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Carmustine Injection

Last Updated: May 24, 2011
Status: Resolved

Products Affected - Description

BICNU Injection, Bristol-Myers Squibb

Reason for the Shortage

Bristol-Myers Squibb could not provide a reason for the shortage.1

Estimated Resupply Dates

  • Bristol-Myers Squibb has available BICNU injection 100 mg vials (NDC 00015-3015-30).1
  • Gliadel (carmustine) wafer manufactured by Eisai is not affected by the shortage.2

Implications for Patient Care

  • Carmustine injection is a nitrosourea-derivative alkylating agent. It is labeled for use in adults with brain tumors, multiple myeloma, Hodgkin’s disease, and non-Hodgkin’s lymphoma.3-5
  • Carmustine is used off-label in adults for treating hematopoietic stem cell transplantation, mycosis fungoides, colorectal carcinoma, and malignant melanoma.3-5

Safety

  • Chemotherapy agents, such as carmustine, pose additional safety risks both for patients and for healthcare workers handling these agents.3,4
  • Use additional caution when processing orders for chemotherapy drugs, especially when switching between chemotherapy agents or when processing orders for chemotherapy agents with which staff may be unfamiliar (eg, those not normally prescribed at a specific institution).3,4

Alternative Agents & Management

  • The choice of an alternative agent must be patient-specific and based on renal function, liver function, and the neoplasm type and location. No single agent can be substituted for carmustine.3-5
  • Consider evaluating the health-care system’s total supply of carmustine before beginning patients on combination chemotherapy regimens containing carmustine. If adequate supplies are not available, select an alternative regimen.
  • Consult a Hematology/Oncology specialist for patient- and neoplasm-specific recommendations.
  • Refer to the ASHP Guidelines on Managing Drug Product Shortages for more guidance on developing a multidisciplinary plan when the supply must be allocated.

Related Shortages

References

  1. Bristol-Myers Squibb (personal communications). January 5,10, 14, 21 and 28, February 15 and 24, March 8 and 14, April 14, and May 5, 17, and 24, 2011.
  2. Eisai (personal communications). January 5, 2011.
  3. Beckwith MC, Tyler LS, eds. Cancer Chemotherapy Manual. St. Louis, MO: Wolters Kluwer Health Inc. 2010.
  4. Antineoplastic agents. In: McEvoy GK, ed. AHFS 2010 Drug Information. Bethesda, MD: American Society of Health-Systems Pharmacists; 2010: 902-1260.
  5. Drug Facts and Comparisons Online. St. Louis, MO: Wolters Kluwer Health Inc. Accessed: September 2010.

Updated

Updated May 24, 2011 by Megan Dryer, Pharm.D., Drug Information Specialist. Created January 5, 2011, by Mary Giouroukakis, Pharm.D., PGY2 Drug Information Resident, University of Utah, Drug Information Service. Copyright 2011, Drug Information Service, University of Utah, Salt Lake City, UT.

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