ADVERSE REACTIONS SECTION.

6 ADVERSE REACTIONS. The following serious adverse reactions are discussed in greater detail in other sections of the labeling:Delayed myelosuppression [see Warnings and Precautions (5.1) Risks of overdosage [see Warnings and Precautions (5.2) Pulmonary toxicity [see Warnings and Precautions (5.3) Secondary malignancies [see Warnings and Precautions (5.4) Hepatotoxicity [see Warnings and Precautions (5.5) Nephrotoxicity [see Warnings and Precautions (5.6) The following adverse reactions associated with the use of Lomustine Capsules were identified in clinical trials or postmarketing reports. Because these reactions were reported from population of uncertain size, it is not possible to estimate their frequency, reliability, or establish causal relationship to drug exposure.Gastrointestinal disorders: nausea, vomiting, and stomatitisOcular disorders: optic atrophy, visual disturbances, and blindnessNeurologic disorders: disorientation, lethargy, ataxia, and dysarthriaOther: alopecia. Delayed myelosuppression [see Warnings and Precautions (5.1) . Risks of overdosage [see Warnings and Precautions (5.2) . Pulmonary toxicity [see Warnings and Precautions (5.3) . Secondary malignancies [see Warnings and Precautions (5.4) . Hepatotoxicity [see Warnings and Precautions (5.5) . Nephrotoxicity [see Warnings and Precautions (5.6) . Common adverse reactions include delayed myelosupression, nausea, vomiting, stomatitis, and alopecia. (6) To report SUSPECTED ADVERSE REACTIONS, contact Carnegie Pharmaceuticals LLC at 1-732-783-7010 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

BOXED WARNING SECTION.

WARNING: DELAYED MYELOSUPPRESSION and RISK OF OVERDOSAGE. DELAYED MYELOSUPPRESSIONLomustine Capsules cause myelosuppression including fatal myelosuppression. Myelosuppression is delayed, dose-related, and cumulative; occurring to weeks after drug administration and persisting for to weeks. Thrombocytopenia is generally more severe than leukopenia. Cumulative myelosuppression from Lomustine Capsules is manifested by greater severity and longer duration of cytopenias. Monitor blood counts for at least weeks after each dose. Do not give Lomustine Capsules more frequently than every weeks [see Warnings and Precautions (5.1), Dosage and Administration (2.2, 2.3) ].RISK OF OVERDOSAGEPRESCRIBE, DISPENSE, AND ADMINISTER ONLY ENOUGH CAPSULES FOR ONE DOSE. Fatal toxicity occurs with overdosage of Lomustine Capsules. Both physician and pharmacist should emphasize to the patient that only one dose of Lomustine Capsules is taken every weeks [see Dosage and Administration (2.1), Warnings and Precautions (5.2), Overdosage (10) ].. WARNING: DELAYED MYELOSUPPRESSION and RISK OF OVERDOSAGESee full prescribing information for complete boxed warning.Delayed Myelosuppression Lomustine Capsules cause myelosuppression including fatal myelosuppression. Myelosuppression is delayed, dose-related, and cumulative. Thrombocytopenia is generally more severe than leukopenia. Monitor blood counts and do not give Lomustine Capsules more frequently than every weeks. (2.2, 2.3, 5.1)Risk of Overdosage PRESCRIBE, DISPENSE, AND ADMINISTER ONLY ENOUGH CAPSULES FOR ONE DOSE. Fatal toxicity occurs with overdosage of Lomustine Capsules. Both physician and pharmacist should emphasize to patient that only one dose of Lomustine Capsules is taken every weeks. (2.1, 5.2, 10).

CARCINOGENESIS & MUTAGENESIS & IMPAIRMENT OF FERTILITY SECTION.

