Carmustine


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV Brain tumours; Multiple myeloma; Hodgkin's disease; Non-Hodgkin's lymphoma As a single dose of 150-200 mg/m2 or divided into doses of 75-100 mg/m2 given on 2 successive days. Doses are given via IV infusion over 1-2 hours. May repeat dose every 6 weeks provided that blood counts have returned to acceptable levels. Intracavitary Malignant glioma; Recurrent glioblastoma multiforme Implantation of wafers containing 7.7 mg/wafer into the cavity left by removal of the tumour. Max: 8 wafers.
Dosage Details
Intracavitary
Malignant glioma, Recurrent glioblastoma multiforme
Adult: Implantation of wafers containing 7.7 mg/wafer into the cavity left by removal of the tumour. Max: 8 wafers.

Intravenous
Brain tumour, Hodgkin's disease, Multiple myeloma, Non-Hodgkin's lymphoma
Adult: As a single dose of 150-200 mg/m2 or divided into doses of 75-100 mg/m2 given on 2 successive days. Doses are given via IV infusion over 1-2 hours. Doses may be repeated every 6 weeks provided that blood counts have returned to acceptable levels. Adjust subsequent doses based on haematological toxicity. Used in combination with prednisolone for the treatment of multiple myeloma. Used as secondary therapy (with other approved drugs) in the treatment of Hodgkin's disease and non-Hodgkin's lymphomas.
Reconstitution
Initially, reconstitute 100 mg of carmustine with 3 mL of supplied diluent, then further dilute with 27 mL of sterile water for injection, resulting to a 3.3 mg of carmustine in 10% alcohol. Further dilute for infusion with 500 mL 0.9% Na chloride for injection or 5% glucose for injection.
Contraindications
Hypersensitivity. Pregnancy and Lactation.
Special Precautions
Patient with bone marrow suppression (e.g. thrombocytopenia, leucopenia), reduced lung function or pre-existing lung disease. Children.
Adverse Reactions
Significant: Bone marrow suppression (e.g. thrombocytopenia, leucopenia), hepatotoxicity (reversible increased serum transaminase, alkaline phosphatase and bilirubin), renal failure, progressive azotemia; intracranial hypertension, wound healing impairment (implant); secondary malignancies (long-term IV use).
Cardiac disorders: Hypotension, tachycardia, chest pain.
Eye disorders: Conjunctival flushing, blurred vision, retinal haemorrhage.
Gastrointestinal disorders: Nausea, vomiting, anorexia, constipation, diarrhea, stomatitis.
Nervous system disorders: Dizziness, somnolence, hemiplegia, convulsion, brain oedema.
Psychiatric disorders: Depression, anxiety, abnormal thinking, hallucinations.
Reproductive system and breast disorders: Gynecomastia.
Respiratory, thoracic and mediastinal disorders: Pulmonary embolism.
Skin and subcutaneous tissue disorders: Hyperpigmentation (in skin exposure), rash, alopecia.
Vascular disorders: Phlebitis.
Potentially Fatal: Pulmonary fibrosis, opportunistic infections.
IV/Parenteral/Topical: D
MonitoringParameters
Monitor CBC with differential and platelet count weekly for at least 6 weeks after a dose; pulmonary, renal, and hepatic function periodically. Implant: Monitor for seizures, impaired neurosurgical wound healing; signs and symptoms of meningitis, CNS infection, and obstruction hydrocephalus.
Drug Interactions
May enhance myelosuppressive effects with cimetidine. Increased risk of pulmonary toxicity with melphalan. Decreased antiepileptic activity of phenytoin. Decreased absorption of digoxin.
Action
Description: Carmustine, a cell cycle non-specific antineoplastic agent belonging to nitrosourea group, interferes with the normal function of DNA and RNA by alkylation and cross-linking the strands of DNA and RNA, and by possible protein modification. It inhibits enzymatic processes by carbamoylation of amino acids in proteins.
Pharmacokinetics:
Distribution: Readily crosses the blood-brain barrier.
Metabolism: Rapidly metabolised after IV administration.
Excretion: Mainly via urine (approx 60-70%); lungs (approx 10%, as carbon dioxide). Elimination half-life: 15-75 minutes (IV).
Chemical Structure

Chemical Structure Image
Carmustine

Source: National Center for Biotechnology Information. PubChem Database. Carmustine, CID=2578, https://pubchem.ncbi.nlm.nih.gov/compound/2578 (accessed on June 25, 2020)

Storage
Reconstituted solution for inj: Store intact vials between 2-8°C. Protect from light. Reconstituted solutions may be stored either between 2-8°C for 24 hours or at 25°C for 8 hours. Protect from light. Implant: Store at -20°C. Unopened foil pouches may be kept at 25°C for not more than 6 hours and may only be refrozen once. Refrozen foil pouches must be used within 30 days.
ATC Classification
L01AD01 - carmustine ; Belongs to the class of alkylating agents, nitrosoureas. Used in the treatment of cancer.
References
Anon. Carmustine. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 01/06/2020.

Anon. Carmustine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 01/06/2020.

Bicnu (Heritage Pharmaceuticals Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 05/06/2020.

Buckingham R (ed). Carmustine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 01/06/2020.

Carmustine 100 mg Powder and Solvent for Solution for Infusion (Tillomed Laboratories Ltd). MHRA. https://products.mhra.gov.uk/. Accessed 05/06/2020.

Gliadel 7.7 mg Implant (MGI Pharma Limited). MHRA. https://products.mhra.gov.uk/. Accessed 05/06/2020.

Gliadel Wafer (Arbor Pharmaceuticals). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 05/06/2020.

Joint Formulary Committee. Carmustine. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 01/06/2020.

Disclaimer: This information is independently developed by MIMS based on Carmustine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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