Carmustine

Carmustine is a prescription medicine used for the treatment of brain tumors, multiple myeloma, Hodgkin's disease, non-Hodgkin's lymphoma (NHL), recurrent glioblastoma, and malignant glioma

• Carmustine is available under the following different brand names: BiCNU, Gliadel

Common side effects of Carmustine include:

• nausea, vomiting, decreased appetite;
• diarrhea, constipation;
• tired feeling;
• joint pain, muscle spasms;
• hair loss;
• weight loss; or
• decreased sense of taste.

Serious side effects of Carmustine include:

• hives,
• difficulty breathing,
• swelling of the face, lips, tongue, or throat, and

Rare side effects of Carmustine include:

• none

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out. 

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult dosage

Powder for injection

• 100 mg

Wafers

• 7.7 mg

Brain Tumors, Multiple Myeloma, Hodgkin's Disease, NHL

Adult and geriatric dosage

BiCNU

• 150-200 mg/m² IV (single dose or divided 2 days) every 6 weeks OR  
• 75-100 mg/m²/day IV for 2 days every 6 weeks

Recurrent Glioblastoma

Adult and geriatric  dosage

Gliadel

• Up to 8 wafers were placed in the surgical resection cavity of the brain

Malignant Glioma

Adult and geriatric dosage

Gliadel

• Up to 8 wafers were placed in the surgical resection cavity of the brain

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Carmustine has severe interactions with no other drugs.
• Carmustine has serious interactions with the following drug:
  • adenovirus types 4 and 7 live, oral
  • axicabtagene ciloleucel
  • brexucabtagene autoleucel
  • ciltacabtagene autoleucel
  • idecabtagene vicleucel
  • influenza virus vaccine quadrivalent, adjuvanted
  • influenza virus vaccine trivalent, adjuvanted
  • lisocabtagene maraleucel
  • palifermin
  • ropeginterferon alfa 2b
  • tisagenlecleucel
  • tofacitinib
  • Monitor Closely (34)
  • acalabrutinib
  • belatacept
  • bendamustine
• Carmustine has moderate interactions with at least 34 other drugs.
• Carmustine has minor interactions with the following drugs:
  • vitamin A
  • vitamin E

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• Hypersensitivity

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Carmustine?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Carmustine?”

Cautions

• Do not give more frequently than q6-8wk due to delayed myelosuppression; complete blood count should be monitored weekly for at least six weeks after each dose
• Risk of irreversible pulmonary fibrosis on long-term treatment
• Injection site reactions may occur during administration; rapid infusion may cause burning along the vein and flushing of the skin
• Extravasation risk, monitor closely during infusion
• Ocular toxicity associated with an intracarotid route (investigational); safety and efficacy not established
• Associated with moderate to high emetic potential; administer antiemetics to prevent nausea and vomiting
• Monitor liver function tests periodically during therapy; reversible increases (rare) in bilirubin, alkaline phosphatase levels, and transaminases reported
• Wafer implant associated with intracranial hypertension; brain edema reported in patients with newly diagnosed glioma; monitor closely for intracranial hypertension related to brain edema, inflammation, or necrosis of brain tissues surrounding resection; in refractory cases, removing the wafer may be necessary
• Meningitis reported in patients with recurrent glioma receiving wafer implants; monitor postoperatively for signs/symptoms of meningitis and CNS infection
• Renal failure decreased kidney size, and progressive azotemia are reported in patients receiving low or large cumulative doses or prolonged treatment; monitor renal function periodically
• Long-term use associated with the development of secondary malignancies (acute leukemia and bone marrow dysplasias)
• Wafer implants associated with seizures; treatment-emergent seizures reported within 5 days of surgery; initiate optimal anti-seizure therapy before surgery
• Impaired neurosurgical wound healing, including wound dehiscence, delayed healing, and subdural, subgleal or wound effusions associated with wafer implant treatment; cerebrospinal fluid leaks also reported; monitor for impaired neurosurgical wound healing following surgery
• Avoid pregnancy
• Contraception
  • Advise female patients to avoid pregnancy during therapy because of the risk of fetal harm
  • Advise female patients of reproductive potential to use highly effective contraception during and for up to six months after completion of treatment
  • Advise males with female sexual partners of reproductive potential to use effective contraception during therapy and for at least three months after the final dose of carmustine
• Fertility
  • Based on nonclinical findings, male fertility may be compromised by therapy

Pregnancy and Lactation

• Therapy can cause fetal harm when administered to a pregnant woman; there is no available data on its use in pregnant women
• Lactation
  • No data are available regarding the presence of drug or metabolites in human milk or their effects on the breastfed child or milk production; because of the potential for serious adverse reactions in breastfed children from therapy, advise women not to breastfeed following treatment and for at least 7 days after treatment