II. Indications

  1. Astrocytoma
  2. Brain Metastases
  3. Brainstem Glioma
  4. Ependymoma
  5. Glioblastoma
  6. Lymphoma
  7. Medulloblastoma
  8. Multiple Myeloma
  9. Mycosis Fungoides (off-label)
  10. Stem Cell Transplant

III. Mechanism

  1. See Alkylating Agent
  2. Antineoplastic nitrosourea
    1. Alkylating Agent that cross-links DNA during all Cell Cycle phases
    2. Carbamoylates Proteins, including DNA repair Proteins, resulting in further cytotoxic effects

IV. Medications

  1. Intravenous (BiCNU): 100 mg vial
  2. Wafer (Gliadel): 7.7 mg

V. Dosing

  1. See other references for disease specific dosing protocols

VI. Pharmacokinetics

  1. Highly lipophilic
  2. Easily crosses blood brain barrier

VII. Adverse Effects: General

  1. Alopecia
  2. Bone Marrow Suppression
  3. Hepatotoxicity
  4. Impaired future fertility
  5. Nephrotoxicity
  6. Ocular
    1. Ocular nerve infarctions
    2. Retinal Hemorrhage
  7. Pulmonary Fibrosis
  8. Secondary Malignancy

VIII. Adverse Effects: Infusion

  1. Soft Tissue Injury if extravasates
    1. Run infusion over 2 hours to prevent extravasation

IX. Adverse Effects: Wafer

  1. Seizures
  2. Brain edema (including risk of Cerebral Herniation)
  3. CNS Infection

X. Safety

  1. Avoid in Lactation
  2. Avoid in pregnancy (contraindicated in all trimesters)
    1. Teratogenic and adverse outcomes
    2. Use reliable Contraception
  3. Monitoring
    1. Complete Blood Count
    2. Liver Function Tests
    3. Renal Function tests
    4. Pulmonary Function Tests

XI. Drug Interactions

  1. Drugs that increase Carmustine effects (esp. myelosuppression)
    1. Cimetidine
  2. Carmustine decreases other drug levels
    1. Digoxin
    2. Phenytoin

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Carmustine (C0007257)

Definition (CHV) a kind of cancer treatment drug
Definition (CHV) a kind of cancer treatment drug
Definition (NCI) An antineoplastic nitrosourea. Carmustine alkylates and cross-links DNA during all phases of the cell cycle, resulting in disruption of DNA function, cell cycle arrest, and apoptosis. This agent also carbamoylates proteins, including DNA repair enzymes, resulting in an enhanced cytotoxic effect. Carmustine is highly lipophilic and crosses the blood-brain barrier readily. (NCI04)
Definition (NCI_NCI-GLOSS) An anticancer drug that belongs to the family of drugs called alkylating agents.
Definition (MSH) A cell-cycle phase nonspecific alkylating antineoplastic agent. It is used in the treatment of brain tumors and various other malignant neoplasms. (From Martindale, The Extra Pharmacopoeia, 30th ed, p462) This substance may reasonably be anticipated to be a carcinogen according to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985). (From Merck Index, 11th ed)
Definition (CSP) cell cycle phase nonspecific alkylating antineoplastic agent used in the treatment of brain tumors and various other cancers.
Definition (PDQ) An antineoplastic nitrosourea. Carmustine alkylates and cross-links DNA during all phases of the cell cycle, resulting in disruption of DNA function, cell cycle arrest, and apoptosis. This agent also carbamoylates proteins, including DNA repair enzymes, resulting in an enhanced cytotoxic effect. Carmustine is highly lipophilic and crosses the blood-brain barrier readily. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=43027&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=43027&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C349" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D002330
SnomedCT 387281007, 51326002
English 1,3-Bis(2-Chloroethyl)-1-Nitrosourea, BCNU, Carmustine, FIVB, N,N'-Bis(2-Chloroethyl)-N-Nitrosourea, Urea, N,N'-bis(2-chloroethyl)-N-nitroso-, 1,3-Bis(2-chloroethyl)-1-nitrosourea, N,N'-bis(2-chloroethyl)-N-nitrosourea, 1,3-Bis(beta-chloroethyl)-1-nitrosourea, Bis(chloroethyl) Nitrosourea, Carmustin, carmustine, BCNU (bis chloroethylnitrosourea), carmustine (medication), CARMUSTINE, Carmustine [Chemical/Ingredient], bcnu, bis chloroethylnitrosourea, N,N'-Bis(2-chloroethyl)-N-nitrosourea, BCNU - Carmustine, Carmustine (product), Carmustine (substance), bis-chloronitrosourea, Bis-Chloronitrosourea, CAMUSTINE
Swedish Karmustin
Czech karmustin
Finnish Karmustiini
Russian KARMUSTIN, BCNU, КАРМУСТИН
Japanese カルムスチン
Polish Karmustyna
Spanish carmustina (producto), carmustina (sustancia), carmustina, BCNU, Carmustina
French Carmustine
German BCNU, Carmustin
Italian Carmustina
Portuguese BCNU, Carmustina