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Carmustine

(kar-must-een)

Trade/other name(s): BCNU, BiCNU; Gliadel is the brand name of a carmustine-containing wafer that is implanted in the brain.

Why would this drug be used?

Carmustine is used to treat Hodgkin and non-Hodgkin lymphoma, multiple myeloma, and other types of cancer. The implantable wafer that contains carmustine is used to treat gliomas, which are a type of brain tumor.

How does this drug work?

Carmustine acts as an alkylating agent that can damage DNA to keep cancer cells from growing. It.is in a general group of alkylating chemotherapy drugs called nitrosoureas. It helps to stop cancer cells from growing and causes them to die.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.
  • If you have lung disease or reduced lung capacity. This can increase your risk of lung scarring (fibrosis.)
  • If you have ever been treated for cancer with radiation or chemotherapy. Some of these treatments may affect your response to this medicine.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Men and women who are taking this drug need to use some kind of birth control. Check with your doctor about what kinds of birth control can be used with this medicine.
  • If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it could harm the baby.
  • If you think you might want to have children in the future. Some drugs can affect fertility. Talk with your doctor about the possible risk with this drug and options that may preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Worse side effects on the blood cells (see "Precautions") have been noticed when carmustine was given with cimetidine (Tagamet).

Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with carmustine. These include:

  • vitamin E
  • non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others
  • warfarin (Coumadin)
  • ticlopidine (Ticlid)
  • clopidogrel (Plavix)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren't sure what is in the medicines you take.

No other serious interactions are known at this time. But this does not necessarily mean that none exist. Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Carmustine is infused into the vein (IV) over 1 to 2 hours. It can be given based on several different schedules, although it is generally given no more often than every 6 weeks. The dose depends upon your size but may be lowered, delayed, or not given if your blood counts are low. You will get anti-nausea medicine before you get carmustine.

Carmustine can also be given through a wafer that as part of the treatment for certain brain cancers. After the tumor is removed with surgery, the wafer is soaked with carmustine and then is placed in the space where the tumor was. This allows the highest concentration of the drug to go to the area where the tumor was. This way of giving carmustine may have different side effects than when the drug is given IV.

Precautions

This drug is given into the vein (IV). If the drug leaks out of the vein and under the skin, it may damage the tissue, causing pain, ulceration, and scarring. Tell the doctor or nurse right away if you notice redness, pain, swelling or other symptoms at or near the IV.

You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor may give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. Carmustine may affect your immune system. This could make vaccinations ineffective, or could even lead to serious infections if you get a live virus vaccine during or soon after treatment. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

Your doctor will likely test your blood before, during, and after each treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs such as the liver or kidneys. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it completely.

This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Carmustine can cause lung damage, scarring and stiffness of the lungs (fibrosis). This serious problem can happen in the first two weeks to many years after treatment. Your doctor will test your breathing before and during treatment with carmustine. Tell your doctor right away if you notice cough, trouble breathing, shortness of breath, or chest pain. Lung damage happens more often in children who are treated with the drug.

Call your doctor if you notice yellowing of your skin or eyes, or dark colored urine. This may mean the drug is affecting your liver.

A second type of cancer, such as leukemia,can occur after long-term treatment with this drug. This is rare, but if it does happen it would likely be years after the drug is used. If you are getting this drug, your doctor thinks this risk is outweighed by the risk of what might happen if you do not get this drug. You may want to discuss these risks with your doctor.

Most of the above precautions apply when the drug that is injected into the vein. But after surgery to place a carmustine wafer in the brain, there may be other effects such as brain swelling or infection. You may notice trouble walking, seizures, and trouble thinking or talking. Report any symptoms to your doctor right away.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them. Note that side effects for the implanted wafer are often different from these.

Common

  • low white blood cell count with increased risk of infection*
  • low platelet count with increased risk of bleeding*
  • nausea*
  • vomiting*
  • loss of appetite
  • diarrhea
  • headache
  • pain along vein while the drug is being given
  • irritation of vein used for giving the drug
  • fetal abnormalities if pregnancy occurs while taking this drug

Less common

  • scarring of lung tissue, with cough and shortness of breath, which can happen years after treatment*
  • flushing of skin
  • redness of the eyes (just after infusion)
  • tiredness (fatigue)
  • loss or thinning of hair (including hair on the face and body)
  • low red blood cell counts (anemia) causing tiredness and other symptoms

Rare

  • temporary kidney damage
  • hardening of vein used for injection
  • liver abnormalities, which usually get better when the drug is stopped*
  • death due to lung damage or other problems

*See "Precautions" section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved before 1984 (FDA cannot verify dates of drugs approved before 1984.)

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.

Last Medical Review: 01/08/2010
Last Revised: 04/29/2014