Drug information of Carmustine

Carmustine 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; may also inhibit enzyme processes by carbamylation of amino acids in protein

Absorption
Wafer: Systemic absorption measurable for ~24 hours after insertion
Metabolism
Rapidly hepatic; forms active metabolites
Excretion
IV: Urine (~60% to 70%) within 96 hours; lungs (~10% as CO2)
Time to Peak
Wafer: Systemic: ~3 hours after insertion
Half life
IV: 15 to 75 minutes

Brain tumors:
Injection: Palliative treatment of brain tumors including glioblastoma, brainstem glioma, medulloblastoma, astrocytoma, ependymoma, and metastatic brain tumors
Wafer (implant): Treatment of newly-diagnosed high-grade glioma (as an adjunct to surgery and radiation); treatment of recurrent glioblastoma (as adjunct to surgery)
Hodgkin lymphoma, relapsed/refractory:
Injection: Palliative treatment (secondary) of Hodgkin lymphoma (in combination with other antineoplastics) that has relapsed with or was refractory to primary therapy
Multiple myeloma:
Injection: Palliative treatment of multiple myeloma (in combination with prednisone)
Non-Hodgkin lymphomas, relapsed/refractory:
Injection: Palliative treatment (secondary) of non-Hodgkin lymphoma (in combination with other antineoplastics) that has relapsed with or was refractory to primary therapy

Usual Adult Dose for Brain/Intracranial Tumor
IV
-As a single agent in previously untreated patients: 150 to 200 mg/m2 IV every 6 weeks administered as a single dose or divided into daily injections (75 to 100 mg/m2 IV on two successive days)
-In combination with other myelosuppressive drugs or in patients in whom bone marrow reserve is depleted, doses should be adjusted accordingly.

Adjust doses after the initial dose according to the hematologic response of the patient to the preceding dose. The following schedule is suggested by the manufacturer as a guide:
-Nadir after prior dose: Leukocytes greater than 4000/mm3 and platelets greater than 100,000/m3: Give 100% of the prior dose.
-Nadir after prior dose: Leukocytes 3000 to 3999/mm3 and platelets 75,000 to 99,999/m3: Give 100% of the prior dose.
-Nadir after prior dose: Leukocytes 2000 to 2999/mm3 and platelets 25,000 to 74,999/m3: Give 70% of the prior dose.
-Nadir after prior dose: Leukocytes less than 2000/mm3 and platelets less than 25,000/m3: Give 50% of the prior dose.
Usual Adult Dose for non-Hodgkin's Lymphoma
IV:
-As a single agent in previously untreated patients: 150 to 200 mg/m2 IV every 6 weeks administered as a single dose or divided into daily injections (75 to 100 mg/m2 IV on two successive days)
-In combination with other myelosuppressive drugs or in patients in whom bone marrow reserve is depleted, doses should be adjusted accordingly.

Adjust doses after the initial dose according to the hematologic response of the patient to the preceding dose. The following schedule is suggested by the manufacturer as a guide:
-Nadir after prior dose: Leukocytes greater than 4000/mm3 and platelets greater than 100,000/m3: Give 100% of the prior dose.
-Nadir after prior dose: Leukocytes 3000 to 3999/mm3 and platelets 75,000 to 99,999/m3: Give 100% of the prior dose.
-Nadir after prior dose: Leukocytes 2000 to 2999/mm3 and platelets 25,000 to 74,999/m3: Give 70% of the prior dose.
-Nadir after prior dose: Leukocytes less than 2000/mm3 and platelets less than 25,000/m3: Give 50% of the prior dose.
Usual Adult Dose for Hodgkin's Disease
IV:
-As a single agent in previously untreated patients: 150 to 200 mg/m2 IV every 6 weeks administered as a single dose or divided into daily injections (75 to 100 mg/m2 IV on two successive days)
-In combination with other myelosuppressive drugs or in patients in whom bone marrow reserve is depleted, doses should be adjusted accordingly.

Adjust doses after the initial dose according to the hematologic response of the patient to the preceding dose. The following schedule is suggested by the manufacturer as a guide:
-Nadir after prior dose: Leukocytes greater than 4000/mm3 and platelets greater than 100,000/m3: Give 100% of the prior dose.
-Nadir after prior dose: Leukocytes 3000 to 3999/mm3 and platelets 75,000 to 99,999/m3: Give 100% of the prior dose.
-Nadir after prior dose: Leukocytes 2000 to 2999/mm3 and platelets 25,000 to 74,999/m3: Give 70% of the prior dose.
-Nadir after prior dose: Leukocytes less than 2000/mm3 and platelets less than 25,000/m3: Give 50% of the prior dose.
Usual Adult Dose for Multiple Myeloma
IV:
-As a single agent in previously untreated patients: 150 to 200 mg/m2 IV every 6 weeks administered as a single dose or divided into daily injections (75 to 100 mg/m2 IV on two successive days)
-In combination with other myelosuppressive drugs or in patients in whom bone marrow reserve is depleted, doses should be adjusted accordingly.

