Carmustine

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

  1. astrocytoma
  2. brain metastases
  3. cutaneous T-cell lymphoma (CTCL)
  4. glioblastoma multiforme
  5. Hodgkin lymphoma
  6. malignant glioma
  7. malignant melanoma
  8. medulloblastoma
  9. multiple myeloma
  10. mycosis fungoides
  11. non-Hodgkin’s lymphoma (NHL)
  12. 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

  1. abdominal pain
  2. alopecia
  3. amnesia
  4. anemia
  5. anorexia
  6. anovulation
  7. anxiety
  8. asthenia
  9. ataxia
  10. azotemia
  11. back pain
  12. bleeding
  13. blurred vision
  14. bone marrow suppression
  15. cerebral edema
  16. chest pain (unspecified)
  17. coma
  18. confusion
  19. constipation
  20. depression
  21. diabetes mellitus
  22. diarrhea
  23. diplopia
  24. dizziness
  25. drowsiness
  26. dysphagia
  27. elevated hepatic enzymes
  28. encephalopathy
  29. erythema
  30. fecal incontinence
  31. fever
  32. flushing
  33. GI bleeding
  34. gynecomastia
  35. hallucinations
  36. headache
  37. hydrocephalus
  38. hyperbilirubinemia
  39. hyperglycemia
  40. hyperprolactinemia
  41. hypoesthesia
  42. hypokalemia
  43. hyponatremia
  44. hypothyroidism
  45. impaired wound healing
  46. increased intracranial pressure
  47. infection
  48. injection site reaction
  49. insomnia
  50. intracranial bleeding
  51. leukocytosis
  52. leukopenia
  53. libido decrease
  54. meningitis
  55. menstrual irregularity
  56. muscle paralysis
  57. nausea
  58. new primary malignancy
  59. ocular hemorrhage
  60. ocular pain
  61. paranoia
  62. peripheral edema
  63. phlebitis
  64. pneumonitis
  65. pulmonary fibrosis
  66. pulmonary toxicity
  67. rash
  68. renal failure (unspecified)
  69. seizures
  70. sinus tachycardia
  71. sinusoidal obstruction syndrome (SOS)
  72. skin necrosis
  73. stroke
  74. thrombocytopenia
  75. thrombosis
  76. urinary incontinence
  77. veno-occlusive disease (VOD)
  78. vomiting
  79. 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
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