Comprehensive medication guide to Lomustine including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
Not covered by Medicare Part D (NextSource withdrew in 2021) or standard Medicaid. Commercial insurance coverage varies; prior authorization almost always required. Some Medicare Advantage plans may have separate formulary coverage. Patient assistance programs like Prescription Hope offer lomustine for approximately $70/month.
Estimated Cash Pricing
$600–$2,950 retail per dose for brand Gleostine depending on capsule strength; generic lomustine available with GoodRx coupons from approximately $672 per dose at select pharmacies. Only one dose is dispensed at a time every 6 weeks.
Medfinder Findability Score
45/100
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Lomustine is an oral chemotherapy drug in the nitrosourea alkylating agent class. It is sold under the brand name Gleostine (and formerly as CeeNU, which was discontinued in 2013 by Bristol-Myers Squibb). In oncology literature, it is often referred to as CCNU. The FDA first approved lomustine in 1977, and it remains a clinically important treatment for brain tumors and Hodgkin's lymphoma nearly 50 years later.
Lomustine is FDA-approved for primary and metastatic brain tumors (in patients who have already received surgery and/or radiation) and for relapsed or refractory Hodgkin's lymphoma. It is considered standard of care for recurrent glioblastoma — the most common and aggressive malignant brain tumor — in multiple international clinical guidelines.
Lomustine is taken orally as a single dose once every 6 weeks. It is available in 5 mg, 10 mg, 40 mg, and 100 mg capsules, and because it is a hazardous drug with serious overdose risk, only one dose is dispensed at a time. The drug is not stocked at most retail pharmacies — specialty pharmacies and cancer center pharmacies are the most reliable dispensing sources.
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Lomustine is a highly lipid-soluble nitrosourea compound, which means it can pass through the blood-brain barrier — a protective filter that blocks most chemotherapy drugs from reaching brain tumors. This property makes lomustine uniquely valuable for treating brain cancer.
Once inside cells, lomustine alkylates (chemically modifies) both DNA and RNA, cross-links DNA strands to prevent proper replication, and inhibits key enzymes through carbamoylation of proteins. These combined actions prevent cancer cells from dividing and repairing themselves, ultimately causing cell death. Lomustine is cell-cycle phase-nonspecific, meaning it can damage cancer cells regardless of where they are in the division cycle.
Tumors with MGMT promoter methylation (silencing of the MGMT DNA repair gene) are especially responsive to alkylating agents like lomustine, because these cells cannot repair the DNA damage lomustine causes. Oncologists test for MGMT methylation status in glioblastoma patients to predict response to treatment.
5 mg — capsule
Yellow gelatin capsule
10 mg — capsule
White gelatin capsule
40 mg — capsule
White and green gelatin capsule
100 mg — capsule
Green gelatin capsule; standard adult dose is 130 mg/m² total combining capsule strengths as needed
Lomustine (Gleostine) is not on the FDA's active drug shortage list as of 2026 — the physical supply shortage that occurred in 2013 when Bristol-Myers Squibb discontinued CeeNU was resolved in 2014 when NextSource Biotechnology relaunched the drug. However, lomustine has serious and persistent access barriers that make it genuinely difficult for many patients to obtain.
The key challenges: lomustine is not stocked at most retail pharmacies (it requires specialty dispensing capabilities), it is not covered by Medicare Part D or standard Medicaid since 2021, and the brand-name Gleostine costs $600–$2,950 per dose. NextSource is the sole U.S. manufacturer, creating ongoing sole-source risk. Patients typically need to go through cancer center pharmacies, specialty pharmacy networks, or patient assistance programs to access this drug.
If you're struggling to locate lomustine at a pharmacy near you, medfinder calls pharmacies in your area on your behalf to check which ones have your medication in stock. Results are texted to you, saving you hours of calls.
Lomustine is not a controlled substance, so there are no DEA scheduling restrictions on who can prescribe it. However, it is a high-risk cytotoxic chemotherapy agent with an FDA boxed warning for potentially fatal myelosuppression. It must be prescribed and managed by qualified oncology specialists with experience in cancer chemotherapy. Prescribers must be capable of monitoring patients with weekly blood counts for at least 6 weeks after each dose.
