How does Temodar work?

Temodar works by affecting the DNA inside the cancer cells. Temodar prevents the cells from being able to replicate, or make copies, of themselves properly, which leads to the death of the cells. Because Temodar can work on any cell, not just cancer cells, side effects can occur.

Temodar (Temozolomide) - Oral: Uses, Side Effects, Dosages

What Is Temodar?

Temodar (temozolomide) is an oral medication categorized as an alkylating agent (a class of common anticancer drugs. It is prescribed to treat two different types of brain cancer, anaplastic astrocytoma and glioblastoma multiforme (GBM), in adults whose tumors have returned or whose tumors have just been diagnosed.

Temodar works by slowing the growth of cancer cells through the disruption of the cells' DNA (deoxyribonucleic acid). This kills the cancer cells and keeps them from reproducing.

Temodar is a capsule to be taken by mouth.

Drug Facts

Generic Name: Temozolomide

Brand Name(s): Temodar

Drug Availability: Prescription

Administration Route: Oral

Therapeutic Classification: Antineoplastic agent

Available Generically: Yes

Controlled Substance: N/A

Active Ingredient: Temozolomide

Dosage Form(s): Capsule

What Is Temodar Used For?

The Food and Drug Administration (FDA) has approved Temodar for the treatment of newly diagnosed GBM when paired with radiotherapy and then as a maintenance treatment in adults.

GBM (also referred to as a grade 4 astrocytoma) is an aggressive type of cancer that can develop in either the brain or spinal cord and can cause worsening headaches, nausea, vomiting, and seizures.

The median age of diagnosis is 64 years old, and GBM is more common in men than women. The overall survival rate is poor. About 40% of people diagnosed with GBM are still alive in the first year post-diagnosis and 17% in the second year.

Temodar also is used for adults with refractory (meaning cancer that doesn't respond to treatment) anaplastic astrocytoma who have experienced disease progression on a drug regimen containing nitrosourea (a type of alkylating agent) and procarbazine (another type of alkylating agent used commonly to treat Hodgkin's lymphoma).

Anaplastic astrocytoma is a type of cancer that can form in the brain or spinal cord. Astrocytoma begins in cells called astrocytes, which support nerve cells. While the true cause of this cancer is unknown, potential genetic and immunologic problems, environmental factors (e.g., exposure to ultraviolet rays, certain chemicals, radiation), diet, or stress may play contributing roles in causing cancer.

How to Take Temodar

Temodar capsules are taken once per day. Take them on an empty stomach, before bedtime, to help reduce nausea. The capsules should be taken whole and should not be broken open or crushed.

Each cycle of Temodar is given for a varying amount of days. The exact dosing instructions will be determined by your healthcare provider.

Sometimes anti-nausea medication is prescribed along with Temodar. Take it about an hour or so before your dose of Temodar to help reduce nausea. An antibiotic to prevent a type of pneumonia, called pneumocystis pneumonia, may also be prescribed along with Temodar.

Storage

Temodar should be kept in its original package, not removed and put into a pill box or other container. The medication should be stored at room temperature (about 77 degrees Fahrenheit) in a secure location that's away from children or pets.

If possible, Temodar should only be handled by the person who is taking it. Wash your hands after handling the drug. If any of the capsules have opened, contact the pharmacy immediately for instructions.

How Long Does Temodar Take to Work?

Once swallowed, Temodar typically gets into the system quickly. However, it could take a few months to determine how effective it is in treating your cancer.

What Are the Side Effects of Temodar?

This is not a complete list of side effects. Others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or your healthcare provider. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.

As with all medications, Temodar can cause side effects. Tell your healthcare provider about any side effects you experience while taking this medication.

Common Side Effects

Some side effects may be commonly experienced by people taking Temodar. Some of the most common side effects are:

Hair loss
Nausea and/or vomiting
Fatigue
Constipation
Diarrhea
Poor appetite
Mouth sores
Rash
Headache

Severe Side Effects

Call your healthcare provider immediately if you’re experiencing any serious side effects. If you feel your symptoms are life-threatening or you’re having a medical emergency, call 911. Severe side effects and their symptoms can include:

Low white blood cell (WBC) counts (neutropenia/decreased number of leukocytes): Fever, chills, signs of infection
Thrombocytopenia (low platelets): Bleeding, consistent bruising
Pneumocystis pneumonia: Cough, dyspnea (shortness of breath)
Liver dysfunction: Jaundice (yellowing of the eyes or skin), abdominal pain
Seizures

Long-Term Side Effects

Temodar may prevent future sperm production. Anyone taking Temodar who wishes to have children should consider using a sperm bank before starting Temodar.

Temodar has the potential to cause different cancers in the future, such as myelodysplastic syndrome or myeloid leukemia. Talk to your healthcare provider about these and other long-term side effects associated with Temodar use.

Report Side Effects

Temodar may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

(800) 332-1088

Dosage: How Much Temodar Should I Take?

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (capsules):
- For newly diagnosed glioblastoma multiforme:
  - Adults—Dose is based on body size and must be determined by your doctor. The dose is usually 75 milligrams (mg) per square meter (m[2]) of body size given as a single dose for 42 days. This is given together with a radiation treatment followed by a maintenance treatment for 6 cycles. Your doctor may adjust your dose as needed and tolerated.
  - Children—Use and dose must be determined by your doctor.
- For refractory anaplastic astrocytoma:
  - Adults—Dose is based on body size and must be determined by your doctor. The starting dose is usually 150 milligrams (mg) per square meter (m[2]) of body size once a day for 5 days, and then you stop taking it for the next 23 days. This dose cycle may be repeated every 28 days, for up to 2 years. Your doctor may adjust your dose as needed.
  - Children—Use and dose must be determined by your doctor.

