Carmustine
- Atc Codes:L01AD01
- CAS Codes:154-93-8
- PHARMGKB ID:154-93-8
Table of contents
- Brand Names
- Drug Combinations
- Chemistry
- Pharmacologic Category
- Mechanism of Action
- Therapeutic Use
- Unlabeled Use
- Pregnancy and Lactation Implications
- Contraindications
- Warnings and Precautions
- Adverse Reactions
- Toxicological Effects
- Caution and personalized dose adjustment in patients with the following genotypes
- Other genes that may be involved
- Drug Interactions
- Nutrition/Nutraceutical Interactions
- Dosage
- Pharmacokinetics and Pharmacodynamics
- Special Considerations
Brand Names
Europe
Austria: Carmubris, Gliadel; Bulgaria: BiCNU; Czech Republic: BiCNU; France: BiCNU, Gliadel; Germany: Carmubris, Gliadel; Greece: BiCNU, Carmubris, Gliadel; Hungary: BiCNU; Ireland: Gliadel; Italy: Gliadel; Luxembourg: Nitrumon; Netherlands: Gliadel; Portugal: Gliadel; Slovakia: BiCNU; Spain: Gliadel; UK: Gliadel.
North America
Canada: BiCNU; USA: BiCNU, Gliadel.
Latin America
Argentina: BiCNU; Brazil: Becenun; Mexico: BiCNU.
Drug combinations
Carmustine, Cisplatin, and Dacarbazine
Carmustine, Cisplatin, Dacarbazine, and Tamoxifen
Chemistry
Carmustine: C~5~H~9~Cl~2~N~3~O~2~. Mw: 214.05. (1) Urea, N,N’-bis(2-chloroethyl)-N-nitroso-; (2) 1,3-bis(2-Chloroethyl)-1-nitrosourea. UNII-U68WG3173Y. CAS-154-93-8 (1970).
Pharmacologic Category
Antineoplastic Agents; Alkylating Agents; DNA Binding Agent. (ATC-Code: L01AD01).
Mechanism of action
Interrupts the normal function of DNA and RNA by alkylation and cross-linking the strands of DNA and RNA, and by possible protein modification. May inhibit enzyme processes by carbamylation of amino acids in protein.
Therapeutic use
Brain tumors (glioblastoma, brainstem glioma, medulloblastoma, astrocytoma, ependymoma, and metastatic brain tumors). Multiple myeloma. Hodgkin’s disease (relapsed or refractory). Non-Hodgkin lymphomas (relapsed or refractory). Glioblastoma multiforme (adjunct to surgery). High-grade malignant glioma (adjunct to surgery and radiation).
Pregnancy and lactiation implications
Teratogenicity and embryotoxicity demonstrated in animal studies. Carmustine can cause fetal harm if administered to pregnant women. Women of childbearing potential should avoid becoming pregnant while on treatment. Not recommended during lactation.
Unlabeled use
Melanoma. Palliative treatment of cutaneous T-cell lymphoma (mycosis fungoides).
Contraindications
Hypersensitivity to carmustine or any component of the formulation.
Warnings and precautions
Bone marrow suppression (thrombocytopenia, leukopenia) is the major toxicity and may be delayed (caution with clozapine and carbamazepine). Dose-related pulmonary toxicity might occur (higher risk if doses >1400 mg/m^2^). Diluent contains significant amounts of ethanol (caution in aldehyde dehydrogenase-2 deficiency or history of «alcohol-flushing syndrome»). Risk of hypotension. Carmustine is a highly toxic drug with a low therapeutic index. May cause hepatic dysfunction. Mutagenic (in vitro) and clastogenic (in vitro and in vivo). Nitrosourea therapy (i.e. carmustine therapy) has carcinogenic potential in humans (acute leukemia and bone marrow dysplasia reported).