Adjust doses after the initial dose according to the hematologic response of the patient to the preceding dose. The following schedule is suggested by the manufacturer as a guide:
-Nadir after prior dose: Leukocytes greater than 4000/mm3 and platelets greater than 100,000/m3: Give 100% of the prior dose.
-Nadir after prior dose: Leukocytes 3000 to 3999/mm3 and platelets 75,000 to 99,999/m3: Give 100% of the prior dose.
-Nadir after prior dose: Leukocytes 2000 to 2999/mm3 and platelets 25,000 to 74,999/m3: Give 70% of the prior dose.
-Nadir after prior dose: Leukocytes less than 2000/mm3 and platelets less than 25,000/m3: Give 50% of the prior dose.
Usual Adult Dose for Glioblastoma Multiforme
WAFER:
-Eight 7.7 mg wafers (61.6 mg total dose) implanted intracranially
Usual Adult Dose for Malignant Glioma
WAFER:
-Eight 7.7 mg wafers (61.6 mg total dose) implanted intracranially

IV formulation: Hypersensitivity to the active component or any of the ingredients

Wafer formulation: None

Safety and efficacy have not been established in patients younger than 18 years.

Implant
>10%
Central nervous system: Seizure, cerebral edema, depression
Dermatologic: Skin rash
Gastrointestinal: Nausea, vomiting, constipation
Genitourinary: Urinary tract infection
Neuromuscular & skeletal: Weakness
Miscellaneous: Wound healing impairment, fever
1%
to 10%
Cardiovascular: Chest pain (5%)
Central nervous system: Intracranial hypertension (9%), cerebral hemorrhage (6%), meningitis (4%)
Gastrointestinal: Abdominal pain (8%)
Infection: Abscess (local 6%)
Neuromuscular & skeletal: Back pain (7%)
IV: Frequency not defined:
Cardiovascular: Chest pain, flushing (with rapid infusion), occlusive arterial disease, tachycardia
Central nervous system: Brain disease, headache, seizure
Dermatologic: Alopecia, burning sensation of skin, hyperpigmentation
Gastrointestinal: Anorexia, diarrhea, nausea, vomiting
Genitourinary: Gynecomastia
Hematologic & oncologic: Acute leukemia, anemia, bone marrow dysplasia, leukemia, leukopenia (common; onset: 5 to 6 weeks; recovery: after 1 to 2 weeks), thrombocytopenia (common: onset: ~4 weeks; recovery: after 1 to 2 weeks)
Hepatic: Increased serum alkaline phosphatase, increased serum bilirubin, increased serum transaminases
Hypersensitivity: Hypersensitivity reaction
Infection: Opportunistic infection
Local: Burning sensation at injection site, erythema at injection site, pain at injection site, swelling at injection site, tissue necrosis at injection site
Ophthalmic: Blurred vision, conjunctival edema, conjunctival hemorrhage, ophthalmic signs and symptoms (loss of depth perception), suffusion of the conjunctiva (with rapid infusion)
Renal: Azotemia (progressive), nephron atrophy, renal failure
Respiratory: Interstitial pulmonary disease, pneumonitis, pulmonary fibrosis (occurring up to 17 years after treatment), pulmonary infiltrates
<1%, postmarketing, and/or case reports: Febrile neutropenia (Chopra 1993), sepsis (implant), venous thrombosis at injection site (IV)

Baricitinib, BCG (Intravesical), BCG (Intravesical), Chloramphenicol (Ophthalmic), Cimetidine,
Cladribine, CloZAPine, Coccidioides immitis Skin Test, Deferiprone, Denosumab, Dipyrone,
Echinacea, Fingolimod, Leflunomide, Lenograstim, Lipegfilgrastim, Melphalan, Mesalamine,
Natalizumab, Nivolumab, Ocrelizumab, Ozanimod, Palifermin, Pidotimod, Pimecrolimus,
Promazine, Roflumilast, Siponimod, Sipuleucel-T, Smallpox and Monkeypox Vaccine (Live),
Tacrolimus (Topical), Tertomotide, Tofacitinib, Trastuzumab, Upadacitinib, Vaccines (Inactivated), Vaccines (Live)

carmustine can pass into body fluids (urine, feces, vomit). For at least 48 hours after you receive a dose, avoid allowing your body fluids to come into contact with your hands or other surfaces. Caregivers should wear rubber gloves while cleaning up a patient's body fluids, handling contaminated trash or laundry or changing diapers. Wash hands before and after removing gloves.

MYELOSUPPRESSION: This drug, when given IV, causes suppression of marrow function (including thrombocytopenia and leukopenia), which may result in bleeding and infections.
3- This drug, when given IV, causes dose-related pulmonary toxicity. 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 discontinuing therapy and can result in death, particularly in patients treated in childhood

To make sure carmustine is safe for you, tell your doctor if you have ever had-lung disease or breathing problems
bone marrow suppression
kidney disease

Carmustine may harm an unborn baby. Use effective birth control to prevent pregnancy while you are receiving this medicine

Carmustine is usually given once every 6 weeks. You may be given either a single injection, or multiple injections over a 2-day period. You may also be given medication to prevent nausea or vomiting

Tell your caregivers if you feel any burning or pain around the IV needle when carmustine is injected

Carmustine can lower blood cells that help your body fight infections and help your blood to clot. Carmustine can also cause serious lung problems, especially if you receive high doses. You will need frequent medical tests to check your blood cells and lung function. Your cancer treatments may be delayed based on the results of these tests

Carmustine can have long-lasting effects on your body. Your blood will need to be tested weekly for at least 6 weeks after each dose

Therapy can cause fetal harm when administered to a pregnant woman; there are no available data on use in pregnant women