Modifications

Users should be aware of the following before beginning Temodar:

Pregnancy: Temodar can cause harm to a fetus when administered to the pregnant parent. Additionally, because of the potential for toxicity and negative effects on sperm cells, males with pregnant partners or with partners of reproductive potential should use condoms during treatment with Temodar for at least three months after the final dose

Breastfeeding: Due to the possibility of myelosuppression (a decrease in the ability of the bone marrow to produce blood cells), people should not breastfeed for at least one week after taking the final dose of Temodar.

Adults over 65: Studies have shown that people 70 years and older have a higher probability of grade 4 neutropenia (25%) and grade 4 thrombocytopenia (20%) in the first cycle of therapy than people younger than 70 years of age.

Pediatric use: Temodar is not prescribed for people under the age of 18 as the safety and effectiveness of Temodar have not been sufficiently proven.

People who smoke: Smoking can lower Temodar's effectiveness. Try to stop smoking before starting Cefoxitin, and avoid smoking while taking Temodar. Your healthcare provider can help you with this goal.

Missed Dose

If a dose of Temodar is missed, the healthcare provider should be contacted for the next steps. A double dose of Temodar should never be taken.

Overdose: What Happens If I Take Too Much Temodar?

Temodar may require dose modifications if you are experiencing severe symptoms. Blood counts are monitored frequently when taking Temodar, and if the white blood cells or platelets are too low, how Temodar is dosed may need to be modified.

Do not take more Temodar than directed on the package label or by your healthcare provider. If too much Temodar is taken, your healthcare provider should be notified immediately. Severe symptoms have been reported with an overdose of Temodar.

Common signs of a potential medication-related overdose include:

Nausea or vomiting
Appetite loss
Sweating
Bleeding
Bruising
Upper stomach pain
Jaundice

What Happens If I Overdose on Temodar?

If you think you or someone else may have overdosed on Temodar, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Temodar, call 911 immediately.

911

Precautions

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for unwanted effects.

Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant during treatment and for at least 6 months after your last dose. Men who are using this medicine, with female partners who can become pregnant must use effective birth control (eg, condoms) during treatment and for at least 3 months after the last dose of this medicine. If you think you or your female partner have become pregnant while using the medicine, tell your doctor right away.

Temozolomide can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
Check with your doctor immediately if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin.
Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
Avoid contact sports or other situations where bruising or injury could occur.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Male patients should not donate semen during treatment and for at least 3 months after the final dose of this medicine.

If you plan to have children, talk with your doctor before using this medicine. Some men using this medicine have become infertile (unable to have children).

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn't Take Temodar?

Temodar is not right for everyone. You should not take this medication if you are allergic to the main ingredient, temozolomide, or any of the inactive ingredients in Temodar.

Temodar may be used with caution in some people only if their healthcare provider determines it is safe. This includes people who are pregnant, may become pregnant, or wish to become pregnant. The effects on pregnancy can last after Temodar is stopped. Therefore, contraception should be used for at least six months after stopping Temodar in women and three months after stopping Temodar in men.

Additionally, do not take Temodar if you have an allergy to the drug dacarbazine.

What Other Medications May Interact With Temodar?

Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter (OTC) medicines, and vitamins or supplements.

There are many medications that may cause similar side effects as Temodar. Be sure your healthcare provider has an up-to-date list of medications you're taking so they can review the potential of any interactions with Temodar.

Medications that may interact negatively with Temodar include:

What Medications Are Similar?

There are multiple medications that are in the drug class of alkylating agents, including dacarbazine and procarbazine.

Neither dacarbazine nor procarbazine is used to treat types of brain cancer. Both typically are used to treat Hodgkin’s lymphoma.

Frequently Asked Questions

What is Temodar used for?

Temodar is used to treat two types of brain cancer, glioblastoma and astrocytoma. For glioblastoma, Temodar is used along with radiation, and for astrocytoma, Temodar is used after other medications have not worked.
How does Temodar work?

Temodar works by affecting the DNA inside the cancer cells. Temodar prevents the cells from being able to replicate, or make copies, of themselves properly, which leads to the death of the cells. Because Temodar can work on any cell, not just cancer cells, side effects can occur.
What are the side effects of Temodar?
Side effects from Temodar include:
- Low white blood cell and platelet counts
- Nausea and/or vomiting
- Diarrhea
- Constipation
- Hair loss
- Feeling tired
- Decreased appetite

How Can I Stay Healthy While Taking Temodar?

It is important to remember that although Temodar comes with a long list of potential side effects, it does not mean that you will encounter all of them. Regardless, it is important to communicate any concerns or questions you have to your healthcare provider.

If you have been prescribed an anti-nausea medication, be sure to take that before taking Temodar (if instructed to do so by your healthcare provider) to help reduce nausea associated with Temodar.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

7 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Food and Drug Administration. Temodar (temozolomide) prescribing information.
MedlinePlus. Temozolomide.
American Association of Neurological Surgeons. Glioblastoma multiforme.
National Organization for Rare Disorders. Anaplastic astrocytoma.
American Addiction Centers. Overdose symptoms, risks & treatment.
Prescribers’ Digital Reference. Temozolomide - drug summary.
Armand JP, Ribrag V, Harrousseau JL, Abrey L. Reappraisal of the use of procarbazine in the treatment of lymphomas and brain tumors. Ther Clin Risk Manag. 2007;3(2):213-224. doi:10.2147/tcrm.2007.3.2.213

By Julie Scott, MSN, ANP-BC, AOCNP
Julie is an Adult Nurse Practitioner with oncology certification and a healthcare freelance writer with an interest in educating patients and the healthcare community.

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