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Carmustine

    Brands

    DEA Class; Rx

    Common Brand Names; BiCNU, Gliadel

    • Antineoplastics, Alkylating

    A nitrosourea alkylating agent
    IV formulation used for brain tumors including malignant gliomas and glioblastoma multiforme, multiple myeloma, Hodgkin lymphoma, and non-Hodgkin’s lymphoma; implantable wafer used for newly diagnosed high-grade glioma as an adjunct to surgery and radiation and for recurrent glioblastoma as an adjunct to surgery
    IV formulation has a black box warning for myelosuppression and pulmonary toxicity

    Indicated for recurrent glioblastoma as an adjunct to surgery

    Indicated for newly-diagnosed high-grade glioma as an adjunct to surgery and radiation

    Hypersensitivity

    • Convulsions (19%)
    • Hemiplegia (19%)
    • Headache (15%)
    • Metabolic disorder (14%)
    • Somnolence (14%)
    • Fever (12%)
    • 1-10%
    • Confusion (10%)
    • Aphasia (9%)
    • Nausea (8%)
    • Vomiting (8%)
    • Pain (7%)
    • Rash (5%)
    • Abscess (4%)
    • Cranial edema (4%)
    • ICP elevation (4%)
    • Meningitis (4%)
    • Hyperglycemia (3%)
    • HTN (3%)
    • Constipation (2%)
    • Diarrhea (2%)
    • Dizziness (2%)
    • Depression (2

    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 skin

    Extravasation risk, monitor closely during infusion

    Ocular toxicity associated with 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 reported in patients receiving low or large cumulative doses or prolonged treatment; monitor renal function periodically

    Long-term use associated with development of secondary malignancies (acute leukemia and bone marrow dysplasias)

    Therapy can cause fetal harm when administered to a pregnant woman; there are no available data on use in pregnant women

    No data are available regarding presence of drug or metabolites in human milk or effects on breastfed child or on milk production

    Adults

    IV: 200 mg/m2 IV every 6 weeks; doses of 300 mg/m2 have been used in combination with other agents for stem-cell transplant preparation. Wafers: 61.6 mg (eight 7.7-mg wafers) implanted intracranially.

    Geriatric

    IV: 200 mg/m2 IV every 6 weeks; doses of 300 mg/m2 have been used in combination with other agents for stem-cell transplant preparation.[44331] [44330]Wafers: 61.6 mg (eight 7.7-mg wafers) implanted intracranially.

    Adolescents

    Safety and efficacy not established.

    Children

    Safety and efficacy not established.

    Carmustine 

    powder for injection

    • 100mg

    wafers

    • 7.7mg