Carmustine

Indications

Carmustine is a prescription cancer medicine. As an injection it is used, alone or with other medicines, for certain brain tumours (such as glioblastoma and other gliomas), multiple myeloma, and Hodgkin and non-Hodgkin lymphoma, including as part of high-dose treatment before a stem cell transplant. A wafer implant form may be placed in the brain during surgery for some brain tumours. Treatment is decided by a cancer specialist.

How It Works

Carmustine belongs to a group of chemotherapy medicines called nitrosoureas, which are alkylating agents. It attaches to the DNA inside cells and damages it, so cancer cells cannot divide and grow. Because it dissolves in fat, it can cross into the brain, which is why it is useful for brain tumours.

Dosage and Administration

Carmustine injection is given as a slow drip into a vein by a doctor or nurse in a hospital or cancer centre. The dose is calculated from body surface area, blood counts and the treatment plan, and courses are usually spaced at least 6 weeks apart because blood counts drop late. The wafer implant is placed by a neurosurgeon. Use only as prescribed.

Interactions

• Other medicines that lower blood counts, and radiotherapy, increase the risk of bone marrow suppression.
• Cimetidine may increase its effect on the bone marrow.
• Some epilepsy medicines such as Phenytoin may have their levels changed.
• Live vaccines should be avoided during treatment.

Contraindications

• Allergy to Carmustine or any ingredient
• Severe bone marrow suppression (very low blood counts) from earlier treatment
• Pregnancy and breastfeeding

Side Effects

• Delayed drop in blood counts (about 4 to 6 weeks after a dose), raising the risk of infection, bleeding and anaemia
• Nausea and vomiting, usually within a few hours of the dose
• Pain, burning or flushing along the vein during the drip
• Lung damage (fibrosis), which can appear during treatment or even years later; the risk rises with higher total doses
• Liver and kidney effects, eye problems, and a small long-term risk of other cancers

Get urgent medical help if you have fever or chills, unusual bleeding or bruising, cough or shortness of breath, yellow skin or eyes, a large drop in urine, or signs of a severe allergic reaction.

Pregnancy and Lactation

Carmustine can harm an unborn baby and must not be used in pregnancy. Both women and men should use effective contraception during treatment and for the period advised by the doctor afterwards. It may reduce fertility. Do not breastfeed during treatment.

Precautions and Warnings

• Blood counts are checked regularly, and lung function tests are done before and during treatment.
• Tell your doctor if you have lung disease or smoke, or have liver or kidney problems.
• Report breathing problems at any time, even years after treatment.
• Prepared and handled only by trained staff using safety precautions for cytotoxic medicines.

Overdose

Carmustine is given by health professionals, so overdose is unlikely. Overdose would cause severe bone marrow suppression and other toxic effects; there is no antidote and supportive care is given in hospital.

Therapeutic Class

Antineoplastic alkylating agent (nitrosourea).

Storage

Hospital medicine. Store as directed on the pack, unopened vials in a refrigerator at 2 to 8°C, protected from light. Prepared solutions must be used within the time stated in the leaflet.