method during treatment and for at least 6 months after stopping Temozolomide.
If you have a partner who could become pregnant, you should use an effective birth control method during treatment and for at least 3 months after stopping Temozolomide.
You should not breastfeed during treatment and for at least 1 week after stopping Temozolomide.

What food or medication should I avoid when I take or use Temozolomide?

Avoid eating any raw, uncooked or under-cooked food as your immunity is weakened.

Side Effects

What are some common side effects of Temozolomide?

The table below will list some of the common side effects as well as the rare but serious side effects.

Side Effect	Management
Nausea or vomiting	Take Temozolomide on an empty stomach and / or at bedtime to reduce nausea and vomiting. Your doctor may prescribe medications to help prevent nausea or vomiting. Take them before taking Temozolomide. Take small and frequent meals. Avoid foods or smells that may make you feel nauseous, such as oily, fried or strong-smelling food. Avoid tight-fitting clothes around the waist.
Liver problems	Proceed to the A&E department immediately if you experience any: Dark or tea-coloured urine Pale or light-coloured stools Yellowing of skin or eyes Severe nausea, vomiting with loss of appetite Severe abdominal pain
Risk of Pneumocystis carinii/jirovecii (PCP) infection Temozolomide may weaken your immunity and increase the chance of getting a lung infection caused by the fungus Pneumocystis carinii/jirovecii.	You may be given medication (co-trimoxazole) to prevent the infection while you are on treatment with Temozolomide. Take as instructed and do not stop unless informed by your doctor. If you are prescribed co-trimoxazole, inform your doctor if you know that you are G6PD-deficient or have any sulphur allergy.
Decrease in white blood cell count. This may increase your chances of getting an infection.	To reduce risk of infection: Maintain good hand hygiene. Wash your hands before handling food and after using the toilet. Avoid crowds and do not go near people who are sick. Wear a mask if necessary. Eat freshly cooked and well-cooked food. Avoid raw meats, vegetables and eggs, or half-cooked or uncooked food. Proceed to the A&E department immediately if you have any signs of infection such as fever of 38°C and above, chills, bad sore throat, pain when you pass urine or have mouth sores or wounds that do not heal. Avoid taking Paracetamol to relieve fever as this may mask your fever and delay treatment of the infection.
Decrease in platelet count. Low platelet levels can increase your chance of bleeding.	To reduce risk of bleeding: Be careful when using sharp objects such as scissors or knives. Brush your teeth gently with a soft bristle toothbrush to prevent gum bleeding. Try not to bruise, cut or knock yourself. Apply direct pressure to any cuts or wounds to help stop bleeding. Proceed to the A&E department immediately if you have: Bruising without a cause or bruises that get larger in size Black, sticky stools Blood in the urine Coughing out blood or vomit that looks like coffee grounds Bleeding which does not stop
Decrease in the number of red blood cells (anaemia) As your red blood cells help to carry oxygen to the different parts of your body, this may cause you to feel tired more easily.	Proceed to the A&E department immediately if you have: Unusual giddiness or light-headedness that does not go away Severe breathlessness or rapid breathing An unusually fast heartbeat while resting
Symptoms of drug allergy including one or more of the following: Swollen face/eyes/lips/tongue Difficulty in breathing Itchy skin rashes over your whole body	If you experience any of these symptoms, you should stop your medication and see your healthcare professional immediately.

It is normal to experience some side effects from Temozolomide. As discussed with your doctor, taking Temozolomide will be beneficial for your condition. Do not stop taking Temozolomide without checking with your doctor.

Handling

How should I store Temozolomide?

Store in a cool and dry place below 30°C, away from direct sunlight. Keep this medication away from children.

How do I throw away Temozolomide safely?

Pack the medication into a bag and bring it back to the pharmacy where you received the medication from.

For more information

What else should I know about Temozolomide?

Tips to help manage your condition while you are on Temozolomide

Exercise	Light exercise is recommended as it helps to improve mobility, balance, and even emotional well-being. Avoid strenuous exercise, and rest when you are feeling tired.
Adequate hydration	Maintain adequate hydration with 2 to 3 litres of fluids per day unless you have been informed by your doctor to limit how much fluids you can drink. This will decrease your chances of getting constipation and prevent dehydration.
Seek support if you feel overwhelmed	It is normal to feel fearful or worried about your condition. Do not be afraid to share your concerns with your healthcare team or loved ones. There may be resources and support available to help you.

Disclaimers

Please take note that the above is not a complete list of all possible side-effects. If you have any concerns about your medication or if you have other side-effects that you think are caused by this medication, please consult your doctor or pharmacist. If you take more than the recommended dose, please seek medical advice immediately. The information provided on this page does not replace information from your healthcare professional. Please consult your healthcare professional for more information.

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (NHG Health, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.