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Temodar

Last reviewed on RxList: 10/25/2017
Temodar Side Effects Center

Last reviewed on RxList 10/25/2017

Temodar (temozolomide) is a chemotherapy drug used together with radiation therapy to treat certain types of brain tumor in adults. Temodar is sometimes given after other cancer medications have been tried without successful treatment of the tumor. Common side effects of Temodar include:

Temporary hair loss may occur. Normal hair growth should return after treatment with Temodar has ended.

Dose of Temodar is individualized for each patient depending on the condition being treated. Temodar may interact with carbamazepine, divalproex sodium, phenytoin, valproic acid, steroids, or sulfa drugs. Tell your doctor all medications you are taking. Temodar is not recommended for use during pregnancy. It may harm a fetus. It is not known if this drug passes into breast milk. Due to the potential risk to the infant, breastfeeding while using this drug is not recommended. Consult your doctor before breastfeeding.

Our Temodar (temozolomide) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Temodar Consumer Information

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • a seizure (convulsions);
  • sudden chest pain or discomfort, wheezing, dry cough, feeling short of breath;
  • easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;
  • low white blood cell counts--fever, swollen gums, painful mouth sores, skin sores, cold or flu symptoms, cough, trouble breathing; or
  • liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Common side effects may include:

  • nausea, vomiting, loss of appetite;
  • bruising, skin rash;
  • loss of movement on one side of the body;
  • diarrhea, constipation;
  • headache, tired feeling, memory problems;
  • dizziness, weakness, loss of coordination;
  • sleep problems (insomnia);
  • low white blood cell counts (fever, flu symptoms); or
  • hair loss.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the entire detailed patient monograph for Temodar (Temozolomide)

Temodar Professional Information

SIDE EFFECTS

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Newly Diagnosed Glioblastoma Multiforme

During the concomitant phase (TEMODAR+radiotherapy), adverse reactions including thrombocytopenia, nausea, vomiting, anorexia, and constipation were more frequent in the TEMODAR+RT arm. The incidence of other adverse reactions was comparable in the two arms. The most common adverse reactions across the cumulative TEMODAR experience were alopecia, nausea, vomiting, anorexia, headache, and constipation (see Table 7). Forty-nine percent (49%) of patients treated with TEMODAR reported one or more severe or life-threatening reactions, most commonly fatigue (13%), convulsions (6%), headache (5%), and thrombocytopenia (5%). Overall, the pattern of reactions during the maintenance phase was consistent with the known safety profile of TEMODAR.

TABLE 7: Number (%) of Patients with Adverse Reactions: All and Severe/Life Threatening (Incidence of 5% or Greater)

Subjects Reporting any Adverse Reaction Concomitant Phase RT Alone (n=285) Concomitant Phase RT+TMZ (n=288)* Maintenance Phase TMZ (n=224)
All Grade ≥ 3 All Grade ≥ 3 All Grade ≥ 3
258 (91) 74 (26) 266 (92) 80 (28) 206 (92) 82 (37)
Body as a Whole — General Disorders
Anorexia 25 (9) 1 (<1) 56 (19) 2 (1) 61 (27) 3 (1)
Dizziness 10 (4) 0   12 (4) 2 (1) 12 (5) 0  
Fatigue 139 (49) 15 (5) 156 (54) 19 (7) 137 (61) 20 (9)
Headache 49 (17) 11 (4) 56 (19) 5 (2) 51 (23) 9 (4)
Weakness 9 (3) 3 (1) 10 (3) 5 (2) 16 (7) 4 (2)
Central and Peripheral Nervous System Disorders
Confusion 12 (4) 6 (2) 11 (4) 4 (1) 12 (5) 4 (2)
Convulsions 20 (7) 9 (3) 17 (6) 10 (3) 25 (11) 7 (3)
Memory Impairment 12 (4) 1 (<1) 8 (3) 1 (<1) 16 (7) 2 (1)
Disorders of the Eye
Vision Blurred 25 (9) 4 (1) 26 (9) 2 (1) 17 (8) 0  
Disorders of the Immune System
Allergic Reaction 7 (2) 1 (<1) 13 (5) 0   6 (3) 0  
Gastrointestinal System Disorders
Abdominal Pain 2 (1) 0   7 (2) 1 (<1) 11 (5) 1 (<1)
Constipation 18 (6) 0   53 (18) 3 (1) 49 (22) 0  
Diarrhea 9 (3) 0   18 (6) 0   23 (10) 2 (1)
Nausea 45 (16) 1 (<1) 105 (36) 2 (1) 110 (49) 3 (1)
Stomatitis 14 (5) 1 (<1) 19 (7) 0   20 (9) 3 (1)
Vomiting 16 (6) 1 (<1) 57 (20) 1 (<1) 66 (29) 4 (2)
Injury and Poisoning
Radiation Injury NOS 11 (4) 1 (<1) 20 (7) 0   5 (2) 0  
Musculoskeletal System Disorders
Arthralgia 2 (1) 0   7 (2) 1 (<1) 14 (6) 0  
Platelet, Bleeding and Clotting Disorders
Thrombocytopenia 3 (1) 0   11 (4) 8 (3) 19 (8) 8 (4)
Psychiatric Disorders
Insomnia 9 (3) 1 (<1) 14 (5) 0   9 (4) 0  
Respiratory System Disorders
Coughing 3 (1) 0   15 (5) 2 (1) 19 (8) 1 (<1)
Dyspnea 9 (3) 4 (1) 11 (4) 5 (2) 12 (5) 1 (<1)
Skin and Subcutaneous Tissue Disorders
Alopecia 179 (63) 0   199 (69) 0   124 (55) 0  
Dry Skin 6 (2) 0   7 (2) 0   11 (5) 1 (<1)
Erythema 15 (5) 0   14 (5) 0   2 (1) 0  
Pruritus 4 (1) 0   11 (4) 0   11 (5) 0  
Rash 42 (15) 0   56 (19) 3 (1) 29 (13) 3 (1)
Special Senses Other, Disorders
Taste Perversion 6 (2) 0   18 (6) 0   11 (5) 0  
*One patient who was randomized to RT only arm received RT+temozolomide.
RT+TMZ=radiotherapy plus temozolomide; NOS=not otherwise specified.
Note: Grade 5 (fatal) adverse reactions are included in the Grade ≥ 3 column.