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility. Lomustine is carcinogenic in rats and mice, producing marked increase in tumor incidence in doses lower than those employed clinically.In female rats, daily intraperitoneal treatment with lomustine for weeks prior to mating with untreated males resulted in dose dependent decreases in number of corpora lutea and resorption rates with no live births at dose of mg/kg (approximately 0.14 times the recommended clinical dose of 130 mg/m2 based on body surface area (BSA), or approximately twice the total clinical dose of lomustine over weeks) and decreased pup survival during the first postnatal days at doses greater than or equal to 1.5 mg/kg (a daily dose of approximately 0.06 times the recommended clinical dose of 130 mg/m2 based on BSA or approximately equal to the total clinical dose of lomustine over weeks). Lomustine Capsules may also result in decreased male fertility. Intraperitoneal injection of lomustine resulted in decreased fertility in male rats mated to untreated females based on decreased implantations and decreased fetal body weight at weekly doses greater than or equal to mg/kg (approximately 0.23 times the single clinical dose of 130 mg/m2 based on BSA, or approximately equal to the total clinical dose of lomustine over weeks), and increased resorptions at doses greater than or equal to 2.5 mg/kg/week.

CLINICAL PHARMACOLOGY SECTION.

12 CLINICAL PHARMACOLOGY. 12.1 Mechanism of Action. Lomustine alkylates DNA and RNA. As with other nitrosoureas, it may also inhibit several key enzymatic processes by carbamoylation of amino acids in proteins.. 12.2 Pharmacodynamics. The pharmacodynamics of lomustine are unknown.. 12.3 Pharmacokinetics. DistributionLomustine crosses the blood-brain barrier.EliminationThe serum half-life of lomustine metabolites ranges from 16 hours to 48 hours.MetabolismMetabolic pathways involved in the elimination of lomustine have not been characterized.ExcretionFollowing oral administration of radioactive lomustine at doses ranging from 30 mg/m2 to 100 mg/m2, approximately half of the radioactivity administered was excreted in the urine in the form of degradation products within 24 hours.Specific PopulationsThe impact of patient specific (e.g., age, sex, and race) or disease (e.g., renal or hepatic impairment) characteristics on the pharmacokinetics of lomustine is unknown.

DESCRIPTION SECTION.

11 DESCRIPTION. Lomustine Capsules, USP (lomustine) is an alkylating drug for oral administration. The chemical name for lomustine is 1-(2-chloro-ethyl)-3-cyclohexyl-1-nitrosourea and the molecular formula is C9H16ClN3O2. The molecular weight is 233.71. Lomustine is yellow powder, which is soluble in 10% ethanol (0.05 mg per mL) and in absolute alcohol (70 mg per mL). Lomustine is insoluble in water (<0.05 mg per mL).The chemical structure is:Lomustine Capsules, USP are supplied as 10 mg, 40 mg, and 100 mg capsules and contain the following inactive ingredients: magnesium stearate NF and mannitol USP. The 10 mg capsule shells are composed of gelatin and titanium dioxide. The 40 mg and 100 mg capsule shells are composed of FD&C blue 1, gelatin, iron oxide black, iron oxide yellow, and titanium dioxide. The capsules are printed with black ink composed of iron oxide black, potassium hydroxide, propylene glycol, shellac, and strong ammonia solution.FDA approved dissolution method is not listed in the USP Monograph for Lomustine Capsules, USP, 10 mg, 40 mg, and 100 mg.. image description.

DOSAGE & ADMINISTRATION SECTION.

2 DOSAGE AND ADMINISTRATION. Recommended dose in adult and pediatric patients is 130 mg/m2 orally every weeks. (2.1) Round dose to nearest mg.Give as single oral dose and do not repeat for at least weeks.. Recommended dose in adult and pediatric patients is 130 mg/m2 orally every weeks. (2.1) Round dose to nearest mg.. Give as single oral dose and do not repeat for at least weeks.. 2.1 Important Prescribing and Dispensing Information. PRESCRIBE ONLY ONE DOSE FOR EACH TREATMENT CYCLE. DO NOT DISPENSE ENTIRE CONTAINER. Dispense only sufficient number of capsules for one dose.Confirm the total dose prescribed by the physician and the appropriate combination of capsule strengths.Dispense only the appropriate number of Lomustine Capsules required for the administration of single dose.The prescribed dose may consist of two or more different strengths and colors of capsules.Instruct patients that Lomustine Capsules are taken as single oral dose and will not be repeated for at least weeks. Taking more than the recommended dose causes toxicities, including fatal outcomes [see Warnings and Precautions (5.2) and Overdosage (10) ]. Lomustine Capsules is cytotoxic drug. Follow applicable special handling and disposal procedures.1 To minimize the risk of dermal exposure, always wear impervious gloves when handling bottles containing Lomustine Capsules. Do not break Lomustine Capsules; avoid exposure to broken capsules. If dermal contact occurs, wash areas of skin contact immediately and thoroughly.. 2.2 Recommended Dose. The recommended dose of Lomustine Capsules in adult and pediatric patients is 130 mg/m2 taken as single oral dose every weeks. Round doses to the nearest mg. Give as single oral dose and do not repeat for at least weeks. Reduce dose to 100 mg/m2 every weeks in patients with compromised bone marrow function. Also reduce dose accordingly when using with other myelosuppressive drugs.. 2.3 Dose Modifications. Perform weekly complete blood counts and withhold each subsequent dose for more than weeks if needed until platelet counts recover to 100,000/mm3 or greater and leukocytes recover to 4000/mm3 or greater [see Warnings and Precautions (5.1) ]. Modify each dose of Lomustine Capsules according to the hematologic response of the preceding dose as described in Table 1:Table 1. Dose Modifications for Lomustine CapsulesNadir After Prior DoseDose AdjustmentLeukocytes (/mm3)Platelets (/mm3)>= 4000>= 100,000None3000 399975,000 99,999None2000 299925,000 74,999Reduce dose by 30%< 2000< 25,000Reduce dose by 50%.

