NAME OF DRUG
carmustine

CLASSIFICATION 

Cytotoxic agent- vesicant 
alkylating agent

ALTERNATE NAMES

BiCNU, BCNU

INDICATIONS

• as a component of various chemotherapeutic regimens in the treatment of primary brain tumors, Hodgkin's disease, non-Hodgkin's lymphoma, multiple myeloma and for the treatment of solid tumors

PHARMACOLOGY

• carmustine is thought to inhibit both DNA and RNA synthesis
• carmustine and its metabolites are highly lipid soluble and readily cross the blood-brain barrier
• the metabolites are slowly excreted in the urine: about 30% within 24 hours, 60-70% within 96 hours; some enterohepatic circulation is believed to occur
• the enterohepatic circulation and protein binding of carmustine and its metabolites may be responsible for delayed hematologic toxicity

RECONSTITUTION AND STABILITY

• ALL cytotoxic agents are prepared in pharmacy and will be sent to the ward with a label indicating storage conditions and the expiry date. All cytotoxic waste including bags, sets, tubing, gloves etc. must be properly disposed of in the cytotoxic waste containers on the nursing units.

COMPATIBILITY

• compatible with NS and D5W
• incompatible with sodium bicarbonate

ROUTES OF ADMINISTRATION

CENTRAL ROUTE:

• IV intermittent - in 100-250 mL NS or D5W over 1-2 hours.

VH & HSC ADMINISTRATION POLICY

A Parenteral Chemotherapy/Immunotherapy pre-printed order form (PPO # 45) must be used for prescribing if this cytotoxic agent
is not already on an existing PPO.

A - Not to be administered by the side arm technique.
G - Cytotoxic Agents - See Drug Table G for specific administration guidelines.
H - Central route: the IV infusion rate must be controlled by an automated infusion control device.

DOSAGE

Dose and schedule depend on protocol and patient response.

Usual dose ranges up to 200 mg/m2 every 6 weeks.

Tumor ablation prior to bone marrow transplant: up to 500 mg/m2

In elderly patients or those with already compromised marrow function 50-75% of the dose may be used.

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• burning pain and venospasm at the injection site
• intense flushing of the skin lasting up to 4 hours after administration
• extravasation may lead to tissue necrosis (see Appendix VII for extravasation protocol)

IMPORTANT IMPLICATIONS

• major bone marrow toxicity (delayed 4-6 weeks after drug administration and cumulative)
• severe nausea and vomiting occur frequently shortly after administration; premedication with antiemetics may be indicated
• nephrotoxicity can occur after large cumulative doses or (doses > 1500 mg/m2) after prolonged therapy; renal function should be monitored
• pulmonary fibrosis, often delayed by years, can occur after cumulative doses > 1000 mg/m2
• mild, reversible hepatotoxicity may occur when high doses are used; monitor liver function
• skin contact causes transient brown staining

VGH Site only:
Notify security -84 immediately upon accidental spillage.
DO NOT ATTEMPT CLEAN-UP

• See also Appendix VI

Rev. May 2006