II. Indications
- Astrocytoma
- Brain Metastases
- Brainstem Glioma
- Ependymoma
- Glioblastoma
- Lymphoma
- Medulloblastoma
- Multiple Myeloma
- Mycosis Fungoides (off-label)
- Stem Cell Transplant
III. Mechanism
- See Alkylating Agent
- Antineoplastic nitrosourea
- Alkylating Agent that cross-links DNA during all cell cycle phases
- Carbamoylates Proteins, including DNA repair Proteins, resulting in further cytotoxic effects
IV. Medications
- Intravenous (BiCNU): 100 mg vial
- Wafer (Gliadel): 7.7 mg
V. Dosing
- See other references for disease specific dosing protocols
VI. Pharmacokinetics
- Highly lipophilic
- Easily crosses blood brain barrier
VII. Adverse Effects: General
- Alopecia
- Bone Marrow Suppression
- Hepatotoxicity
- Impaired future fertility
- Nephrotoxicity
- Ocular
- Ocular nerve infarctions
- Retinal Hemorrhage
- Pulmonary Fibrosis
- Secondary Malignancy
VIII. Adverse Effects: Infusion
-
Soft Tissue Injury if extravasates
- Run infusion over 2 hours to prevent extravasation
IX. Adverse Effects: Wafer
- Seizures
- Brain edema (including risk of Cerebral Herniation)
- CNS Infection
X. Safety
- Avoid in Lactation
- Avoid in pregnancy (contraindicated in all trimesters)
- Teratogenic and adverse outcomes
- Use reliable Contraception
- Monitoring
XI. Drug Interactions
- Drugs that increase Carmustine effects (esp. myelosuppression)
- Carmustine decreases other drug levels
XII. Resources
- Carmustine IV (BiCNU, DailyMed)
- Carmustine Wafer (Gliadel, DailyMed)