GERIATRIC USE SECTION.

8.5 Geriatric Use. No data in the clinical studies of Lomustine Capsules are available for patients 65 years of age and over to determine whether they respond differently than younger patients. Other reported clinical experience has not identified differences in responses between elderly and younger patients. In general, dose selection for an elderly patient should be cautious, reflecting the greater frequency of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy.Lomustine and its metabolites are known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and renal function should be monitored.

HOW SUPPLIED SECTION.

16 HOW SUPPLIED/STORAGE AND HANDLING. 16.1 How Supplied. Lomustine Capsules, USP are available in three strengths, distinguishable by the color of the capsules, in individual bottles of capsules each:StrengthCapsule DescriptionNDC Code100 mgHard gelatin capsule shell with light green opaque body and light green opaque cap, imprinted with black ink CP116 on cap, containing white powder.80005-116-0240 mgHard gelatin capsule shell with light green opaque body and bright white opaque cap, imprinted with black ink CP115 on cap, containing white powder.80005-115-0210 mgHard gelatin capsule shell with bright white opaque body and bright white opaque cap, imprinted with black ink CP114 on cap, containing white powder.80005-114-02. 16.2 Storage and Handling. Store at 20o to 25oC (68o to 77oF); excursions permitted to 15 to 30C (59 to 86F) [See USP Controlled Room Temperature]. Avoid temperatures over 40C (104F).Lomustine Capsules, USP is cytotoxic drug. Follow applicable special handling and disposal procedures.1 To minimize the risk of dermal exposure, always wear impervious gloves when handling bottles containing Lomustine Capsules, USP. Do not break Lomustine Capsules, USP; avoid exposure to broken capsules. If dermal contact occurs, wash areas of skin contact immediately and thoroughly.

INDICATIONS & USAGE SECTION.

1 INDICATIONS AND USAGE. Lomustine Capsules are an alkylating drug indicated for the treatment of patients with:Brain tumors, primary and metastatic, following appropriate surgical and/or radiotherapeutic procedures. (1) Hodgkins lymphoma in combination with other chemotherapies, following disease progression with initial chemotherapy. (1) Brain tumors, primary and metastatic, following appropriate surgical and/or radiotherapeutic procedures. (1) Hodgkins lymphoma in combination with other chemotherapies, following disease progression with initial chemotherapy. (1) 1.1 Brain Tumors. Lomustine Capsules are indicated for the treatment of patients with primary and metastatic brain tumors following appropriate surgical and/or radiotherapeutic procedures.. 1.2 Hodgkins Lymphoma. Lomustine Capsules are indicated as component of combination chemotherapy for the treatment of patients with Hodgkins lymphoma whose disease has progressed following initial chemotherapy.

INFORMATION FOR PATIENTS SECTION.

