carmustine

carmustine

 [kahr-mus´tēn]

a cytotoxic alkylating agent of the nitrosourea group, used as an antineoplastic agent, primarily against brain tumors, multiple myeloma, colorectal carcinoma, Hodgkin's disease, and non-Hodgkin's lymphomas. Called also BCNU.

Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

carmustine

Gliadel Wafer

Pharmacologic class: Alkylating agent

Therapeutic class: Antineoplastic

Pregnancy risk category D

FDA Box Warning

• Give under supervision of physician experienced in cancer chemotherapy.

• Most common and severe toxic effect is bone marrow suppression-notably thrombocytopenia and leukopenia, which may contribute to bleeding and overwhelming infections in already compromised patient. Monitor blood counts weekly for at least 6 weeks after dose. Don't give courses more often than every 6 weeks.

Action

Unclear. Thought to interfere with bacterial cell-wall synthesis by cross-linking strands of DNA and disrupting RNA transcription, causing cell to rupture and die. Exhibits minimal immunosuppressant activity.

Availability

Intracavitary wafer implant: 7.7 mg (available in packages of eight wafers)

Powder for injection: 100-mg vials

Indications and dosages

➣ Brain tumor; multiple myeloma; Hodgkin's disease; other lymphomas

Adults and children: 150 to 200 mg/m² I.V. as a single dose q 6 to 8 weeks, or 75 to 100 mg/m²/day for 2 days q 6 weeks, or 40 mg/m²/day for 5 days q 6 weeks. Repeat dose q 6 weeks if platelet count exceeds 100,000/mm³ and white blood cell (WBC) count exceeds 4,000/mm³.

➣ Adjunct to brain surgery

Adults: Up to 61.6 mg (eight wafers) implanted in surgical cavity created during brain tumor resection

Dosage adjustment

• Based on WBC and platelet counts

Off-label uses

• Mycosis fungoides

Contraindications

• Hypersensitivity to drug

• Radiation therapy

• Chemotherapy

• Pregnancy or breastfeeding

Precautions

Use cautiously in:

• infection; depressed bone marrow reserve; respiratory, hepatic, or renal impairment

• females of childbearing age.

Administration

• Know that drug may be used alone or in conjunction with other treatments, such as surgery or radiation.

• Follow facility policy when preparing, administering, and handling drug.

• Reconstitute drug by dissolving vial of 100 mg with 3 ml of sterile dehydrated alcohol (provided with drug), followed by 27 ml of sterile water for injection; yields solution with concentration of 3.3 mg carmustine/ml. Solution may be further diluted with 5% dextrose injection and delivered by I.V. infusion over 1 to 2 hours.

• Know that infusion lasting less than 1 hour causes intense pain and burning at I.V. site.

• Infuse solution in glass containers only; drug is unstable in plastic I.V. bags.

• Know that skin contact with reconstituted drug may cause transient hyperpigmentation. If contact occurs, wash skin thoroughly with soap and water.

• Be aware that oxidized regenerated cellulose may be placed over wafers to secure them against surgical cavity surface.

• Know that resection cavity should be irrigated after wafer placement and that dura should be closed in watertight fashion.

Adverse reactions

CNS: ataxia, drowsiness

GI: nausea, vomiting, diarrhea, esophagitis, stomatitis, anorexia

GU: azotemia, renal failure, nephrotoxicity

Hematologic: anemia, leukopenia, thrombocytopenia, cumulative bone marrow depression, bone marrow dysplasia

Hepatic: hepatotoxicity

Respiratory: pulmonary fibrosis, pulmonary infiltrates

Skin: alopecia, hyperpigmentation, facial flushing, abnormal bruising

Other: I.V. site pain, secondary malignancies

Interactions

Drug-drug. Anticoagulants, aspirin, nonsteroidal anti-inflammatory drugs: increased risk of bleeding

Antineoplastics: additive bone marrow depression

Cimetidine: potentiation of bone marrow depression

Digoxin, phenytoin: decreased blood levels of these drugs

Live-virus vaccines: decreased antibody response to vaccines, increased risk of adverse reactions

Drug-diagnostic tests. Alkaline phosphatase, aspartate aminotransferase, bilirubin, nitrogenous compounds (urea): increased levels

Hemoglobin, WBCs: decreased values

Drug-behaviors. Smoking: increased risk of respiratory toxicity

Patient monitoring

• Assess baseline kidney and liver function tests.

• Monitor CBC for up to 6 weeks after giving dose to detect delayed bone marrow toxicity.

• Know that pulmonary function tests should be performed before therapy begins and regularly throughout therapy to assess for toxicity.

Patient teaching

• Instruct patient to report signs and symptoms of allergic response and other adverse reactions.

• Inform patient that severe flushing may follow I.V. dose but should subside in 2 to 4 hours.

• Tell patient to avoid activities that can cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury.

• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.

• Instruct patient to monitor urinary output and report significant changes.

• Inform patient that drug may cause hair loss.

• Advise patient that he'll undergo regular blood testing during therapy.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved

car·mus·tine

(kar-mŭs'tēn),

An antineoplastic agent.

Synonym(s): BCNU

Farlex Partner Medical Dictionary © Farlex 2012

carmustine

(kär′mŭs-tēn′)

n.

An antineoplastic drug, C₅H₉Cl₂N₃O₂, used to treat various malignancies, including Hodgkin and non-Hodgkin lymphomas, melanoma, multiple myeloma, and brain tumors.

The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

BCNU

A chemotherapeutic related to lomustine (CCNU) and semustine, which partially overlaps the activity/toxicity of alkylating agents.
 
Indications
Hodgkin lymphoma, non-Hodgkin lymphoma, melanoma, myeloma, brain tumours, gastrointestinal carcinomas; BCNU crosses the blood-brain barrier and may be used for meningeal leukaemia and brain tumours.
 
Side effects
Nausea, vomiting, decreased platelets, reduced WBCs, secondary leukaemia, pulmonary fibrosis, renal failure.

Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.

carmustine

BCNU Oncology An anticancer alkylating nitrosourea

McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

car·mus·tine

(kahr-mŭs'tēn)

An antineoplastic agent.
Synonym(s): BCNU.

Medical Dictionary for the Health Professions and Nursing © Farlex 2012

carmustine

An alkylating agent anticancer drug. A brand name is Bicnu.

Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005

car·mus·tine

(kahr-mŭs'tēn)

An antineoplastic agent.

Medical Dictionary for the Dental Professions © Farlex 2012