Myelosuppression (neutropenia and thrombocytopenia), which is a known dose-limiting toxicity for most cytotoxic agents, including TEMODAR, was observed. When laboratory abnormalities and adverse reactions were combined, Grade 3 or Grade 4 neutrophil abnormalities including neutropenic reactions were observed in 8% of the patients, and Grade 3 or Grade 4 platelet abnormalities, including thrombocytopenic reactions, were observed in 14% of the patients treated with TEMODAR.

Refractory Anaplastic Astrocytoma

Tables 8 and 9 show the incidence of adverse reactions in the 158 patients in the anaplastic astrocytoma study for whom data are available. In the absence of a control group, it is not clear in many cases whether these reactions should be attributed to temozolomide or the patients’ underlying conditions, but nausea, vomiting, fatigue, and hematologic effects appear to be clearly drug-related. The most frequently occurring adverse reactions were nausea, vomiting, headache, and fatigue. The adverse reactions were usually NCI Common Toxicity Criteria (CTC) Grade 1 or 2 (mild to moderate in severity) and were self-limiting, with nausea and vomiting readily controlled with antiemetics. The incidence of severe nausea and vomiting (CTC Grade 3 or 4) was 10% and 6%, respectively. Myelosuppression (thrombocytopenia and neutropenia) was the dose-limiting adverse reaction. It usually occurred within the first few cycles of therapy and was not cumulative.

Myelosuppression occurred late in the treatment cycle and returned to normal, on average, within 14 days of nadir counts. The median nadirs occurred at 26 days for platelets (range: 21-40 days) and 28 days for neutrophils (range: 1-44 days). Only 14% (22/158) of patients had a neutrophil nadir and 20% (32/158) of patients had a platelet nadir, which may have delayed the start of the next cycle. Less than 10% of patients required hospitalization, blood transfusion, or discontinuation of therapy due to myelosuppression.

In clinical trial experience with 110 to 111 women and 169 to 174 men (depending on measurements), there were higher rates of Grade 4 neutropenia (ANC less than 500 cells/μL) and thrombocytopenia (less than 20,000 cells/μL) in women than men in the first cycle of therapy (12% vs. 5% and 9% vs. 3%, respectively).

In the entire safety database for which hematologic data exist (N=932), 7% (4/61) and 9.5% (6/63) of patients over age 70 experienced Grade 4 neutropenia or thrombocytopenia in the first cycle, respectively. For patients less than or equal to age 70, 7% (62/871) and 5.5% (48/879) experienced Grade 4 neutropenia or thrombocytopenia in the first cycle, respectively. Pancytopenia, leukopenia, and anemia have also been reported.