17 PATIENT COUNSELING INFORMATION. MyelosuppressionAdvise patients that periodic assessment of their blood counts are required. Advise patients to contact their healthcare provider for new onset of bleeding or fever or symptoms of infection [see Warnings and Precautions (5.1) ]. OverdosageAdvise patients that toxicity including fatal toxicity occurs with Lomustine Capsules overdosage [see Warnings and Precautions (5.2), Overdosage (10), Dosage and Administration (2.1) ]. Advise patients to take Lomustine Capsules as directed:Lomustine Capsules are taken as single oral dose that will not be repeated for at least weeks.Use of the recommended dose at less than week intervals leads to toxicities including fatal toxicities.Each dose may consist of or more different strengths and colors of capsules.Pulmonary FibrosisAdvise patients to contact their healthcare provider for new or worsening cough, chest pain, or shortness of breath [see Warnings and Precautions (5.3)]. HepatotoxicityInform patients that Lomustine Capsules can cause hepatotoxicity and that liver function monitoring during treatment is necessary [see Warnings and Precautions (5.5) ]. NephrotoxicityInform patients that Lomustine Capsules can cause nephrotoxicity and that renal function and electrolyte monitoring during treatment is necessary [see Warnings and Precautions (5.6) ]. Embryo-Fetal ToxicityAdvise females of reproductive potential of the potential risk to fetus and to inform their healthcare provider of known or suspected pregnancy [see Warnings and Precautions (5.7), Use in Specific Populations (8.1) ]. Advise females of reproductive potential to use effective contraception during treatment with Lomustine Capsules and for at least weeks after the final dose [see Use in Specific Populations (8.3) ]. Advise male patients with female partners of reproductive potential to use condoms during treatment with Lomustine Capsules and for months after the final dose [see Use in Specific Populations (8.3) ]. LactationAdvise women not to breastfeed during treatment with Lomustine Capsules and for weeks after the final dose [see Use in Specific Populations (8.2) ]. InfertilityAdvise females and males of reproductive potential of the potential for reduced fertility from Lomustine Capsules [see Use in Specific Populations (8.3) and Nonclinical Toxicology (13.1) ]. Distributed by:Carnegie Pharmaceuticals LLCDelran, NJ 08075, USARevised: 07/2025. Lomustine Capsules are taken as single oral dose that will not be repeated for at least weeks.. Use of the recommended dose at less than week intervals leads to toxicities including fatal toxicities.. Each dose may consist of or more different strengths and colors of capsules.

NONCLINICAL TOXICOLOGY SECTION.

13 NONCLINICAL TOXICOLOGY. 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility. Lomustine is carcinogenic in rats and mice, producing marked increase in tumor incidence in doses lower than those employed clinically.In female rats, daily intraperitoneal treatment with lomustine for weeks prior to mating with untreated males resulted in dose dependent decreases in number of corpora lutea and resorption rates with no live births at dose of mg/kg (approximately 0.14 times the recommended clinical dose of 130 mg/m2 based on body surface area (BSA), or approximately twice the total clinical dose of lomustine over weeks) and decreased pup survival during the first postnatal days at doses greater than or equal to 1.5 mg/kg (a daily dose of approximately 0.06 times the recommended clinical dose of 130 mg/m2 based on BSA or approximately equal to the total clinical dose of lomustine over weeks). Lomustine Capsules may also result in decreased male fertility. Intraperitoneal injection of lomustine resulted in decreased fertility in male rats mated to untreated females based on decreased implantations and decreased fetal body weight at weekly doses greater than or equal to mg/kg (approximately 0.23 times the single clinical dose of 130 mg/m2 based on BSA, or approximately equal to the total clinical dose of lomustine over weeks), and increased resorptions at doses greater than or equal to 2.5 mg/kg/week.

PREGNANCY SECTION.

8.1 Pregnancy. Risk Summary Based on animal data and its mechanism of action, Lomustine Capsules can cause fetal harm when administered to pregnant woman [see Clinical Pharmacology (12.1) ]. There are no available data on Lomustine Capsules exposure in pregnant women. Lomustine was teratogenic in rats and embryotoxic in rabbits at total dose levels approximately two to four times the total human dose of 130 mg/m2 over weeks (0.18 to 0.27 times the single human dose of 130 mg/m2) based on BSA [see Data]. Advise pregnant women of the potential risk to fetus.In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.Data Animal Data Lomustine was administered by intraperitoneal injection daily to pregnant rats during the period of organogenesis at dose levels of 0, 2, 4, 6, and mg/kg. Resorption rates and post-implantation loss occurred at doses greater than or equal to mg/kg (approximately 0.18 times the clinical dose of 130 mg/m2 based on BSA or approximately twice the total clinical dose of lomustine over weeks). Malformations (omphalocele, ectopia cordis, scoliosis, syndactyly, hydrocephalus, microphthalmia, anophthalmia, anomalies of aortic arch, dextrocardia, malpositioning of the ovaries and testes, sternoschisis, and shortened/misshapen bone of the fore or hind limbs) and decreased fetal body weight occurred at all dose levels. In pregnant rabbits treated with lomustine at mg/kg (approximately 0.27 times the 130 mg/m2 clinical dose based on BSA or approximately four times the total clinical dose of lomustine over weeks) during organogenesis, there were increases in abortions and decreases in surviving pup weight that persisted postnatally.

