How to take and dosage of Temozolomide

Temozolomide is an oral capsule or injection. To reduce nausea and vomiting, take temozolomide capsules on an empty stomach or at bedtime. Consider antiemetic treatment before and after administration. Take temozolomide capsules at approximately the same time each day. Swallow with water. Patients should not open, chew, or dissolve the contents of the capsules. Temozolomide capsules are available in several different strengths, and doctors may prescribe a combination of capsules to make up the full dose. Patients need to make sure they know what each capsule looks like and how much of each capsule to take.

1. Recommended dosage for newly diagnosed glioblastoma:

(1) During the simultaneous use phase with lesion radiotherapy, temozolomide is administered orally or intravenously once a day for 42-49 days, and then during the maintenance phase, it is administered once a day on days 1-5 of each 28-day cycle for a total of 6 cycles. Provide Pneumocystis pneumonia (PCP) prophylaxis during the combination phase and continue in patients who develop lymphopenia until remission to Grade 1 or less.

(2) Concomitant use phase: The recommended dose of temozolomide is 75 mg/m2, taken orally or intravenously, once a day for 42-49 days, and used in combination with lesion radiotherapy. Local radiation therapy covers the tumor bed or resection site, with a margin of 2-3 cm. Perform a complete blood count weekly.

(3) Single-agent maintenance use phase: Beginning 4 weeks after completion of the concomitant use phase, temozolomide is administered orally or intravenously once daily on days 1-5 of each 28-day cycle for 6 cycles. The recommended dose of temozolomide in the maintenance phase is 150 mg/m2 per day on days 1-5 of the first cycle. If there is no need to interrupt or stop dosing, it can be increased to 200 mg/m2 per day on days 1-5 before the start of the second cycle. If the dose is not increased at the beginning of Cycle 2, do not increase the dose for Cycles 3-6.

2. Recommended dose for anaplastic astrocytoma:

(1) Adjuvant treatment of newly diagnosed anaplastic astrocytoma: A single dose of oral temozolomide on days 1-5 of a 28-day cycle starting 4 weeks after completion of radiation therapy for 12 cycles. The recommended dose of temozolomide is 150 mg/m2 per day on days 1-5 of cycle 1, or 200 mg/m2 per day on days 1-5 if the patient has no or minimal toxicity in cycle 1. If the dose is not increased at the beginning of Cycle 2, do not increase the dose during Cycles 3-6.

(2) Refractory anaplastic astrocytoma: The recommended initial dose of temozolomide is 150 mg/m2 once daily on days 1-5 of each 28-day cycle. Increase the temozolomide dose to 200 mg/m2 daily if the following conditions are met at nadir: ANC ≥ 1.5 × 109/L and platelet count ≥ 100 × 109/L. Temozolomide is usually continued until disease progression or unacceptable toxicity occurs.

Perform a complete blood count on day and then weekly until ANC >1.5×109/L and platelet count >100×109/L. Do not start the next cycle until the ANC and platelet count exceed these levels.

3. Dose adjustment: IfANC <1×109/L or platelet count <50×109/L in any cycle, reduce the dose of temozolomide in the next cycle by 50 mg/m2/day. Permanently discontinue temozolomide in patients who cannot tolerate the 100 mg/m2 daily dose.

Temozolomide capsules will be store at 25°C (77°F). If any capsules of temozolomide rupture or leak, do not touch them with your hands and be careful not to inhale the powder in the capsules. When patients handle broken or opened capsules, they should wear rubber or latex gloves so that the powder does not come into contact with their skin. In case of accidental contact with skin, wash immediately and thoroughly with water.

The original drug temozolomide has been launched in China and has entered the scope of Class B medical insurance. Common specificationsThe price of 100mg*1 tablet*5 bags per box may be around 2,000 yuan. The price of generic temozolomide drugs marketed overseas is relatively low, and its pharmaceutical ingredients are basically the same as those of the original temozolomide drug. For example, the price of a box of 100mg*5 produced by a Bangladeshi pharmaceutical factory may be around a few hundred yuan (the price may fluctuate due to exchange rates).