Generic Name: carmustine (Intravenous route)
Carmustine for injection should be administered under the supervision of a qualified physician experienced in the use of cancer chemotherapeutic agents. Bone marrow suppression, notably thrombocytopenia and leukopenia, which may contribute to bleeding and overwhelming infections in an already compromised patient, is the most common and severe of the toxic effects of carmustine. Blood counts should be monitored weekly for at least 6 weeks after a dose. At the recommended dosage, courses of carmustine should not be given more frequently than every 6 weeks. Pulmonary toxicity from carmustine appears to be dose related, as patients receiving greater than 1400 mg/m(2) cumulative dose are at significantly higher risk than those receiving less. Delayed pulmonary toxicity can occur years after treatment, and can result in death, particularly in patients treated in childhood .
Commonly used brand name(s)
In the U.S.
Available Dosage Forms:
- Powder for Solution
Therapeutic Class: Antineoplastic Agent
Pharmacologic Class: Alkylating Agent
Chemical Class: Nitrosourea
Uses For Bicnu
Carmustine injection is used alone or together with other medicines to treat certain type of brain tumors (e.g., glioblastoma, brainstem glioma, medulloblastoma, astrocytoma, ependymoma, and metastatic brain tumors), cancer of the lymph system (e.g., Hodgkin's disease, non-Hodgkin's lymphoma), and a certain type of cancer in the bone marrow (e.g., multiple myeloma). It may also be used to treat other kinds of cancer, as determined by your doctor.
Carmustine belongs to the group of alkylating agents. It interferes with the growth of cancer cells, which are eventually destroyed. Since the growth of normal body cells may also be affected by carmustine, other effects may occur. Some of these may be serious and must be reported to your doctor. Other effects (e.g., hair loss), may not be serious but may cause concern. Some effects may not occur for months or years after the medicine is used.
Before you begin treatment with carmustine, you and your doctor should talk about the benefits this medicine will do as well as the risks.
This medicine is to be administered only by or under the immediate supervision of your doctor.
Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, carmustine injection is used in certain patients with the following conditions:
- Cancer of the colon and rectum.
- Cancer of the stomach.
- Malignant melanoma (a type of skin cancer).
- Mycosis fungoides (tumors on the skin).
- Waldenström's macroglobulinemia (a certain type of cancer of the blood).
Before Using Bicnu
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies on the relationship of age to the effects of carmustine injection have not been performed in the pediatric population. Safety and efficacy have not been established.
No information is available on the relationship of age to the effects of carmustine injection in geriatric patients. However, elderly patients are more likely to have age-related kidney, liver, or heart problems, which may require caution and an adjustment in the dose for patients receiving carmustine injection.
|All Trimesters||D||Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.|
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with Medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Rotavirus Vaccine, Live
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Adenovirus Vaccine Type 4, Live
- Adenovirus Vaccine Type 7, Live
- Bacillus of Calmette and Guerin Vaccine, Live
- Influenza Virus Vaccine, Live
- Measles Virus Vaccine, Live
- Mumps Virus Vaccine, Live
- Rubella Virus Vaccine, Live
- Smallpox Vaccine
- Typhoid Vaccine
- Varicella Virus Vaccine
- Yellow Fever Vaccine
Interactions with Food/Tobacco/Alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other Medical Problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Anemia (low red cells in the blood) or
- Bone marrow problems (e.g., leukemia) or
- Leukopenia or neutropenia (low white cells in the blood) or
- Liver disease or
- Thrombocytopenia (low platelets in the blood)—Use with caution. May make these conditions worse.
- Chickenpox (including recent exposure) or
- Herpes zoster (shingles) or
- Infection—May decrease the body's ability to fight an infection.
- Kidney disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
- Lung disease (e.g., pulmonary fibrosis, pulmonary toxicity)—Use with caution. May increase risk of lung problems.
Proper Use of Bicnu
Medicines used to treat cancer are very strong and can have many side effects. Before receiving this medicine, make sure you understand all the risks and benefits. It is important for you to work closely with your doctor during your treatment.
