busulfan

Generic Name: busulfan (bue SUL fan)
Brand Name: Busulfex, Myleran

What is busulfan?

Busulfan is a cancer medicine that interferes with the growth and spread of cancer cells in the body.

Busulfan taken by mouth is used to treat the symptoms of chronic myelogenous leukemia (a type of blood cancer). Busulfan injection is used together with a medicine called cyclophosphamide, to prepare your body to receive a stem cell transplant from a donor's bone marrow.

Busulfan is not a cure for leukemia.

Busulfan may also be used for purposes not listed in this medication guide.

What is the most important information I should know about busulfan?

Busulfan can lower blood cells that help your body fight infections and help your blood to clot. You may get an infection or bleed more easily. Call your doctor if you have unusual bruising or bleeding, or signs of infection (fever, chills, body aches).

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Busulfan can have long lasting effects on your body. You may need frequent medical tests for a short time after you stop using this medicine.

What should I discuss with my healthcare provider before using busulfan?

You should not use busulfan if you are allergic to it.

To make sure you can safely take busulfan, tell your doctor if you have any of these other conditions:

  • a weak immune system (bone marrow depression) caused by other cancer medications or radiation treatment;

  • epilepsy or other seizure disorder;

  • history of head injury; or

  • a history of lung or breathing problems.

Some people treated with busulfan have developed new forms of cancer. Talk to your doctor about your specific risks and benefits of using this medicine.

FDA pregnancy category D. Do not use busulfan if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment.

Busulfan may affect fertility (your ability to have children), whether you are a man or a woman.

It is not known whether busulfan passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

How should I use busulfan?

Use exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Take the busulfan tablet with a full glass of water.

Busulfan injection is given through a needle placed into a vein in your upper chest (central IV). You will receive this injection in a clinic or hospital setting. You will also receive other medicines to help prevent certain side effects of busulfan.

Busulfan can lower blood cells that help your body fight infections and help your blood to clot. Your blood will need to be tested often. Your cancer treatments may be delayed based on the results of these tests.

Busulfan can have long lasting effects on your body. You may need frequent medical tests for a short time after you stop using this medicine.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

Since busulfan injection is given by a healthcare professional, you are not likely to miss a dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using busulfan?

Avoid being near people who are sick or have infections. Tell your doctor at once if you develop signs of infection.

This medicine can pass into body fluids (including urine, feces, vomit, semen, vaginal fluid). 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. Patients and caregivers should wear rubber gloves while cleaning up body fluids, handling contaminated trash or laundry or changing diapers. Wash hands before and after removing gloves. Wash soiled clothing and linens separately from other laundry.

Body fluids should not be handled by a woman who is pregnant or who may become pregnant. Use condoms during sexual activity to avoid exposure to body fluids.

Do not receive a "live" vaccine while using busulfan, and avoid coming into contact with anyone who has recently received a live vaccine. There is a chance that the virus could be passed on to you. Live vaccines include measles, mumps, rubella (MMR), rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine.

Busulfan side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • blurred vision, tunnel vision, eye pain, or seeing halos around lights;

  • coughing up blood;

  • hallucinations;

  • persistent cough, congestion, low fever, feeling short of breath (may occur several months or years after using busulfan).

  • seizure (convulsions);

  • adrenal gland problems (after long-term busulfan use)--nausea, vomiting, loss of appetite, weight loss and severe weakness or tired feeling;

  • low magnesium--unusual eye movements, muscle tightness or contraction, muscle weakness or limp feeling, numbness;

  • low platelets--easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;

  • low potassium--confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling;

  • low red blood cells (anemia)--pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating;

  • low white blood cell counts--fever, swollen gums, painful mouth sores, pain when swallowing, skin sores, cold or flu symptoms, cough, trouble breathing;

  • signs of a heart problem--stomach pain, vomiting, sharp chest pain, trouble breathing; or

  • signs of liver problems--weight gain, stomach swelling or tenderness, jaundice (yellowing of the skin or eyes).

Common side effects may include:

  • stomach pain, diarrhea, nausea, vomiting;

  • blisters or ulcers in your mouth, red or swollen gums, trouble swallowing;

  • fever;

  • low red blood cells, low potassium;

  • headache, weakness, anxiety;

  • skin rash;

  • sleep problems (insomnia); or

  • high blood sugar--increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, blurred vision, weight loss.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Busulfan dosing information

Usual Adult Dose for Chronic Myelogenous Leukemia:

Initial dose: 60 mcg/kg or 1.8 mg/m2 orally once a day. The usual dosage range for remission induction is 4 to 8 mg/day.

Usual Adult Dose for Bone Marrow Transplantation:

2 to 4 mg/kg (up to 560 mg) orally every 6 hours for 4 days. High dose cyclophosphamide has been used in combination with busulfan to prepare patients for bone marrow transplantation.

Usual Pediatric Dose for Chronic Myelogenous Leukemia:

Initial Dose:
Less than or equal to 12 kg : 1.1 mg/kg (based on actual body weight.)
Greater than 12 kg: 0.8 mg/kg (based on actual body weight.)

Doses are administered every 6 hours as 2 hour infusions over 4 days for a total of 16 doses.

Therapeutic drug monitoring and dose adjustment following the first dose is recommended.

Adjust subsequent doses to achieve the desired target AUC (1125 uM/min) using the formula below:

Adjusted Dose (mg) = Actual Dose (mg) x Target AUC (uM/min) / Actual AUC (uM/min)

Usual Pediatric Dose for Bone Marrow Transplantation:

Marrow-ablative conditioning regimen:
0.5 mg/kg to 1 mg/kg orally every 6 hours for 4 days.

Hematopoetic stem cell transplant program:
Less than or equal to 6 years:
40 mg/m2/dose every 6 hours for 4 days.

What other drugs will affect busulfan?

Other drugs may interact with busulfan, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about busulfan.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 8.01. Revision Date: 2014-10-15, 10:02:13 AM.

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