- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Parenteral formulations of carmustine.
Conditioning prior to haematopoietic progenitor cell transplantation
Lymphoma - non-Hodgkin's
Myeloma - multiple
Tumour of the brain
Brain tumours, including glioblastoma, brain-stem gliomas, medulloblastoma, astrocytoma, ependymoma and metastatic brain tumours.
Multiple myeloma, in combination with glucocorticoid such as prednisone.
Hodgkin's disease, as secondary therapy in combination with other approved drugs in patients who relapse while being treated with primary therapy, or who fail to respond to primary therapy.
Non-Hodgkin's lymphomas, as secondary therapy in combination with other approved drugs in patients who relapse while being treated with primary therapy, or who fail to respond to primary therapy.
Conditioning treatment prior to autologous haematopoietic progenitor cell transplantation (HPCT) in malignant haematological diseases (Hodgkin's/Non-Hodgkin's lymphoma).
Whilst the doses stated below are those recommended by the manufacturer, local cancer network protocols for the relevant indication should be consulted.
Doses may vary significantly if this agent is used as monotherapy or different combinations.
When using this agent, specialist literature, national guidelines, cancer network protocols and Trust chemotherapy protocols should be consulted.
150mg to 200mg per metre squared every 6 weeks. This may be given as a single dose or as two daily injections on two consecutive days.
Subsequent doses should be adjusted based on the haematological response of the patient in the prior treatment cycle.
Leucocyte count 3000 per mm cubed and above, and platelet count 75,000 and above
100% of prior dose.
Leucocyte count above 2000 and up to 3000 per mm cubed, and platelet count above 25,000 and up to 75,000
70% of prior dose.
Leucocyte count below 2000 per mm cubed, and platelet count below 25,000
50% of prior dose.
Conditioning treatment prior to HPCT
Carmustine (300mg to 600mg per metre squared) is given in combination with other chemotherapeutic agents in patients with malignant haematological diseases before HPCT.
For intravenous infusion via a drip, over a 1-2 hour period.
Children under 18 years
Leucocyte count below 4 x 10 to the power of 9 / L
Platelet count below 100 x 10 to the power of 9/ L
Severe renal impairment
Precautions and Warnings
History of thoracic radiotherapy
Advise patient ability to drive or operate machinery may be impaired
Give pre-treatment counselling and consideration of sperm cryopreservation
Consult local policy on the safe use of anti-cancer drugs
Staff: Not to be handled by pregnant staff
Treatment to be administered by or under supervision of specialist
Perform chest X-ray prior to and periodically during treatment
Monitor full blood count regularly
Monitor hepatic function regularly
Monitor pulmonary function regularly
Monitor renal function regularly
Potentially mutagenic and carcinogenic
Female: Contraception required during and for 6 months after treatment
Male: Contraception required during and for 6 months after treatment
Breastfeeding: Do not breastfeed during & for 1 week after treatment
Pregnancy and Lactation
Carmustine is contraindicated during pregnancy.
The manufacturer recommends that carmustine should not be given to pregnant women. There is limited available data on the use of carmustine in pregnant women. Carmustine has been shown to be carcinogenic, mutagenic and embryotoxic in animal studies.
Carmustine is contraindicated during breastfeeding.
The manufacturer recommends discontinuing breastfeeding during treatment with carmustine and for seven days after treatment. It is not known whether this agent or its metabolites are excreted in human breast milk. The low molecular weight of Carmustine suggests that it may be secreted into breast milk. The effect on the breast-fed infant is unknown.
Bone marrow dysplasias
Disturbances in liver enzymes and bilirubin (transient)
Grand mal seizure
Injection site reactions
Localised ocular toxicity
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Last Full Review Date: October 2022
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.
Summary of Product Characteristics: Carmustine 100mg powder and solvent for solution for infusion. Tillomed Laboratories Ltd. October 2021.
Summary of Product Characteristics: Carmustine 100mg powder and solvent for concentrate for solution for infusion vials. Sovereign Medical Ltd. November 2021.
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Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.