carmustine

Generic Name: carmustine (kar MUS teen)Brand Names: BiCNU, Gliadel

What is carmustine?

Carmustine is a cancer medication that interferes with the growth of cancer cells and slows their spread in the body.

Carmustine is used to treat brain tumors, Hodgkin's disease, multiple myeloma, and non-Hodgkin's lymphoma.

Carmustine is sometimes given with other cancer medications.

Carmustine may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about carmustine?

Do not use carmustine if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment. You should not use this medication if you are allergic to carmustine.

Before receiving carmustine, tell your doctor if you have bone marrow suppression, liver or kidney disease, or a history of lung or breathing problems.

Carmustine is usually given once every 6 weeks. You may be given either a single injection or multiple injections over a 2-day period. Follow your doctor's dosing instructions very carefully.

Carmustine can cause nausea and vomiting that may last up to 6 hours after your injection. To be sure this medication is not causing harmful effects, your blood will need to be tested weekly for at least 6 weeks after you receive a dose of carmustine. Your kidneys, liver, and lung function may also need to be tested. Do not miss any follow-up visits to your doctor.

What should I discuss with my healthcare provider before receiving carmustine?

You should not receive this medication if you are allergic to it.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely receive this medication:

• bone marrow suppression;

• liver disease;
• kidney disease; or

• a history of lung or breathing problems.

FDA pregnancy category D. Do not use carmustine if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment. It is not known whether carmustine passes into breast milk or if it could harm a nursing baby. You should not breast-feeding while you are being treated with carmustine.

How is carmustine given?

Carmustine is given as an injection through a needle placed into a vein. You will receive this injection in a clinic or hospital setting. The medicine must be given slowly through an IV infusion and may take at least 2 hours to complete.

Carmustine is usually given once every 6 weeks. You may be given either a single injection or multiple injections over a 2-day period. Follow your doctor's dosing instructions very carefully.

Tell your caregivers if you feel any burning or pain around the IV needle when carmustine is injected. Carmustine can cause nausea and vomiting that may last up to 6 hours after your injection. You may be given anti-nausea medications to help prevent these side effects.

Carmustine can lower the blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill.

To be sure your blood cells do not get too low, your blood will need to be tested weekly for at least 6 weeks after you receive a dose of carmustine. This medication can have long-lasting effects on your body. Your kidneys, liver, and lung function may also need to be tested. Do not miss any follow-up visits to your doctor for blood or urine tests.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your carmustine injection.

What happens if I overdose?

Seek emergency medical attention if you think you have received too much of this medicine.

Overdose symptoms may include severe forms of the serious side effects listed in this medication guide.

What should I avoid while receiving carmustine?

Avoid being near people who have colds, the flu, or other contagious illnesses. Contact your doctor at once if you develop signs of infection.

Carmustine side effects

Get emergency medical help if you have any of these 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 serious side effect such as:

• redness of your eyes or skin and severe warmth or tingling under your skin (within 2 to 4 hours after your carmustine injection);

• signs of infection such as fever, chills, sore throat, mouth sores;

• easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;

• pale skin, feeling light-headed, rapid heart rate, trouble concentrating;

• wheezing, rapid breathing, feeling short of breath;

• chest pain, dry cough, fever, feeling ill;

• urinating less than usual or not at all;

• confusion, mood changes, increased thirst;

• swelling in your ankles or feet; or

• jaundice (yellowing of the skin or eyes).

Less serious side effects may include darkened skin color where the IV needle was placed.

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.

Carmustine Dosing Information

Usual Adult Dose for Brain/Intracranial Tumor:

For use as a single agent in previously untreated patients: 150 to 200 mg/m2 IV every 6 weeks. This dose can be given as a single or divided daily injections (75 to 100 mg/m2 on two successive days). When used with other myelosuppressive drugs or in patients in whom bone marrow reserve is depleted, doses should be adjusted accordingly. A repeat course should not be administered until platelets are >100,000/m3 and leukocytes are >4,000/mm3. An adequate number of neutrophils should be present on a peripheral blood smear. Blood counts should be monitored weekly. Repeat courses should not be administered before 6 weeks because of delayed and cumulative toxicity.

Usual Adult Dose for non-Hodgkin's Lymphoma:

For use as a single agent in previously untreated patients: 150 to 200 mg/m2 IV every 6 weeks. This dose can be given as a single or divided daily injections (75 to 100 mg/m2 on two successive days). When used with other myelosuppressive drugs or in patients in whom bone marrow reserve is depleted, doses should be adjusted accordingly. A repeat course should not be administered until platelets are >100,000/m3 and leukocytes are >4,000/mm3. An adequate number of neutrophils should be present on a peripheral blood smear. Blood counts should be monitored weekly. Repeat courses should not be administered before 6 weeks because of delayed and cumulative toxicity.

Usual Adult Dose for Hodgkin's Disease:

For use as a single agent in previously untreated patients: 150 to 200 mg/m2 IV every 6 weeks. This dose can be given as a single or divided daily injections (75 to 100 mg/m2 on two successive days). When used with other myelosuppressive drugs or in patients in whom bone marrow reserve is depleted, doses should be adjusted accordingly. A repeat course should not be administered until platelets are >100,000/m3 and leukocytes are >4,000/mm3. An adequate number of neutrophils should be present on a peripheral blood smear. Blood counts should be monitored weekly. Repeat courses should not be administered before 6 weeks because of delayed and cumulative toxicity.

Usual Adult Dose for Multiple Myeloma:

For use as a single agent in previously untreated patients: 150 to 200 mg/m2 IV every 6 weeks. This dose can be given as a single or divided daily injections (75 to 100 mg/m2 on two successive days). When used with other myelosuppressive drugs or in patients in whom bone marrow reserve is depleted, doses should be adjusted accordingly. A repeat course should not be administered until platelets are >100,000/m3 and leukocytes are >4,000/mm3. An adequate number of neutrophils should be present on a peripheral blood smear. Blood counts should be monitored weekly. Repeat courses should not be administered before 6 weeks because of delayed and cumulative toxicity.

Usual Adult Dose for Glioblastoma Multiforme:

polifeprosan 20 with carmustine implant (brand name = Gliadel Wafer):Each wafer contains 7.7 mg of carmustine, resulting in a dose of 61.6 mg when eight wafers are implanted. It is recommended that eight wafers be placed in the resection cavity if the size and shape of it allows. Should the size and shape not accommodate eight wafers, the maximum number of wafers as allowed should be placed. Since there is no clinical experience, no more than eight wafers should be used per surgical procedure.

Usual Adult Dose for Malignant Glioma:

polifeprosan 20 with carmustine implant (brand name = Gliadel Wafer):Each wafer contains 7.7 mg of carmustine, resulting in a dose of 61.6 mg when eight wafers are implanted. It is recommended that eight wafers be placed in the resection cavity if the size and shape of it allows. Should the size and shape not accommodate eight wafers, the maximum number of wafers as allowed should be placed. Since there is no clinical experience, no more than eight wafers should be used per surgical procedure.

What other drugs will affect carmustine?

Tell your doctor about all other medications you use, especially cimetidine (Tagamet).

There may be other drugs that can interact with carmustine. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Where can I get more information?

• Your doctor or pharmacist can provide more information about carmustine.

• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 2.02. Revision Date: 12/22/2009 1:30:28 PM.