- Carmustine side effects
- Carmustine side effects of carmustine
- Carmustine drug
- Carmustine effects of carmustine
- Carmustine used to treat
- Carmustine dosage
- Carmustine uses
- Carmustine usual dose
- Carmustine therapeutic effect
- Carmustine injection
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 Food Interactions
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.
Carmustine and Pregnancy
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.
Interactions for Carmustine
No formal drug interaction studies to date.124 In clinical trials, chemotherapy was withheld for at least 4 weeks (6 weeks for nitrosoureas) prior to and 2 weeks after surgery.124 Implantation in conjunction with radiotherapy does not appear to have any short-term or chronic toxicities;124 in clinical trials, external beam radiation therapy was administered >3 weeks after surgery.124
Potentiation of neutropenic and thrombocytopenic effect of carmustined
Possible changes in tear films, with subsequent damage of corneal and conjunctival epithelium146
Possible decreased serum phenytoin concentrations147
Monitor serum phenytoin concentrations carefully and adjust dosage accordingly147
(kar MUS teen)
Off Label Uses
Mycosis fungoides (topical)
Data from a nonrandomized observational study of patients with mycosis fungoides treated with topical carmustine suggests that topical carmustine is beneficial for the treatment of patients with this condition [Zackheim 2003]. Additional data may be necessary to further define the role of topical carmustine in the treatment of this condition.
Stem cell or bone marrow transplant (autologous) conditioning regimen
Data from a nonrandomized clinical study in patients with poor-risk Hodgkin lymphoma, a randomized active comparator study in patients with poor prognosis histologically aggressive non-Hodgkin lymphoma, and a nonrandomized study in relapsed or refractory non-Hodgkin lymphoma support the use of carmustine (in combination with etoposide, cytarabine, and melphalan [BEAM regimen]) administered prior to stem cell or bone marrow transplantation [Chopra 1993], [Linch 2010], [Mills 1995]. Data from a nonrandomized clinical study in patients with advanced Hodgkin lymphoma also supports the use of carmustine (in combination with cyclophosphamide and etoposide [CBV regimen]) administered prior to stem cell or bone marrow transplantation [Reece 1991]. Data from a study in pediatric patients with either relapsed or refractory Hodgkin or non-Hodgkin lymphomas supports the use of carmustine (in combination with cyclophosphamide and etoposide [CBV regimen]) as a myeloablative conditioning regimen prior to stem cell transplant ([Harris 2011]).
Dosing Renal Impairment
IV: Manufacturer’s labeling: CrCl <10 mL/minute: Discontinue treatment.
The following dosage adjustments have also been reported (Kintzel 1995):
CrCl 46 to 60 mL/minute: Reduce dose to 80% of the usual dose
CrCl 31 to 45 mL/minute: Reduce dose to 75% of the usual dose
CrCl ≤30 mL/minute: Consider use of alternative drug.
Wafer implant: There are no dosage adjustments provided in the manufacturer’s labeling.
BCG (Intravesical): Immunosuppressants may diminish the therapeutic effect of BCG (Intravesical). Avoid combination
BCG (Intravesical): Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical). Avoid combination
Cimetidine: May enhance the myelosuppressive effect of Carmustine. Management: Consider alternatives to cimetidine in patients receiving carmustine. If the combination cannot be avoided, monitor for enhanced carmustine myelotoxicity. Consider therapy modification
CloZAPine: Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased. Monitor therapy
Coccidioides immitis Skin Test: Immunosuppressants may diminish the diagnostic effect of Coccidioides immitis Skin Test. Monitor therapy
Deferiprone: Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone. Avoid combination
Denosumab: May enhance the adverse/toxic effect of Immunosuppressants. Specifically, the risk for serious infections may be increased. Monitor therapy
Dipyrone: May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased Avoid combination
Echinacea: May diminish the therapeutic effect of Immunosuppressants. Consider therapy modification
Fingolimod: Immunosuppressants may enhance the immunosuppressive effect of Fingolimod. Management: Avoid the concomitant use of fingolimod and other immunosuppressants when possible. If combined, monitor patients closely for additive immunosuppressant effects (eg, infections). Consider therapy modification
Leflunomide: Immunosuppressants may enhance the adverse/toxic effect of Leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Management: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Patients receiving both leflunomide and another immunosuppressant should be monitored for bone marrow suppression at least monthly. Consider therapy modification
Lenograstim: Antineoplastic Agents may diminish the therapeutic effect of Lenograstim. Consider therapy modification
Melphalan: May enhance the adverse/toxic effect of Carmustine. Specifically, melphalan may sensitize patients to carmustine lung toxicity. Monitor therapy
Natalizumab: Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased. Avoid combination
Nivolumab: Immunosuppressants may diminish the therapeutic effect of Nivolumab. Consider therapy modification
Ocrelizumab: May enhance the immunosuppressive effect of Immunosuppressants. Monitor therapy
Palifermin: May enhance the adverse/toxic effect of Antineoplastic Agents. Specifically, the duration and severity of oral mucositis may be increased. Management: Do not administer palifermin within 24 hours before, during infusion of, or within 24 hours after administration of myelotoxic chemotherapy. Consider therapy modification
Pimecrolimus: May enhance the adverse/toxic effect of Immunosuppressants. Avoid combination
Promazine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Monitor therapy
Roflumilast: May enhance the immunosuppressive effect of Immunosuppressants. Consider therapy modification
Sipuleucel-T: Immunosuppressants may diminish the therapeutic effect of Sipuleucel-T. Monitor therapy
Tacrolimus (Topical): May enhance the adverse/toxic effect of Immunosuppressants. Avoid combination
Tertomotide: Immunosuppressants may diminish the therapeutic effect of Tertomotide. Monitor therapy
Tofacitinib: Immunosuppressants may enhance the immunosuppressive effect of Tofacitinib. Management: Concurrent use with antirheumatic doses of methotrexate or nonbiologic disease modifying antirheumatic drugs (DMARDs) is permitted, and this warning seems particularly focused on more potent immunosuppressants. Consider therapy modification
Trastuzumab: May enhance the neutropenic effect of Immunosuppressants. Monitor therapy
Vaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting an immunosuppressant. If vaccinated during immunosuppressant therapy, revaccinate at least 3 months after immunosuppressant discontinuation. Consider therapy modification
Vaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of Vaccines (Live). Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live organism vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants. Avoid combination
Central nervous system: Seizure (37%; new or worsening: 20%), cerebral edema (4% to 23%), depression (16%)
Dermatologic: Skin rash (5% to 12%)
Gastrointestinal: Nausea (22%), vomiting (21%), constipation (19%)
Genitourinary: Urinary tract infection (21%)
Neuromuscular & skeletal: Weakness (22%)
Miscellaneous: Wound healing impairment (14% to 16%), fever (12%)
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
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)
Liver Dose Adjustments
Data not available