Types of specialists who prescribe lomustine:
Neuro-oncologists — primary prescribers for brain tumor patients
Medical oncologists — may prescribe for both brain tumors and lymphoma
Hematologist-oncologists — for Hodgkin's lymphoma patients
Pediatric oncologists — at pediatric cancer centers for appropriate childhood brain tumor cases
Telehealth availability is limited for lomustine. Initial prescribing requires in-person evaluation and cannot be done through a general telehealth platform. Ongoing management discussions may include telehealth components at institutions with oncology telehealth programs, but clinical monitoring (weekly blood counts) must be conducted in person or through a local lab.
No. Lomustine (Gleostine) is not classified as a controlled substance by the DEA. It has no abuse potential and is not scheduled under the Controlled Substances Act. You do not need a DEA-issued controlled substance prescription to fill lomustine at a pharmacy.
However, lomustine has strict dispensing regulations for a different reason: it carries an FDA boxed warning for potentially fatal myelosuppression, and accidental overdose can be lethal. As a result, pharmacy regulations require that only one dose be dispensed at a time (every 6 weeks), and prescriptions are subject to prior authorization by most insurers. Safe handling requirements (hazardous drug classification) also restrict which pharmacies can dispense lomustine.
Common side effects that most patients experience:
Nausea and vomiting (typically within 3–6 hours of dose, resolves within 24 hours)
Loss of appetite (may last several days)
Hair loss (alopecia)
Mouth sores (oral ulcers)
Diarrhea
Fatigue
Delayed myelosuppression — bone marrow suppression with dangerously low blood counts; onset 28–42 days after dose (FDA boxed warning)
Fever 100.4°F or higher — may indicate febrile neutropenia; seek emergency care immediately
Unusual bruising or bleeding — sign of dangerous thrombocytopenia
Pulmonary fibrosis / shortness of breath — risk increases with cumulative doses >1,100 mg/m²
Progressive renal failure — monitor renal function throughout treatment
Secondary malignancies — including leukemia, may occur months to years after treatment
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Temozolomide (Temodar)
Oral alkylating agent; standard first-line chemotherapy for glioblastoma with radiation; generally covered by Medicare and most insurers; most effective in MGMT-methylated tumors
Carmustine (BiCNU/Gliadel)
Nitrosourea with same mechanism as lomustine; IV administration or as Gliadel wafers (surgically implanted); cross-resistant with lomustine
Bevacizumab (Avastin)
Anti-VEGF monoclonal antibody; FDA-approved for recurrent glioblastoma; IV administration covered under Medicare Part B; often combined with lomustine or used as monotherapy
Procarbazine (Matulane)
Component of PCV regimen (Procarbazine + Lomustine + Vincristine) for certain brain tumors; oral alkylating agent
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Cimetidine (Tagamet)
moderateDecreases hepatic metabolism of lomustine via CYP inhibition, increasing lomustine blood levels and myelotoxicity. Switch to famotidine or a PPI for heartburn.
Live vaccines (BCG, FluMist, etc.)
majorContraindicated — lomustine's immunosuppression may allow vaccine strain infection. Avoid live vaccines during treatment and for 3 months after last dose.
Cisplatin
moderateAdditive myelosuppression when combined; dose adjustments required and close monitoring of blood counts essential.
Cyclophosphamide
moderateAdditive immunosuppression and myelosuppression.
Clozapine (Clozaril)
moderateAdditive myelosuppression, significantly increased risk of neutropenia. Monitor closely; inform prescribing psychiatrist.
Adalimumab (Humira) and other TNF inhibitors
moderateAdditive immunosuppression increases infection risk. Discuss all biologic medications with your oncologist.
Ciltacabtagene autoleucel (Carvykti)
majorAvoid combination — greatly increased immunosuppression and infection risk.
Lomustine (Gleostine) is a clinically irreplaceable chemotherapy drug for many brain cancer and lymphoma patients. Its unique ability to cross the blood-brain barrier and its decades of clinical evidence make it a cornerstone of neuro-oncology treatment. Yet accessing it has become increasingly difficult — not because of a physical supply shortage, but due to pricing, insurance coverage gaps, and limited pharmacy availability.
Patients and caregivers facing lomustine access challenges should work closely with their oncology team, explore patient assistance programs like Prescription Hope, and utilize prescription discount cards like GoodRx. Proactive planning — starting the pharmacy and insurance process at least 2 weeks before each dose date — is the single most important step to prevent treatment delays.
When it comes to locating lomustine at a pharmacy near you, medfinder can help by calling pharmacies on your behalf to check real-time availability. You provide the medication, dosage, and location — medfinder does the calling and texts you the results.
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