Pharm

Carmustine

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Carmustine, BiCNU, Gliadel

  • See Also
  1. Chemotherapy
  2. Alkylating Agent
  • Indications
  1. Astrocytoma
  2. Brain Metastases
  3. Brainstem Glioma
  4. Ependymoma
  5. Glioblastoma
  6. Lymphoma
  7. Medulloblastoma
  8. Multiple Myeloma
  9. Mycosis Fungoides (off-label)
  10. Stem Cell Transplant
  • Mechanism
  1. See Alkylating Agent
  2. Antineoplastic nitrosourea
    1. Alkylating Agent that cross-links DNA during all Cell Cycle phases
    2. Carbamoylates Proteins, including DNA repair Proteins, resulting in further cytotoxic effects
  • Medications
  1. Intravenous (BiCNU): 100 mg vial
  2. Wafer (Gliadel): 7.7 mg
  • Dosing
  1. See other references for disease specific dosing protocols
  • Pharmacokinetics
  1. Highly lipophilic
  2. Easily crosses blood brain barrier
  • Adverse Effects
  • General
  1. Alopecia
  2. Bone Marrow Suppression
  3. Hepatotoxicity
  4. Impaired future fertility
  5. Nephrotoxicity
  6. Ocular
    1. Ocular nerve infarctions
    2. Retinal Hemorrhage
  7. Pulmonary Fibrosis
  8. Secondary Malignancy
  • Adverse Effects
  • Infusion
  1. Soft Tissue Injury if extravasates
    1. Run infusion over 2 hours to prevent extravasation
  • Adverse Effects
  • Wafer
  1. Seizures
  2. Brain edema (including risk of Cerebral Herniation)
  3. CNS Infection
  • 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
    3. Renal Function tests
    4. Pulmonary Function Tests
  • Drug Interactions
  1. Drugs that increase Carmustine effects (esp. myelosuppression)
    1. Cimetidine
  2. Carmustine decreases other drug levels
    1. Digoxin
    2. Phenytoin
  • Resources
  1. Carmustine IV (BiCNU, DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0bdd91e1-fd94-4ce8-9c99-1b0fa6fe8ae4
  2. Carmustine Wafer (Gliadel, DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=38962a55-a514-4c48-bea5-f99a8da4beec