Temozolomide adverse effects
Check with your doctor immediately if any of the following side effects occur:
Less common or rare
Amnesia
black, tarry stools
blood in the urine or stools
convulsions
cough or hoarseness
fever or chills
lower back or side pain
muscle weakness or paralysis on one or both sides of the body
painful or difficult urination
pinpoint red spots on the skin
swelling of the feet or lower legs
unusual bleeding or bruising
Incidence not known
Abdominal or stomach pain or tenderness
blistering, peeling, or loosening of the skin
chest pain
clay colored stools
cough
decreased appetite
diarrhea
difficulty with swallowing
dizziness
fast heartbeat
headache
hives, itching, or skin rash
joint or muscle pain
nausea or vomiting
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
red skin lesions, often with a purple center
red, irritated eyes
sneezing
sore throat
sores, ulcers, or white spots in the mouth or on the lips
tightness in the chest
troubled breathing
unusual tiredness or weakness
yellow skin or eyes
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your healthcare professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Constipation
Less common or rare
Anxiety
blurred or double vision
breast pain (in females)
burning or prickling feeling on the skin
confusion
diarrhea
difficulty with speaking
drowsiness
increased urge to urinate
loss of appetite
loss of muscle coordination
mental depression
runny or stuffy nose
trouble sleeping
unusual weight gain
Bone marrow suppression
The most common side effect is bone marrow suppression.
Nausea or vomiting
The most common non-hematological adverse effects associated with temozolomide are nausea and vomiting, which are either self-limiting or readily controlled with standard antiemetic therapy. These latter effects are usually mild to moderate (grade 1 to 2). The incidence of severe nausea and vomiting is around 4% each. Patients who have pre-existing or a history of severe vomiting may require antiemetic therapy before initiating temozolomide treatment. Temozolomide should be administered in the fasting state, at least one hour before a meal. Antiemetic therapy may be administered before, or following, administration of temozolomide.
Genotoxic effects
Temozolomide is genotoxic, teratogenic and fetotoxic and should not be used during pregnancy. Lactating women should discontinue nursing while receiving the drug because of the risk of secretion into breast milk. One study indicated that women that have taken temozolomide without concomitant fertility preservation measures achieve pregnancy at a lesser rate later in life, but the study was too small to show statistical significance in the hypothesis that temozolomide would confer a risk of female infertility 1). In male patients, temozolomide can have genotoxic effects. Men are advised not to father a child during or up to six months after treatment and to seek advice on cryoconservation of sperm prior to treatment, because of the possibility of irreversible infertility due to temozolomide therapy.
In male patients, temozolomide can have genotoxic effects. Men are advised not to father a child during or up to six months after treatment and to seek advice on cryoconservation of sperm prior to treatment, because of the possibility of irreversible infertility due to temozolomide therapy.
DRESS syndrome
There are minimal reports of temozolomide-induced DRESS syndrome. The diagnosis can be life-threatening, which makes the glioblastoma treatment with no alternative treatment option challenging. The use of de-sensitization therapy to temozolomide has been proposed for the management of severe adverse cutaneous drug reactions 2).
Mehta et al reported a Temozolomide-induced drug rash with eosinophilia and systemic symptoms syndrome 3).