A nurse or other trained health professional will give you this medicine in a hospital. This medicine is given through a needle placed in one of your veins.
This medicine is usually given every 6 weeks. This maybe given as a single dose or divided into daily injections on two consecutive days.
Carmustine is sometimes given together with certain other medicines. If you are using a combination of medicines, it is important that you receive each one at the proper time. If you are taking some of these medicines by mouth, ask your doctor to help you plan a way to take them at the right times.
This medicine often causes nausea and vomiting, which usually last no longer than 4 to 6 hours. It is very important that you continue to receive the medicine, even if you begin to feel ill. Ask your doctor for ways to lessen these effects.
Precautions While Using Bicnu
It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.
Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.
This medicine may increase your risk of developing cancer and lung problems (such as pulmonary fibrosis or toxicity). This is more likely if you receive high doses of this medicine or use it for a long time.
While you are being treated with carmustine injection, and after you stop treatment with it, do not have any immunizations (vaccines) without your doctor's approval. Carmustine may lower your body's resistance and the vaccine may not work as well for you or you might get the infection the vaccine is meant to prevent. In addition, you should not be around other persons living in your household who receive live vaccines because there is a chance they could pass the virus on to you. Some examples of live vaccines include measles, mumps, influenza (nasal flu vaccine), poliovirus (oral form), rotavirus, and rubella. Do not get close to them and do not stay in the same room with them for very long. If you have questions about this, talk to your doctor.
Carmustine can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:
- If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
- Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in the urine or stools; or pinpoint red spots on your skin.
- Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
- Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
- Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
- Avoid contact sports or other situations where bruising or injury could occur.
If carmustine accidentally seeps out of the vein into which it is injected, it may damage some tissues and cause scarring. Tell the doctor or nurse right away if you notice redness, pain, or swelling at the injection site.
This medicine may increase risk of lung problems while smoking.
Bicnu Side Effects
Along with its needed effects, medicines like carmustine can sometimes cause some unwanted effects such as blood problems, loss of hair, and other side effects ; these are described below. Also, because of the way these medicines act on the body, there is a chance that they might cause other unwanted effects that may not occur until months or years after the medicine is used. These delayed effects may include certain types of cancer, such as leukemia. Discuss these possible effects with your doctor.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:More common
- pain or redness at the injection site
- shortness of breath
- Black, tarry stools
- blood in the urine or stools
- cough or hoarseness, accompanied by fever or chills
- fever or chills
- flushing of the face
- lower back or side pain, accompanied by fever or chills
- painful or difficult urination, accompanied by fever or chills
- pinpoint red spots on the skin
- sores in the mouth or on the lips
- unusual bleeding or bruising
- unusual tiredness or weakness
- Decrease in urination
- swelling of the feet or lower legs
- Abdominal or stomach pain, severe
- bleeding gums
- bone pain
- chest pain
- cloudy urine
- dark urine
- decreased frequency or amount of urine
- difficulty with swallowing
- dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- dry mouth
- fast, pounding, or irregular heartbeat or pulse
- feeling of warmth
- increased blood pressure
- increased thirst
- loss of appetite
- nausea or vomiting
- pain in the lower back or side
- pale skin
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- redness of the face, neck, arms, and occasionally, upper chest
- skin rash
- sore throat
- swelling of the face, fingers, or lower legs
- swollen glands
- tightness in the chest
- troubled breathing
- troubled breathing with exertion
- weight gain
- yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:Less common
- discoloration of the skin along the injection site
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
See also: Bicnu side effects (in more detail)
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More Bicnu resources
- Carmustine Professional Patient Advice (Wolters Kluwer)
- Carmustine Monograph (AHFS DI)
- BiCNU Prescribing Information (FDA)
- BiCNU Concise Consumer Information (Cerner Multum)
- BiCNU MedFacts Consumer Leaflet (Wolters Kluwer)
- Gliadel Prescribing Information (FDA)
- Gliadel implant wafer MedFacts Consumer Leaflet (Wolters Kluwer)