USE IN SPECIFIC POPULATIONS SECTION.

8 USE IN SPECIFIC POPULATIONS. Lactation: Do not breastfeed. (8.2) 8.1 Pregnancy. Risk Summary Based on animal data and its mechanism of action, Lomustine Capsules can cause fetal harm when administered to pregnant woman [see Clinical Pharmacology (12.1) ]. There are no available data on Lomustine Capsules exposure in pregnant women. Lomustine was teratogenic in rats and embryotoxic in rabbits at total dose levels approximately two to four times the total human dose of 130 mg/m2 over weeks (0.18 to 0.27 times the single human dose of 130 mg/m2) based on BSA [see Data]. Advise pregnant women of the potential risk to fetus.In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.Data Animal Data Lomustine was administered by intraperitoneal injection daily to pregnant rats during the period of organogenesis at dose levels of 0, 2, 4, 6, and mg/kg. Resorption rates and post-implantation loss occurred at doses greater than or equal to mg/kg (approximately 0.18 times the clinical dose of 130 mg/m2 based on BSA or approximately twice the total clinical dose of lomustine over weeks). Malformations (omphalocele, ectopia cordis, scoliosis, syndactyly, hydrocephalus, microphthalmia, anophthalmia, anomalies of aortic arch, dextrocardia, malpositioning of the ovaries and testes, sternoschisis, and shortened/misshapen bone of the fore or hind limbs) and decreased fetal body weight occurred at all dose levels. In pregnant rabbits treated with lomustine at mg/kg (approximately 0.27 times the 130 mg/m2 clinical dose based on BSA or approximately four times the total clinical dose of lomustine over weeks) during organogenesis, there were increases in abortions and decreases in surviving pup weight that persisted postnatally.. 8.2 Lactation. Risk Summary There is no information on the presence of lomustine or its metabolites in human milk, its effects on the breastfed infant, or its effects on milk production. Because of the potential for serious adverse reactions in breastfed infants from Lomustine Capsules, advise women not to breastfeed during treatment with Lomustine Capsules and for weeks after the final dose.. 8.3 Females and Males of Reproductive Potential. ContraceptionFemalesBased on animal data and its mechanism of action, Lomustine Capsules can cause fetal harm [see Use in Specific Populations (8.1) ]. Advise females of reproductive potential to use effective contraception during treatment and for weeks after the final dose.MalesBased on Lomustine Capsuless mechanism of action, advise males with female partners of reproductive potential to use effective contraception during treatment with Lomustine Capsules and for 3.5 months after the final dose [see Clinical Pharmacology (12.1) ]. InfertilityBased on animal findings and its mechanism of action, Lomustine Capsules may result in reduced fertility in males and females of reproductive potential [see Nonclinical Toxicology (13.1) ]. 8.4 Pediatric Use. Pediatric use, including dose, is not based on adequate and well-controlled clinical studies.. 8.5 Geriatric Use. No data in the clinical studies of Lomustine Capsules are available for patients 65 years of age and over to determine whether they respond differently than younger patients. Other reported clinical experience has not identified differences in responses between elderly and younger patients. In general, dose selection for an elderly patient should be cautious, reflecting the greater frequency of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy.Lomustine and its metabolites are known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and renal function should be monitored.

WARNINGS AND PRECAUTIONS SECTION.

