Comprehensive medication guide to Temozolomide including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$300+ per cycle on most commercial plans; classified as specialty tier. Medicare Part D may cover oral capsules with a $2,000 annual out-of-pocket cap (as of 2025). Prior authorization required by most plans.
Estimated Cash Pricing
$50–$3,420 retail depending on strength and quantity; as low as $112.75 with GoodRx or $49.98 for 5×100 mg with SingleCare coupons for a treatment supply.
Medfinder Findability Score
60/100
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Temozolomide, sold under the brand name Temodar, is an oral chemotherapy medication used to treat brain tumors. It is the cornerstone of treatment for glioblastoma multiforme (GBM) — the most common and aggressive primary brain cancer in adults — given alongside radiation therapy and then as maintenance treatment. It is also FDA-approved for anaplastic astrocytoma.
Temozolomide is classified as an alkylating agent. Unlike most chemotherapy drugs, it is taken orally as a capsule and crosses the blood-brain barrier effectively — making it particularly well-suited for treating tumors in the brain and central nervous system.
Generic temozolomide is manufactured by several companies including Lannett, Amneal, Sun Pharma, and Camber Pharmaceuticals. The FDA first approved temozolomide in 1999 and updated its labeling in September 2023 under Project Renewal, adding the indication for adjuvant treatment of newly diagnosed anaplastic astrocytoma.
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Temozolomide works as an alkylating agent — a type of chemotherapy that damages cancer cell DNA to prevent tumor growth. After being absorbed into the bloodstream and crossing the blood-brain barrier, temozolomide is spontaneously converted to its active form: MTIC (5-(3-methyltriazen-1-yl)-imidazole-4-carboxamide).
MTIC methylates DNA at the O6 position of guanine. This chemical modification creates DNA mismatches that cancer cells cannot repair correctly, triggering programmed cell death (apoptosis). Temozolomide works synergistically with radiation therapy — each modality sensitizes tumor cells to the other.
The effectiveness of temozolomide is significantly influenced by the MGMT methylation status of the tumor. Tumors with a methylated MGMT promoter cannot produce the DNA repair enzyme MGMT, making them highly susceptible to temozolomide's DNA damage. Patients with MGMT-methylated GBM typically have better outcomes with the Stupp protocol (temozolomide + radiotherapy).
5 mg — capsule
Lowest strength; used to fine-tune BSA-calculated doses
20 mg — capsule
Used in combination with other strengths for precise dosing
100 mg — capsule
Most commonly used strength; also available as IV powder
140 mg — capsule
Mid-range strength for BSA-based dosing combinations
180 mg — capsule
Higher strength capsule for larger patients or higher-dose cycles
250 mg — capsule
Highest oral capsule strength; reduces pill burden for large doses
100 mg/vial — IV powder for injection
Lyophilized powder for intravenous infusion over 90 minutes; used when oral route is not feasible
Temozolomide is not currently listed on the FDA's active drug shortage list as of 2026. Multiple generic manufacturers produce it, providing supply stability. However, patients routinely encounter difficulty filling prescriptions at retail pharmacies because temozolomide is a specialty oncology medication that most community pharmacies do not stock on a regular basis.
The primary challenge is distribution: temozolomide is dosed by body surface area and available in six capsule strengths (5 mg, 20 mg, 100 mg, 140 mg, 180 mg, and 250 mg). Patients often need multiple strengths to fill a single prescription, and a pharmacy may have one strength but not another. Insurance prior authorization requirements add additional time delays.
Specialty pharmacies are the most reliable source for temozolomide. Patients struggling to find their specific capsule strength at local pharmacies can use medfinder to check which pharmacies near them have their medication in stock and can fill their prescription before each treatment cycle.
Temozolomide is not a controlled substance and does not require a DEA license. However, as a cytotoxic chemotherapy drug for brain tumors, it requires specialist prescribing with appropriate CBC monitoring infrastructure, PCP prophylaxis management, and oncology-level expertise.
Telehealth is not suitable for initial prescribing due to required CBC monitoring and in-person oncology evaluation. However, some cancer centers offer telehealth follow-up visits between treatment cycles for established patients. Telehealth second-opinion consultations from major academic brain tumor programs are increasingly available for patients at smaller community hospitals.
No. Temozolomide is not a controlled substance and is not scheduled by the Drug Enforcement Administration (DEA). It does not require a DEA license to prescribe, and there are no federal restrictions on the number of refills or prescription quantity.
However, temozolomide is a cytotoxic chemotherapy drug that requires a prescription from a licensed healthcare provider. Because it is classified as a specialty medication, most insurance plans require prior authorization before dispensing. Prescribing temozolomide requires specialist oncology or neuro-oncology expertise given the need for CBC monitoring, PCP prophylaxis, and management of myelosuppression.
The following side effects occur in at least 20% of patients taking temozolomide:
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Lomustine (CCNU/Gleostine)
Oral nitrosourea alkylating agent; used in recurrent GBM and in combination with temozolomide. Causes prolonged myelosuppression; dosed every 6 weeks.
Bevacizumab (Avastin)
Anti-VEGF monoclonal antibody; FDA-approved for recurrent GBM. Given IV every 2 weeks. Biosimilars available (Mvasi, Zirabev, Alymsys).
Carmustine (BCNU/Gliadel)
Nitrosourea alkylating agent; IV formulation (BiCNU) or surgically implanted wafers (Gliadel). Used in GBM at initial surgery.
Procarbazine (in PCV regimen)
Oral alkylating agent; part of PCV (procarbazine, lomustine, vincristine) regimen for IDH-mutant low-grade and anaplastic gliomas.
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Valproic acid (Depakote)
moderateDecreases temozolomide clearance by ~5%, increasing temozolomide exposure. Monitor CBC more closely.
Live vaccines (influenza nasal, some shingles)
majorAvoid live vaccines during temozolomide treatment due to immunosuppression. May cause vaccine-related infection.
Deferiprone
majorAdditive risk of neutropenia/agranulocytosis. Avoid combination; monitor ANC closely if unavoidable.
Ropeginterferon alfa-2b
majorAdditive myelosuppression. Avoid combination.
Palifermin (Kepivance)
majorDo not administer within 24 hours before, during, or after temozolomide. Increases mucositis severity.
Tofacitinib (Xeljanz)
moderateIncreased immunosuppression and infection risk.
Carbamazepine/Phenytoin
moderateBoth drugs associated with aplastic anemia; combination with temozolomide warrants extra CBC monitoring.
Temozolomide remains the cornerstone chemotherapy for glioblastoma and anaplastic astrocytoma, backed by decades of clinical evidence. Its oral formulation and blood-brain barrier penetration make it uniquely effective for brain tumors. The standard Stupp protocol — concurrent temozolomide with radiotherapy followed by maintenance chemotherapy — continues to be the primary standard of care for newly diagnosed GBM.
While not in a national shortage as of 2026, temozolomide can be difficult to find at retail pharmacies due to its specialty drug distribution. Patients should plan ahead: start looking for their specific capsule strengths 7–10 days before each treatment cycle, work with a specialty pharmacy, and ensure prior authorization is in place.
If you're struggling to find temozolomide at a pharmacy near you, medfinder calls local pharmacies to check which ones have your specific strength in stock and can fill your prescription — so you can focus on your treatment, not pharmacy calls.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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