BiCNU Side Effects

Generic Name: carmustine

Please note - some side effects for BiCNU may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).

Side Effects of BiCNU - for the Consumer

BiCNU

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using BiCNU:

Flushing; headache; nausea; vomiting.

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bleeding problems; chest pain; chills; dark urine; decreased amount of urine produced; difficulty breathing; fast heartbeat; fever; pain, redness, swelling, or burning at the injection site; persistent cough; shortness of breath; sore throat; unusual bruising or bleeding; unusual tiredness or weakness; vision changes; yellowing of the skin or eyes.

BiCNU Side Effects - for the Professional

BiCNU

Pulmonary Toxicity

Pulmonary toxicity characterized by pulmonary infiltrates and/or fibrosis has been reported to occur from 9 days to 43 months after treatment with BiCNU and related nitrosoureas. Most of these patients were receiving prolonged therapy with total doses of BiCNU greater than 1400 mg/m2. However, there have been reports of pulmonary fibrosis in patients receiving lower total doses. Other risk factors include past history of lung disease and duration of treatment. Cases of fatal pulmonary toxicity with BiCNU have been reported.

Additionally, delayed onset pulmonary fibrosis occurring up to 17 years after treatment has been reported in a long-term study with 17 patients who received BiCNU in childhood and early adolescence (1–16 years) in cumulative doses ranging from 770 to 1800 mg/m2 combined with cranial radiotherapy for intracranial tumors. Chest x-rays demonstrated pulmonary hypoplasia with upper zone contraction. Gallium scans were normal in all cases. Thoracic CT scans have demonstrated an unusual pattern of upper zone fibrosis. There was some late reduction of pulmonary function in all long-term survivors. This form of lung fibrosis may be slowly progressive and has resulted in death in some cases. In this long-term study, 8 of 17 died of delayed pulmonary lung fibrosis, including all those initially treated (5 of 17) at less than 5 years of age.

Hematologic Toxicity

A frequent and serious toxicity of BiCNU is delayed myelosuppression. It usually occurs 4 to 6 weeks after drug administration and is dose related. Thrombocytopenia occurs at about 4 weeks postadministration and persists for 1 to 2 weeks. Leukopenia occurs at 5 to 6 weeks after a dose of BiCNU and persists for 1 to 2 weeks. Thrombocytopenia is generally more severe than leukopenia. However, both may be dose-limiting toxicities.

BiCNU may produce cumulative myelosuppression, manifested by more depressed indices or longer duration of suppression after repeated doses.

The occurrence of acute leukemia and bone marrow dysplasias have been reported in patients following long-term nitrosourea therapy.

Anemia also occurs, but is less frequent and less severe than thrombocytopenia or leukopenia.

Greater myelotoxicity (e.g., leukopenia and neutropenia) has been reported when carmustine was combined with cimetidine.

Gastrointestinal Toxicity

Nausea and vomiting after IV administration of BiCNU are noted frequently. This toxicity appears within 2 hours of dosing, usually lasting 4 to 6 hours, and is dose related. Prior administration of antiemetics is effective in diminishing and sometimes preventing this side effect.

Hepatotoxicity

A reversible type of hepatic toxicity, manifested by increased transaminase, alkaline phosphatase and bilirubin levels, has been reported in a small percentage of patients receiving BiCNU.

Nephrotoxicity

Renal abnormalities consisting of progressive azotemia, decrease in kidney size and renal failure have been reported in patients who received large cumulative doses after prolonged therapy with BiCNU and related nitrosoureas. Kidney damage has also been reported occasionally in patients receiving lower total doses.

Other Toxicities

Accidental contact of reconstituted BiCNU with skin has caused burning and hyperpigmentation of the affected areas.

Rapid IV infusion of BiCNU (carmustine for injection) may produce intensive flushing of the skin and suffusion of the conjunctiva within 2 hours, lasting about 4 hours. It is also associated with burning at the site of injection although true thrombosis is rare.

Neuroretinitis, chest pain, headache, allergic reaction, hypotension and tachycardia have been reported as part of ongoing surveillance.

Side Effects by Body System

Respiratory

Most of the patients with respiratory toxicity received prolonged therapy with total doses greater than 1400 mg/m2, although respiratory problems have been reported in patients receiving as little as 600 mg/m2.

Delayed onset pulmonary fibrosis occurring up to 17 years after treatment has been reported in one long-term study (n=17) on patients who received carmustine in childhood and early adolescence combined with cranial radiotherapy (for intracranial tumors). Chest X-rays revealed pulmonary hypoplasia with upper zone contraction. Thoracic CT scans showed an unusual pattern of upper zone fibrosis. Some late reduction of pulmonary function was reported in all long-term survivors. In this long-term study, 8 of 17 died of delayed pulmonary lung fibrosis, including all those initially treated (5 of 17) at less than 5 years old.

Respiratory side effects including pulmonary infiltrates and/or fibrosis have been reported to occur from 9 days to 43 months after treatment with carmustine and related nitrosoureas. Cases of fatal respiratory toxicity have been reported.

Hematologic

Carmustine may produce cumulative myelosuppression. Thrombocytopenia has generally been reported to occur approximately four weeks after administration. Leukopenia has generally been reported to occur approximately five to six weeks after administration. Both have been reported to persist for one to two weeks.

Hematologic side effects including myelosuppression have been reported frequently. Thrombocytopenia, leukopenia, and less frequently, anemia have also been reported. Acute leukemia and bone marrow dysplasias have been reported following long-term nitrosourea therapy.

Gastrointestinal

Nausea and vomiting generally appear within two hours of dosing and last for four to six hours. Prior administration of antiemetics has been effective in diminishing and sometimes preventing these side effects.

Gastrointestinal side effects including nausea and vomiting have been reported frequently.

Hepatic

Hepatic side effects including increased transaminase, alkaline phosphatase, and bilirubin levels have been reported infrequently.

The increased levels are generally reversible.

Renal

Renal side effects including progressive azotemia, decrease in kidney size, and renal failure have been reported in patients after prolonged therapy and usually after large cumulative doses.

Cardiovascular

Cardiovascular side effects including hypotension and tachycardia have been reported. Three cases of myocardial ischemia during and immediately after high-dose carmustine infusion have been reported.

Local

Local side effects including burning and hyperpigmentation have been reported.

Other

Other side effects have included intensive flushing of the skin and suffusion of the conjunctiva following rapid intravenous infusion of carmustine.

This effect usually has been reported to occur within two hours and last for approximately four hours.

Ocular

Ocular side effects including neuroretinitis have been reported.

General

General side effects including chest pain and headache have been reported.

Oncologic

Oncologic side effects have included spontaneous reports of cyst formation after gliadel wafer implantation. Carcinogenicity has been reported in animal studies.

Cyst formation occurred at varying time intervals post-implantation. Cyst formation has also been reported in patients following resection of malignant glioma who have not had gliadel implanted.

Carmustine has been reported in animal studies to produce a marked increase in tumor incidence at doses approximating clinical doses.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This information does not endorse drugs, diagnose patients, or recommend therapy. This drug information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug of drug combination is safe, effective, or appropriate for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of information provided. 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.