Drug General Information (ID: DDIN0AET7F)
Drug Name			Cimetidine		Drug Info		Lomustine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiulcer Agents				Antineoplastics
Structure

Mechanism of Cimetidine-Lomustine Interaction (Severity Level: Major)
Additive myelosuppressive effects Click to Show/Hide Mechanism Graph
Drug Name		Cimetidine				Lomustine
Mechanism		Myelosuppressive effects				Myelosuppressive effects
Key Mechanism Factor 1
		Factor Name		Myelosuppressive effects
		Factor Description		Myelosuppression, also known as bone marrow suppression, is a decrease in bone marrow activity that leads to a decrease in the production of blood cells. Some blood cell disorders include: erythrocytopenia (anemia), leukopenia (neutropenia), and thrombocytopenia (thrombocytopenia).
Mechanism Description		Additive myelosuppressive effects by the combination of Cimetidine and Lomustine

Recommended Action
Management		Caution is advised if carmustine or lomustine is used in combination with cimetidine. Patients should be closely monitored for the development of delayed myelosuppression that may occur 4 to 6 weeks after administration of the nitrosourea. Blood counts are recommended weekly for at least 6 weeks after a dose. alternatively, other H2-receptor antagonists such as ranitidine and famotidine may be considered in patients who require treatment with carmustine or lomustine, since they have not been reported to cause the interaction and generally have minimal effects on hepatic metabolism.

References
1	Product Information. Gliadel Wafer (carmustine). Rhone-Poulenc Rorer, Collegeville, PA.
2	Hess WA, Kornblith PL "Combination of lomustine and cimetidine in the treatment of a patient with malignant glioblastoma: a case report." Cancer Treat Rep 69 (1985): 733.[PMID: 4016781]
3	Feagin OT "Alternative mechanisms for severe neutropenia." Arch Intern Med 142 (1982): 1971.[PMID: 7125784]