Drug reference

Carmustine

Alkylating Agent · Antineoplastic

Also known as BCNU

Alkylating AgentAntineoplastic

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Avoid (teratogenic in animals for cytotoxic drugs generally). Effective contraception advised during and for 6 months after treatment in men or women (general advice for cytotoxic drugs).

FDA category + note

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Mechanism

Carmustine, as an alkylating drug, acts by damaging DNA, thus interfering with cell replication. This mechanism prevents normal cellular division in rapidly multiplying cancer cells.

Indications

Brain tumoursMultiple myelomaNon-Hodgkin's lymphomasHodgkin's diseaseRecurrent glioblastoma multiforme as an adjunct to surgery (intralesional implant)High-grade malignant glioma as adjunctive treatment to surgery and radiotherapy (intralesional implant)malignant gliomasrecurrent glioblastoma multiforme (as an implantable wafer adjunct to surgery)

Dosing

Adult: By intravenous infusion: consult product literature. By intralesional implantation: consult product literature.

Pharmacokinetics

Onset

not specified

Peak effect

not specified

Protein binding

not specified

Metabolism

not specified

Contraindications

Acute porphyrias
Acute infection (for cytotoxic drugs generally; any infection should be treated before, or when starting, cytotoxic drugs)
Significant bone-marrow suppression (for cytotoxic drugs generally; peripheral blood counts must be checked before each treatment)

Side effects

Common

AlopeciaAnaemiaAtaxiaConstipationDiarrhoeaDizzinessHeadacheNauseaSeizuresVomitingAbdominal pain (implant)Abscess (implant)Anxiety (implant)Asthenia (implant)Chest pain (implant)Confusion (implant)Conjunctival oedema (implant)Depression (implant)Diabetes mellitus (implant)Drowsiness (implant)Dysphagia (implant)Electrolyte imbalance (implant)Eye pain (implant)Faecal incontinence (implant)Fever (implant)Gait abnormal (implant)Healing impaired (implant)Hyperglycaemia (implant)Hypersensitivity (implant)Hypertension (implant)Hypotension (implant)Injury (implant)Insomnia (implant)Leucocytosis (implant)Memory loss (implant)Oedema (implant)Pain (implant)Paranoia (implant)Peripheral neuropathy (implant)Personality disorder (implant)Rash (implant)Sensation abnormal (implant)profound and delayed myelosuppression (recovery 4-6 weeks after single dose)pulmonary fibrosis

Serious

Bone-marrow suppression (delayed onset)
Tumour lysis syndrome (hyperkalaemia, hyperuricaemia, hyperphosphataemia, hypocalcaemia, renal damage, arrhythmias)
Acute renal failure (associated with hyperuricaemia)
Coma (implant)
Embolism and thrombosis (implant)
Haemorrhage (implant)
Hallucination (implant)
Hydrocephalus (implant)
Increased risk of infection (implant)
Intracranial pressure increased (implant)
Meningitis (implant)
Paralysis (implant)
Sepsis (implant)
hepatic VOD (with high doses and bone marrow rescue)
renal failure (with high doses and bone marrow rescue)
secondary leukemia (with high doses and bone marrow rescue)
highly carcinogenic
mutagenic
pigmentary retinopathy

Pregnancy & lactation

Pregnancy

Avoid (teratogenic in animals for cytotoxic drugs generally). Effective contraception advised during and for 6 months after treatment in men or women (general advice for cytotoxic drugs).

Lactation

Discontinue breast-feeding (general advice for cytotoxic drugs).