Carmustine

Carmustine is a prescription medication used to treat certain types of brain tumors, multiple myeloma (cancer of the bone marrow), and Hodgkin's and non-Hodgkin's lymphoma (cancers of the immune system). Carmustine belongs to a group of drugs called alkylating agents, which prevent cancer cells from growing and multiplying.

This medication comes in injectable form that is slowly injected into a vein (IV) by a healthcare provider once every 6 weeks.

This medication also comes in a wafer form that is implanted within the cranium (skull) via surgical procedure.

Common side effects of carmustine include nausea, vomiting, and headache.

Carmustine is a prescription medicine used to treat certain types of brain tumors, multiple myeloma (cancer of the bone marrow), and Hodgkin's and non-Hodgkin's lymphoma (cancers of the immune system).

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Carmustine may be found in some form under the following brand names:

• BiCNU

• Gliadel

Less serious, more common side effects include:

• nausea
• vomiting
• headache
• loss of balance or coordination
• pale skin
• flushing
• fainting
• dizziness
• fast or irregular heartbeat
• chest pain
• darkened skin

Tell your doctor right away if you experience any of these symptoms:

• swelling, pain, redness, burning, or leakage of fluid at the injection site
• rash
• itching
• swelling of the face, lips, or throat
• difficulty breathing
• fever
• sore throat
• chills
• aches and pains
• unusual bleeding or bruising
• black and tarry stools
• red blood in stools
• bloody vomit
• vomited material that looks like coffee grounds
• extreme tiredness
• paleness
• lack of energy
• loss of appetite
• pain in the upper right part of the stomach
• yellowing of the skin or eyes
• decreased urination
• swelling of the hands, feet, ankles, or lower legs
• changes in vision

Tell your doctor about any side effect that is bothersome or doesn't go away.

See "Drug Precautions" for serious side effects.

This is not a complete list of carmustine drug interactions. Ask your doctor or pharmacist for more information.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• cimetidine (Tagamet)
• phenytoin (Dilantin)
• digoxin (Lanoxin)

Other medications may interact with carmustine. It is possible that medications that suppress the immune system could increase the risk of low blood cell counts and infections associated with carmustine. Be sure to discuss all of your medications with your doctor and pharmacist.

Injectable/Topical:

• Before receiving carmustine, tell your doctor if you are allergic to it.
• Carmustine can cause a severe decrease in the number of blood cells in your body, increasing your risk for anemia, infections, and bleeding. Your doctor will monitor your blood counts with weekly blood tests. Tell your doctor right away if you experience unusual bleeding, bruising, fever, chills, and shortness of breath. Wash your hands frequently and avoid people who have recently received live vaccines.
• Carmustine can cause lung damage that may be revealed years after treatment. The risk of lung damage, which has caused death in people who received this medication as children, is increased in people who receive carmustine treatments lasting for a long duration. Before receiving carmustine, tell your doctor if you have lung disease, or if you have ever had lung disease.
• Carmustine may increase the risk of developing other cancers.
• If this medication comes in contact with skin it can cause burning and darkening of the skin.
• This medication should not be used during pregnancy or while breastfeeding. See "Pregnancy" and "Lactation" sections for more information.

Topical:

• Carmustine wafers may increase your chance of brain infection, swelling or increased pressure in the brain, and seizures.

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of carmustine there are no specific foods that you must exclude from your diet when receiving carmustine.

Before receiving carmustine, tell your doctor about all of your medical conditions including if you:

• are allergic to carmustine or any other medicine
• have lung, kidney or liver disease
• are pregnant or breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

This medication falls into category D. It is not known if carmustine will harm your unborn baby. Talk to your doctor about birth control methods, as it is important to prevent pregnancy while on this medication. If you become pregnant, tell your doctor right away.

Tell your doctor if you are breastfeeding or plan to breastfeed. It is not known if carmustine is excreted in human breast milk or if it will harm your nursing baby. It is generally recommended that women receiving carmustine treatments should not breastfeed.

Injectable:

• Carmustine comes in powder form. Liquid is added to carmustine and then it is injected slowly, over at least 2 hours, intravenously (into a vein) by a healthcare professional in a medical facility (hospital or clinic). It is usually given once every 6 weeks. The dose is sometimes divided into two doses and is given 2 days in a row, every 6 weeks.
• Your doctor will order weekly blood tests to measure certain cells in your blood. If your blood cell counts are too low, your doctor may order a delay in treatment.

Topical:

• This medication also comes in a wafer form that is implanted within the cranium (skull) via surgical procedure.

Since carmustine is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

WARNINGS

Carmustine for injection should be administered under the supervision of a qualified physician experienced in the use of cancer chemotherapeutic agents.

Bone marrow suppression, notably thrombocytopenia and leukopenia, which may contribute to bleeding and overwhelming infections in an already compromised patient, is the most common and severe of the toxic effects of this medication.

Since the major toxicity is delayed bone marrow suppression, blood counts should be monitored weekly for at least 6 weeks after a dose. At the recommended dosage, courses of carmustine should not be given more frequently than every 6 weeks.

The bone marrow toxicity is cumulative and therefore dosage adjustment must be considered on the basis of nadir blood counts from prior dose.

Pulmonary toxicity appears to be dose related. Patients receiving greater than 1400 mg/m2 cumulative dose are at significantly higher risk than those receiving less.

Delayed pulmonary toxicity can occur years after treatment, and can result in death, particularly in patients treated in childhood.