Pharm

Busulfan

search

Busulfan, Myleran, Busulfex

  • See Also
  1. Chemotherapy
  2. Alkylating Agent
  • Indications
  1. FDA approved
    1. Chronic Myelogenous Leukemia (CML)
  2. Off-Label
    1. Stem Cell Transplant (Leukemia, Lymphoma)
    2. Essential Thrombocythemia
    3. Polycythemia Vera
  • Mechanism
  1. See Alkylating Agent
  2. Synthetic derivative of dimethane-sulfonate with antineoplastic properties
  3. In vivo, generates carbonium ions which alkylate DNA, inhibiting DNA Replication and transcription
  • Medications
  1. Busulfan Tablets (Myleran): 2 mg
  2. Busulfan Injection (Busulfex)
  • Dosing
  1. See other references for disease specific dosing protocols
  • Adverse Effects
  1. Adrenal Insufficiency
  2. Alopecia
  3. Bone Marrow Suppression (severe)
  4. Hepatic Sinusoidal Obstruction Syndrome (Veno-occlusive Disease)
  5. Hyperuricemia
    1. Consider startic Allopurinol for prophylaxis prior to starting Busulfan
    2. Maintain adequate hydration
  6. Impaired future fertility
  7. Pulmonary Fibrosis
  8. Secondary Malignancy (and cellular dysplasia)
  9. Seizures
    1. Seizure Prophylaxis initiated prior to starting Busulfan
  10. Tooth Hypoplasia
  • Safety
  1. Avoid in Lactation
  2. Avoid in pregnancy (contraindicated in all trimesters)
    1. Teratogenic and adverse outcomes
    2. Use reliable Contraception
  3. Monitoring
    1. Complete Blood Count
    2. Liver Function Tests
  • Drug Interactions
  1. Drugs that increase Busulfan levels (decreased clearance)
    1. Acetaminophen
    2. Itraconazole
  2. Drugs that decrease Busulfan levels (increased clearance)
    1. Phenytoin
  • Resources
  1. Busulfan Injection (Busulfex, DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d0fe44f9-7747-4909-b927-3b24aa6e7e09
  2. Busulfan Tablet (Myleran, DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=00ca5f69-8944-47f8-8ebf-98b0b8062c20