Take this medicine only as directed. Do not take more or less of it and do not take it for a longer time than directed. To do so may increase the chance of unwanted side effects. This is especially important for elderly patients, who may be more sensitive to the effects of this medicine.

Temozolomide often causes nausea and vomiting. However, it is very important that you continue to take the medicine, even if you begin to feel ill. Taking the medicine on an empty stomach or at bedtime may help to lessen the nausea. Ask your health care professional for other ways to help lessen these effects.

Temozolomide should be taken at the same time each day in relation to meals.

Temozolomide capsules should be swallowed whole with a full glass of water. The capsules should not be chewed, crushed or broken open. If the capsules are opened accidentally, do not allow the powder to come into contact with your skin or into your mouth or nose. Be careful not to inhale the contents of the capsule.

Dosing

The dose of temozolomide will be different for different patients. The dose that is used will depend on a number of things, including the patient's body size and various laboratory test results. If you are taking temozolomide at home, follow your doctor's orders or the directions on the label. If you have any questions about the proper dose of temozolomide, ask your doctor.

Missed dose

If you miss a dose of this medicine, do not double the next one. Check with your doctor for further instructions.

Storage

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Ask your health care professional how you should dispose of any medicine you do not use. Be sure that any discarded medicine is out of the reach of children.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For temozolomide, the following should be considered:

Allergies Tell your doctor if you have ever had any unusual or allergic reaction to dacarbazine or temozolomide. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy There is a chance that this medicine may cause birth defects if it is taken at the time of conception or if it is taken during pregnancy. You should wait for 6 months after the treatment is finished before becoming pregnant. Studies in rats and rabbits have shown that temozolomide causes birth defects in the fetus and other problems (including miscarriages).

Be sure that you have discussed these possible effects with your doctor before taking this medicine. Before taking temozolomide, make sure your doctor knows if you are pregnant or if you may become pregnant. It is best to use some kind of birth control while you are taking temozolomide. Tell your doctor right away if you think you have become pregnant while taking temozolomide.

If you are a man taking temozolomide you should be very careful not to father a child up to 6 months after treatment. Use a good form of birth control. Treatment with temozolomide may make you sterile. You may want to save and freeze your sperm before you start treatment with temozolomide in case this happens.

Breast-feeding It is not known whether temozolomide passes into human breast milk. However, temozolomide is not recommended during breast-feeding because it may cause unwanted effects in nursing babies.

Children Studies on this medicine have been done only in adult patients, and there is no specific information comparing the use of temozolomide in children with use in other age groups.

Older adults Elderly patients may be more sensitive to the effects of temozolomide. Blood problems such as low platelet (the cell that helps blood to clot) counts and low white blood cell (the cell that helps fight off infections) counts may be especially likely to occur in patients 70 years of age or older.

Other medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking temozolomide it is especially important that your health care professional knows if you are taking any of the following:

• Acyclovir (e.g., Zovirax) or
• Anticonvulsants (seizure medicine) or
• Antidiabetics, oral (diabetes medicine taken by mouth) or
• Anti-infectives by mouth or by injection (medicine for infection) or
• Antipsychotics (medicine for mental illness) or
• Captopril (e.g., Capoten) or
• Enalapril (e.g., Vasotec) or
• Flecainide (e.g., Tambocor) or
• Imipenem or
• Inflammation or pain medicine, except narcotics or
• Lisinopril (e.g., Prinivil, Zestril) or
• Maprotiline (e.g., Ludiomil) or
• Penicillamine (e.g., Cuprimine) or
• Pimozide (e.g., Orap) or
• Procainamide (e.g., Pronestyl) or
• Promethazine (e.g., Phenergan) or
• Ramipril (e.g., Altace) or
• Sulfasalazine (e.g., Azulfidine) or
• Tiopronin (e.g., Thiola) or
• Tocainide (e.g., Tonocard) or
• Tricyclic antidepressants (medicine for depression) or
• Trimeprazine (e.g., Temaril) Concurrent use of these agents with temozolomide may cause blood disorders
• Alpha Interferons (e.g., Intron A, Roferon-A) or
• Amphotericin B by injection (e.g., Fungizone) or
• Antineoplastics, other (cancer medicine) or
• Antithyroid agents (medicine for overactive thyroid) or
• Azathioprine (e.g., Imuran) or
• Chloramphenicol (e.g., Chloromycetin) or
• Colchicine or
• Flucytosine (e.g., Ancoban) or
• Ganciclovir (e.g., Cytovene) or
• Zidovudine (e.g., AZT, Retrovir) Concurrent use of these agents with temozolomide increases the risk of infection
• If you have ever been treated with radiation or cancer medicines Temozolomide may increase the effects that these medicines or radiation therapy may have on the blood

• Bone marrow depression, existing or
• Infection There may be an increased risk of infections or worsening infections because of the body's reduced ability to fight them

• Chickenpox (including recent exposure) or
• Herpes zoster (shingles) Risk of severe disease affecting other parts of the body

• Kidney disease or
• Liver disease Temozolomide should be used with caution