Valproic acid - decreases the oral clearance of temozolamide about 5%

Drug/food interaction- food decreases the rate and extent of temozolamide absorption.

Adverse reactions-

CNS -   Abnormal coordination   10%  abnormal gait   5%   amnesia   8 %   
             Anxiety 5%                              Asthenia 10%              Ataxia 6%  
             confusion 4%                         depression 5%            dizziness 10%
             fatigue  30%                         headache 35%               hemiparesis  15%
             insomnia 8%                        local convulsion 5%      paresthesia 8%
             somnolence  8%

Dermatologic - Pruritus    6%          rash  7%

GI        abdominal pain  8%             anorexia  8%                constipation 30%
            diarrhea     15%                    dyspepsia  6%             nausea 50%
            vomiting      40%

GU -    breast pain, female 5%      micturition increased  5%  urinary continence 7%
            urinary tract infection 7%  

Metabolic/nutrional -   weight increase   4% 

Ophthalmic -  abnormal vision  4%     diplopia  4%

Respiratory -  coughing   4%              pharyngitis   7%        sinustis  5%
                         upper respiratory tract infection 7%

Miscellaneous -  adrenal hypercorticism  7%      

History of hypersensitivity reaction to temozolamide

Special precations/warnings

Myelosuppression- patients treated with temozolamide may experience myelosupression.
elderly patients and women have been shown to have a higher risk of developing
 myelosuppression

Renal /hepatic function impairment - excercise caution when tmozolamide is administered to patients with severe hepatic or renal function impairment

Pregnancy - if this drug is used during pregnancy  or if the patient becomes pregnant
while taking the drug advice the patient of the potential hazard to the fetus.
Advice women of child bearing potential to avoid becoming pregnant  during therapy

Lactation- because of the potential risk to infants , patients should discontinue
breast feeding

Children- efficacy  and safety in children has not been studied

Elderly - patients over 70 years of age and older had a higher incidence of
neutropenia and thrombocytopenia

Monitoring- For concomittant treatment with radiotherapy, obtain a CBC weekly.

Indication-

Anaplastic astrocytoma

Dosage-
Recommended dose for termozolamide as Intravenous IV  infusion, over 90 minutes
is the same as for oral capsule formulation
Iintial dose - adults - 150mg/m2 orally daily for 5 consecutive days per 28 day treatment cycle 

1. Advice patients to take temozolamide on empty stomach to ease nausea, .

2.Instruct patients to swallow capsules whole with a glass of water.

3. Advice patients not to  open or chew capsules . If capsules are accidentally opened
or damaged advice patients to take rigorous precautions with the capsule contents
,to avoid  inhalation or contact  with the skin or mucous membrane.

4.. Advice patients to keep this medication away from children or pets.
  
5. Advice women women of child  bearing potential to avoid becoming pregnant during
   the course of therapy

Food decreases the rate and extent of temozolamide absorption

Pregnancy -
If this drug is used during pregnancy  or if the patient becomes pregnant
while taking the drug advice the patient of the potential hazard to the fetus.
Advice women of child bearing potential to avoid becoming pregnant  during therapy

Lactation-
Because of the potential risk to infants , patients should discontinue
breast feeding

Children-
Efficacy  and safety in children has not been studied

Elderly -
Patients over 70 years of age and older had a higher incidence of
neutropenia and thrombocytopenia