Carmustine parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Parenteral formulations of carmustine.
Drugs List
Therapeutic Indications
Uses
Conditioning prior to haematopoietic progenitor cell transplantation
Hodgkin's disease
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).
Dosage
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.
Adults
Initial dose
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
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.
Administration
For intravenous infusion via a drip, over a 1-2 hour period.
Contraindications
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
Breastfeeding
Erythrocytopenia
Pregnancy
Severe renal impairment
Precautions and Warnings
Elderly
History of thoracic radiotherapy
Tobacco smoking
Alcoholism
Epileptic disorder
Hepatic impairment
Renal impairment
Respiratory disease
Advise patient ability to drive or operate machinery may be impaired
Give pre-treatment counselling and consideration of sperm cryopreservation
Contains alcohol
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
Pregnancy
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.
Lactation
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.
Side Effects
Acute leukaemia
Alopecia
Anaemia
Anorexia
Ataxia
Blurred vision
Bone marrow dysplasias
Chest pain
Conjunctival flushing
Constipation
Dermatitis
Diarrhoea
Disturbances in liver enzymes and bilirubin (transient)
Dizziness
Electrolyte disturbances
Encephalopathy
Extravasation
Flushing
Grand mal seizure
Gynaecomastia
Headache
Hepatotoxicity
Hyperpigmentation
Hypotension
Infections
Infertility
Injection site reactions
Interstitial fibrosis
Localised ocular toxicity
Muscle pain
Myelosuppression
Nausea
Opportunistic infections
Phlebitis
Pneumonitis
Pulmonary toxicity
Renal toxicity
Retinal haemorrhage
Seizures
Status epilepticus
Stomatitis
Tachycardia
Teratogenic effects
Veno-occlusive disease
Vomiting
Overdosage
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 ).
Further Information
Last Full Review Date: October 2022
Reference Sources
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.
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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