====== 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 ((Sitbon Sitruk L, Sanson M, Prades M, Lefebvre G, Schubert B, Poirot C (November 2010). "Chimiothérapie à gonadotoxicité inconnue et préservation de la fertilité: Exemple du témozolomide" [Unknown gonadotoxicity chemotherapy and preservation of fertility: example of Temozolomide]. Gynécologie, Obstétrique & Fertilité (in French). 38 (11): 660–2. doi:10.1016/j.gyobfe.2010.09.002. PMID 21030284.)). 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 [[report]]s 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 reaction]]s ((Ambur A, Ambur L, Khan L, Nathoo R. Drug-induced hypersensitivity syndrome following temozolimide for glioblastoma multiforme and the role of desensitization therapy. J Oncol Pharm Pract. 2022 Apr;28(3):733-735. doi: 10.1177/10781552211062569. Epub 2021 Nov 26. PMID: 34825610.)). ---- Mehta et al reported a Temozolomide-induced drug rash with eosinophilia and systemic symptoms syndrome ((Mehta H, Gendle CS, Kumaran MS, Vinay K. Temozolomide-induced drug rash with eosinophilia and systemic symptoms syndrome. Indian J Dermatol Venereol Leprol. 2022 Aug 27:1-4. doi: 10.25259/IJDVL_754_2021. Epub ahead of print. PMID: 36332091.)). ===== Hepatotoxicity ===== [[Temozolomide Hepatotoxicity]].