5 WARNINGS AND PRECAUTIONS. Pulmonary toxicity: Pulmonary infiltrates and/or fibrosis occurs with Lomustine Capsules. Perform pulmonary function tests prior to treatment and repeat frequently. Permanently discontinue Lomustine Capsules in patients diagnosed with pulmonary fibrosis. (5.3)Secondary malignancies: Acute leukemia and myelodysplasia can occur with long-term use. (5.4)Hepatotoxicity: Increased levels of transaminases, alkaline phosphatase and bilirubin can occur with Lomustine Capsules. Monitor liver function. (5.5)Nephrotoxicity: Can cause renal failure. Monitor renal function. (5.6)Embryo-fetal toxicity: Can cause fetal harm. Advise males and females of reproductive potential of the potential risk to fetus and to use effective contraception. (5.7, 8.1, 8.3) Pulmonary toxicity: Pulmonary infiltrates and/or fibrosis occurs with Lomustine Capsules. Perform pulmonary function tests prior to treatment and repeat frequently. Permanently discontinue Lomustine Capsules in patients diagnosed with pulmonary fibrosis. (5.3). Secondary malignancies: Acute leukemia and myelodysplasia can occur with long-term use. (5.4). Hepatotoxicity: Increased levels of transaminases, alkaline phosphatase and bilirubin can occur with Lomustine Capsules. Monitor liver function. (5.5). Nephrotoxicity: Can cause renal failure. Monitor renal function. (5.6). Embryo-fetal toxicity: Can cause fetal harm. Advise males and females of reproductive potential of the potential risk to fetus and to use effective contraception. (5.7, 8.1, 8.3) 5.1 Delayed Myelosuppression. Lomustine Capsules cause myelosuppression that can result in fatal infections and bleeding. Myelosuppression from Lomustine Capsules is delayed, dose-related, and cumulative. It usually occurs to weeks after drug administration and persists for to weeks. Thrombocytopenia is generally more severe than leukopenia. Cumulative myelosuppression from Lomustine Capsules is manifested by greater severity and longer duration of cytopenias.Monitor blood counts for at least weeks after each dose. Do not give Lomustine Capsules more frequently than every weeks. Adjust dose based on nadir blood counts from prior dose [see Dosage and Administration (2.3) ]. 5.2 Risk of Overdosage. Fatal toxicity occurs with overdosage of Lomustine Capsules. Dispensing or administering more than one dose can lead to fatal toxicity.Prescribe only one dose at time. Dispense only enough capsules for one dose. Both physician and pharmacist should emphasize to the patient that only one dose of Lomustine Capsules is taken every weeks [see Dosage and Administration (2.1) and Overdosage (10)]. 5.3 Pulmonary Toxicity. Pulmonary toxicity characterized by pulmonary infiltrates and/or fibrosis occurs with Lomustine Capsules. Patients with baseline below 70% of the predicted Forced Vital Capacity (FVC) or Carbon Monoxide Diffusing Capacity (DLCO) are at increased risk. The onset of pulmonary toxicity occurs after an interval of months or longer from the start of therapy, with cumulative doses of Lomustine Capsules usually greater than 1100 mg/m2.Obtain baseline pulmonary function tests prior to initiating treatment and repeat frequently during treatment. Permanently discontinue Lomustine Capsules in patients diagnosed with pulmonary fibrosis.. 5.4 Secondary Malignancies. Secondary malignancies, including acute leukemia and myelodysplasia, occur with long term use.. 5.5 Hepatotoxicity. Hepatic toxicity, manifested by increased levels of transaminases, alkaline phosphatase, and bilirubin occurs with Lomustine Capsules.Monitor liver function.. 5.6 Nephrotoxicity. Progressive renal failure with decrease in kidney size occurs with Lomustine Capsules.Monitor renal function.. 5.7 Embryo-Fetal Toxicity. Based on animal data and its mechanism of action, Lomustine Capsules can cause fetal harm when administered to pregnant woman. Embryo-fetal toxicity and teratogenicity occurred in rats and rabbits receiving lomustine daily during organogenesis at doses approximately two to four times the total human dose of 130 mg/m2 over weeks (0.18 to 0.27 times the single human dose of 130 mg/m2) based on body surface area (BSA). Advise pregnant women of the potential risk to fetus. Advise females of reproductive potential to use effective contraception during treatment with Lomustine Capsules and for weeks after the final dose. Advise males with female partners of reproductive potential to use effective contraception during treatment with Lomustine Capsules and for 3.5 months after the final dose [see Use in Specific Populations (8.1, 8.3) ].