Generic
Carmustine
1 brands available in the market
At a glance
Carmustine is a nitrosourea alkylating agent chemotherapy used in the treatment of brain tumors (glioblastoma, brainstem glioma, medulloblastoma, astrocytoma, ependymoma, and metastatic brain tumors), multiple myeloma, and relapsed or refractory Hodgkin's and non-Hodgkin's lymphomas.
Description
Carmustine is a nitrosourea alkylating agent that alkylates DNA and RNA and may also inhibit enzymatic processes through carbamoylation of amino acids in proteins. Its mechanism of action is not fully understood, but it is not cross-resistant with other alkylators.
Carmustine is indicated as palliative therapy as a single agent or in combination therapy for brain tumors (glioblastoma, brainstem glioma, medulloblastoma, astrocytoma, ependymoma, and metastatic brain tumors), multiple myeloma (in combination with prednisone), and relapsed or refractory Hodgkin's and non-Hodgkin's lymphomas.
Indications
- Brain tumors (glioblastoma, brainstem glioma, medulloblastoma, astrocytoma, ependymoma, metastatic brain tumors)
- Multiple myeloma (in combination with prednisone)
- Relapsed or refractory Hodgkin's lymphoma
- Relapsed or refractory non-Hodgkin's lymphoma
Therapeutic class
Cytotoxic Chemotherapy
Pharmacological class
Alkylating Agent (Nitrosourea)
Pharmacology
The mechanism of action of carmustine is not fully understood. While carmustine alkylates DNA and RNA, it is not cross-resistant with other alkylators. As with other nitrosoureas, it may also inhibit several key enzymatic processes by carbamoylation of amino acids in proteins. The metabolites may contribute to antitumor activity and toxicities of carmustine.
Mechanism of action
Carmustine alkylates DNA and RNA and inhibits enzymatic processes through carbamoylation of amino acids in proteins, thereby disrupting cancer cell division and growth.
Dosage
Adults (Single agent): 150-200 mg/m² IV every 6 weeks (as a single dose or divided into 2 consecutive days at 75-100 mg/m²).
Combination therapy or reduced bone marrow reserve: Dose adjustment required.
Administration: Reconstituted solution should be administered as a slow IV infusion over at least 2 hours.
Pediatric: Safety and effectiveness in children have not been established.
Geriatric: Dose selection should be cautious, usually starting at the low end of the dose range.
Administration
For IV infusion only. Administer reconstituted solution as a slow IV infusion over at least 2 hours by a healthcare professional. Monitor infusion site closely during administration (to prevent extravasation).
Missed dose
Hospital-only medicine. Administered by doctor or nurse. Missed dose concept does not apply (hospital-administered).
Side effects
Common (>1%): Nausea, vomiting, renal toxicity, pneumonitis, pulmonary toxicity, myelosuppression (bone marrow suppression).
Pulmonary fibrosis: Delayed-onset pulmonary fibrosis may occur up to 17 years after treatment (especially in patients treated at <5 years of age).
Other: Nephrotoxicity, ocular toxicity (with unapproved intraarterial intracarotid route), carcinogenicity (potentially carcinogenic to humans).
Precautions & warnings
- Monitor infusion site closely during administration to prevent extravasation.
- Potentially carcinogenic to humans; monitor patients periodically and inform them of symptoms to seek medical help.
- Ocular toxicity has occurred with unapproved intraarterial intracarotid route.
- Embryo-fetal toxicity: Can cause fetal harm; advise females of reproductive potential of potential risk and to avoid pregnancy.
- Elderly patients are more likely to have decreased renal function; monitor renal function and select dose cautiously.
- Do not use during pregnancy and lactation (Category D).
Contraindications
- Previous hypersensitivity to carmustine or its components
Drug interactions
- Cimetidine (oral): Coadministration results in greater myelosuppression (leukopenia and neutropenia); consider alternatives to cimetidine.
- Phenobarbital: Induces carmustine metabolism and may compromise antitumor activity; consider alternatives to phenobarbital.
- Phenytoin: Carmustine may reduce phenytoin serum concentrations; consider alternatives to phenytoin.
Food interactions
No food-related restrictions (parenteral administration).
Use in pregnancy
Unsafe during pregnancy (Category D). Based on mechanism of action and animal findings, can cause fetal harm. Embryotoxic and teratogenic in rats and rabbits. No adequate studies in pregnant women. Use only if potential benefit justifies potential risk to the fetus.
Pregnancy Category: D — always consult a doctor before taking during pregnancy.
Use in lactation
No information on presence in human milk. Many drugs are excreted in human milk and due to potential serious adverse events (carcinogenicity and myelosuppression) in nursing infants, discontinue nursing while taking carmustine.
Pediatric use
Safety and effectiveness in children have not been established. Delayed-onset pulmonary fibrosis occurring up to 17 years after treatment has been reported in patients treated in childhood (1-16 years). All 5 patients initially treated at <5 years of age died of pulmonary fibrosis.
Geriatric use
Clinical studies did not include sufficient numbers of patients aged 65 and over. Dose selection should be cautious, usually starting at the low end of the dose range. Carmustine and its metabolites are substantially excreted by the kidney; monitor renal function.
Renal / hepatic impairment
Hepatic impairment: Caution required in liver disease; dose adjustment may be needed.
Overdose effects
Overdose may cause severe myelosuppression, pulmonary toxicity, renal toxicity, and gastrointestinal toxicity. Supportive care and blood transfusions may be required.
Storage conditions
Store product and diluent in a refrigerator at 2-8°C. Unopened carmustine vials are stable for up to 3 years.
Chemical structure
Carmustine (Nitrosourea Alkylating Agent)