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Carmustine Brand Names- BiCNU | Gliadel
What is Carmustine
Carmustine is a nitrosourea alkylating agent.
The IV formulation is indicated for the treatment of the treatment of brain tumors (glioblastoma, brain stem glioma, medulloblastoma, astrocytoma, ependymoma, and metastatic brain cancer); multiple myeloma in combination with prednisone; and relapsed or refractory Hodgkin lymphoma or non-Hodgkin’s lymphoma in combination with other approved drugs.
The implantable carmustine wafer is indicated for the treatment of newly diagnosed high-grade glioma as an adjunct to surgery and radiation and recurrent glioblastoma as an adjunct to surgery.
Hematologic toxicity and dose-related pulmonary toxicity have been reported with IV carmustine.
Indications
- astrocytoma
- brain metastases
- cutaneous T-cell lymphoma (CTCL)
- glioblastoma multiforme
- Hodgkin lymphoma
- malignant glioma
- malignant melanoma
- medulloblastoma
- multiple myeloma
- mycosis fungoides
- non-Hodgkin’s lymphoma (NHL)
- stem cell transplant preparation
For the treatment of brain tumors including malignant glioma and glioblastoma multiforme
for the treatment of brain tumors including malignant glioma, glioblastoma, medulloblastoma, astrocytoma, ependymoma, and brain metastases
NOTE: Carmustine injection has been designated an orphan drug by the FDA for the treatment of intracranial malignancies.
Side Effects
- abdominal pain
- alopecia
- amnesia
- anemia
- anorexia
- anovulation
- anxiety
- asthenia
- ataxia
- azotemia
- back pain
- bleeding
- blurred vision
- bone marrow suppression
- cerebral edema
- chest pain (unspecified)
- coma
- confusion
- constipation
- depression
- diabetes mellitus
- diarrhea
- diplopia
- dizziness
- drowsiness
- dysphagia
- elevated hepatic enzymes
- encephalopathy
- erythema
- fecal incontinence
- fever
- flushing
- GI bleeding
- gynecomastia
- hallucinations
- headache
- hydrocephalus
- hyperbilirubinemia
- hyperglycemia
- hyperprolactinemia
- hypoesthesia
- hypokalemia
- hyponatremia
- hypothyroidism
- impaired wound healing
- increased intracranial pressure
- infection
- injection site reaction
- insomnia
- intracranial bleeding
- leukocytosis
- leukopenia
- libido decrease
- meningitis
- menstrual irregularity
- muscle paralysis
- nausea
- new primary malignancy
- ocular hemorrhage
- ocular pain
- paranoia
- peripheral edema
- phlebitis
- pneumonitis
- pulmonary fibrosis
- pulmonary toxicity
- rash
- renal failure (unspecified)
- seizures
- sinus tachycardia
- sinusoidal obstruction syndrome (SOS)
- skin necrosis
- stroke
- thrombocytopenia
- thrombosis
- urinary incontinence
- veno-occlusive disease (VOD)
- vomiting
- wound dehiscence
Monitoring Parameters
- CBC with differential
- LFTs
- pregnancy testing
- pulmonary function tests (PFTs)
- serum creatinine/BUN
Contraindications
- anemia
- aseptic meningitis
- bleeding
- bone marrow suppression
- breast-feeding
- children
- contraception requirements
- extravasation
- hepatic disease
- hepatotoxicity
- increased intracranial pressure
- infection
- infertility
- intraarterial administration
- leukopenia
- male-mediated teratogenicity
- neutropenia
- new primary malignancy
- pregnancy
- pregnancy testing
- pulmonary fibrosis
- pulmonary toxicity
- renal disease
- renal failure
- renal impairment
- reproductive risk
- seizures
- thrombocytopenia
- vaccination
- wound dehiscence
Interactions
- Amlodipine; Celecoxib
- Antithymocyte Globulin
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Azelastine; Fluticasone
- Bacillus Calmette-Guerin Vaccine, BCG
- Beclomethasone
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Betamethasone
- Budesonide
- Budesonide; Formoterol
- Celecoxib
- Ciclesonide
- Cimetidine
- Clozapine
- Corticosteroids
- Cortisone
- Deflazacort
- Dexamethasone
- Diclofenac
- Diclofenac; Misoprostol
- Diflunisal
- Digoxin
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Echinacea
- Esomeprazole; Naproxen
- Etodolac
- Famotidine; Ibuprofen
- Febuxostat
- Fenoprofen
- Fludrocortisone
- Flunisolide
- Flurbiprofen
- Fluticasone
- Fluticasone; Salmeterol
- Fluticasone; Umeclidinium; Vilanterol
- Fluticasone; Vilanterol
- Formoterol; Mometasone
- Fosphenytoin
- Hydrocodone; Ibuprofen
- Hydrocortisone
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Indomethacin
- Influenza Virus Vaccine
- Intranasal Influenza Vaccine
- Ketoprofen
- Ketorolac
- Lansoprazole; Naproxen
- Live Vaccines
- Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live
- Measles/Mumps/Rubella Vaccines, MMR
- Meclofenamate Sodium
- Mefenamic Acid
- Meloxicam
- Methylprednisolone
- Mometasone
- Nabumetone
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Nonsteroidal antiinflammatory drugs
- Oxaprozin
- Palifermin
- Pegfilgrastim
- Penicillamine
- Phenobarbital
- Phenytoin
- Piroxicam
- Prednisolone
- Prednisone
- Procarbazine
- Rofecoxib
- Rotavirus Vaccine
- Rubella Virus Vaccine Live
- Smallpox and Monkeypox Vaccine, Live, Nonreplicating
- Smallpox Vaccine, Vaccinia Vaccine
- Sulindac
- Tolmetin
- Triamcinolone
- Tuberculin Purified Protein Derivative, PPD
- Typhoid Vaccine
- Valdecoxib
- Varicella-Zoster Virus Vaccine, Live
- Yellow Fever Vaccine, Live