TABLE 8: Adverse Reactions in the Anaplastic Astrocytoma Trial in Adults (≥ 5%)

Any Adverse Reaction No. (%) of TEMODAR Patients (N=158)
All Reactions Grade 3/4
153 (97) 79 (50)
Body as a Whole
Headache 65 (41) 10 (6)
Fatigue 54 (34) 7 (4)
Asthenia 20 (13) 9 (6)
Fever 21 (13) 3 (2)
Back pain 12 (8) 4 (3)
Cardiovascular    
Edema peripheral 17 (11) 1 (1)
Central and Peripheral Nervous System
Convulsions 36 (23) 8 (5)
Hemiparesis 29 (18) 10 (6)
Dizziness 19 (12) 1 (1)
Coordination abnormal 17 (11) 2 (1)
Amnesia 16 (10) 6 (4)
Insomnia 16 (10) 0
Paresthesia 15 (9) 1 (1)
Somnolence 15 (9) 5 (3)
Paresis 13 (8) 4 (3)
Urinary incontinence 13 (8) 3 (2)
Ataxia 12 (8) 3 (2)
Dysphasia 11 (7) 1 (1)
Convulsions local 9 (6) 0
Gait abnormal 9 (6) 1 (1)
Confusion 8 (5) 0
Endocrine
Adrenal hypercorticism 13 (8) 0
Gastrointestinal System
Nausea 84 (53) 16 (10)
Vomiting 66 (42) 10 (6)
Constipation 52 (33) 1 (1)
Diarrhea 25 (16) 3 (2)
Abdominal pain 14 (9) 2 (1)
Anorexia 14 (9) 1 (1)
Metabolic
Weight increase 8 (5) 0
Musculoskeletal System
Myalgia 8 (5)  
Psychiatric Disorders
Anxiety 11 (7) 1 (1)
Depression 10 (6) 0
Reproductive Disorders
Breast pain, female 4 (6)  
Resistance Mechanism Disorders
Infection viral 17 (11) 0
Respiratory System
Upper respiratory tract infection 13 (8) 0
Pharyngitis 12 (8) 0
Sinusitis 10 (6) 0
Coughing 8 (5) 0
Skin and Appendages
Rash 13 (8) 0
Pruritus 12 (8) 2 (1)
Urinary System
Urinary tract infection 12 (8) 0
Micturition increased frequency 9 (6) 0
Vision
Diplopia 8 (5) 0
Vision abnormal* 8 (5)  
*Blurred vision; visual deficit; vision changes; vision troubles

TABLE 9: Adverse Hematologic Effects (Grade 3 to 4) in the Anaplastic Astrocytoma Trial in Adults

  TEMODAR*
Hemoglobin 7/158 (4%)
Lymphopenia 83/152 (55%)
Neutrophils 20/142 (14%)
Platelets 29/156 (19%)
WBC 18/158 (11%)
*Change from Grade 0 to 2 at baseline to Grade 3 or 4 during treatment.

TEMODAR for injection delivers equivalent temozolomide dose and exposure to both temozolomide and 5-(3-methyltriazen-1yl)-imidazole-4-carboxamide (MTIC) as the corresponding TEMODAR capsules. Adverse reactions probably related to treatment that were reported from the 2 studies with the intravenous formulation (n=35) that were not reported in studies using the TEMODAR capsules were: pain, irritation, pruritus, warmth, swelling, and erythema at infusion site as well as the following adverse reactions: petechiae and hematoma.

Postmarketing Experience

The following adverse reactions have been identified during postapproval use of TEMODAR. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to the drug exposure.

Dermatologic disorders: Toxic epidermal necrolysis and Stevens-Johnson syndrome

Immune system disorders: Allergic reactions, including anaphylaxis. Erythema multiforme, which resolved after discontinuation of TEMODAR and, in some cases, recurred upon rechallenge.

Hematopoietic disorders: Prolonged pancytopenia, which may result in aplastic anemia and fatal outcomes [see WARNINGS AND PRECAUTIONS].

Hepatobiliary disorders: Fatal and severe hepatotoxicity, elevation of liver enzymes, hyperbilirubinemia, cholestasis, and hepatitis [see WARNINGS AND PRECAUTIONS].

Infections and infestations: Serious opportunistic infections, including some cases with fatal outcomes, can occur with bacterial, viral (primary and reactivated), fungal, and protozoan organisms.

Pulmonary disorders: Interstitial pneumonitis, pneumonitis, alveolitis, and pulmonary fibrosis.

Endocrine disorders: Diabetes insipidus

Read the entire FDA prescribing information for Temodar (Temozolomide)

Related Resources for Temodar

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Read the Temodar User Reviews »

© Temodar Patient Information is supplied by Cerner Multum, Inc. and Temodar Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.

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