Temozolomide is a prodrug that is quickly converted to the active alkylating metabolite MTIC [(methyl-triazene-1-yl)-imidazole-4-carboxamide)]. The conversion is spontaneous, nonenzymatic, and occurs under physiologic conditions in all tissues. The cytotoxic effects of MTIC are manifested through alkylation (methylation) of DNA at specific sites leading to DNA breakdown and cell apoptosis.
Indications For Use
Temozolomide, Temodal/Temodaris officially indicated for refractory anaplastic astrocytoma, and for new diagnoses of glioblastoma. It is also prescribed off-label for various other forms of cancer. (may be used for conditions not listed)
Before starting Temozolomide, Temodal/Temodarmake sure your physician is aware of any allergies or medications you currently take. Temozolomide, Temodal/Temodarhas been associated with a number of serious health events including bone marrow suppression, severe nausea, liver toxicity, increased risk of certain forms of pneumonia and occurrence of secondary malignancies.
Dosing for this medication is very complex and is calculated based on body surface area and varies with the form and severity of cancer it is being used to treat. It is generally dosed in cycles and is most commonly in an oral form, however IV infusions are also available.
Pharmacist Tips On Using
How to Take: Can take with or without food, but must remain consistent
Cardiovascular: Peripheral edema (11%)
Dermatologic: Alopecia (55%), skin rash (8% to 13%)
Gastrointestinal: Nausea (49% to 53%), vomiting (29% to 42%), constipation (22% to 33%), anorexia (9% to 27%), diarrhea (10% to 16%)
Nervous system: Fatigue (34% to 61%), headache (23% to 41%), seizure (6% to 23%), hemiparesis (18%), dizziness (5% to 12%), ataxia (8% to 11%)
Neuromuscular & skeletal: Asthenia (7% to 13%)
Miscellaneous: Fever (13%)
Note this is not a complete list of side effects for Temozolomide, Temodal/Temodaronly common ones.
Frequently Asked Questions
Why would my physician prescribe a medication with such serious side effects? Your physician takes the most recent clinical guidelines to make evidence-based decisions on what medication is appropriate in which situations. Your current medications, your allergies, age, cost of medication, comorbid conditions and many other factors will further complicate or limit which medications are appropriate. This medication is used for certain forms of cancer and your physician has determined the benefits outweigh the risks. Furthermore, they will be monitoring your bloodwork and symptoms closely to avoid many of the serious side effects and will keep you on the lowest effective dosage for the shortest amount of time possible.