Carmustine (Intravenous)

Carmustine injection is used on its own or with other medicines to treat certain types of brain tumors (like glioblastoma, brainstem glioma, medulloblastoma, astrocytoma, ependymoma, and metastatic brain tumors), cancer of the lymph system (such as Hodgkin's disease and non-Hodgkin's lymphoma), and a specific type of cancer in the bone marrow (like multiple myeloma). Your doctor may also use it to treat other types of cancer.

Carmustine belongs to the group of alkylating agents. It works by interfering with the growth of cancer cells, which are eventually destroyed. Since carmustine can also affect the growth of normal body cells, other effects may happen. Some of these can be serious and should be reported to your doctor. Other effects (like hair loss) may not be serious but can be concerning. Some effects might not appear for months or years after you use the medicine.

Before starting treatment with carmustine, you and your doctor should discuss the benefits of this medicine as well as the risks.

This medicine is to be given only by or under the immediate supervision of your doctor.

It is very important for your doctor to check your progress at regular visits to make sure this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

Using this medicine while you are pregnant can harm your unborn baby. Females need to use an effective form of birth control during treatment and for at least 6 months after using this medicine to prevent pregnancy. If you think you have become pregnant while using the medicine, tell your doctor right away. Males need to use an effective form of contraception during treatment and for at least 3 months after your last dose to prevent their partner from becoming pregnant.

This medicine may increase your risk of developing cancer and lung problems (such as pulmonary fibrosis or toxicity). This is more likely if you receive high doses of this medicine or use it for a long time.

While you are being treated with carmustine injection, and after you stop treatment with it, do not have any immunizations (vaccines) without your doctor's approval. Carmustine may lower your body's resistance, and the vaccine may not work as well for you or you might get the infection the vaccine is meant to prevent. Additionally, you should not be around other people in your household who receive live vaccines because there is a chance they could pass the virus on to you. Some examples of live vaccines include measles, mumps, influenza (nasal flu vaccine), poliovirus (oral form), rotavirus, and rubella. Do not get close to them and do not stay in the same room with them for very long. If you have questions about this, talk to your doctor.

Carmustine can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

• If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
• Check with your doctor immediately if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin.
• Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
• Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
• Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
• Avoid contact sports or other situations where bruising or injury could occur.

If carmustine accidentally seeps out of the vein into which it is injected, it may damage some tissues and cause scarring. Tell the doctor or nurse right away if you notice redness, pain, or swelling at the injection site.

This medicine may increase the risk of lung problems while smoking.

If you plan to have children, talk with your doctor before using this medicine. Some men using this medicine have become infertile (unable to have children).

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

In deciding to use a medicine, you and your doctor will weigh the risks of taking it against the benefits it may provide. The following points should be considered for this medicine:

Allergies

Inform your doctor if you have had any unusual or allergic reactions to this medicine or any other medicines. Also, let your healthcare professional know about any other allergies you may have, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

There have been no appropriate studies on how carmustine injection affects children. Safety and effectiveness have not been established.

Geriatric

There is no information available on how carmustine injection affects older adults. However, elderly patients are more likely to have age-related issues with their kidneys, liver, or heart, which may require caution and a dose adjustment for those receiving carmustine injection.

Breast Feeding

There are no adequate studies in women to determine the risk to infants when using this medicine while breastfeeding. Consider the potential benefits and risks before using this medication during breastfeeding.

Interactions with Medicines

Some medicines should not be used together, while in other cases, two different medicines may be used together despite possible interactions. Your doctor may need to adjust the dose or take other precautions if you are receiving this medicine and are taking any of the following medicines. The following interactions are significant but may not be all-inclusive.

Using this medicine with any of the following is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Measles Virus Vaccine, Live
• Mumps Virus Vaccine, Live
• Rotavirus Vaccine, Live
• Rubella Virus Vaccine, Live
• Varicella Virus Vaccine, Live
• Zoster Vaccine, Live

Using this medicine with any of the following is usually not recommended but may be necessary in some cases. If both medicines are prescribed together, your doctor may adjust the dose or frequency of use for one or both medicines.

• Adenovirus Vaccine
• Bacillus of Calmette and Guerin Vaccine, Live
• Cholera Vaccine, Live
• Cimetidine
• Dengue Tetravalent Vaccine, Live
• Influenza Virus Vaccine, Live
• Melphalan
• Phenobarbital
• Poliovirus Vaccine, Live
• Smallpox Vaccine
• Typhoid Vaccine, Live
• Yellow Fever Vaccine

Interactions with Food/Tobacco/Alcohol

Some medicines should not be taken around mealtimes or with certain foods due to possible interactions. Using alcohol or tobacco with some medicines may also lead to interactions. Talk with your healthcare professional about using your medicine with food, alcohol, or tobacco.

Other Medical Problems

Having other medical issues may affect how you can use this medicine. Be sure to tell your doctor if you have any other medical problems, especially:

• Anemia (low red blood cells) or
• Bone marrow problems (for example, leukemia) or
• Leukopenia or neutropenia (low white blood cells) or
• Liver disease or
• Lung disease (for example, pulmonary fibrosis, pulmonary toxicity) or
• Thrombocytopenia (low platelets in the blood)—Use with caution. This may worsen these conditions.

• Kidney disease—Use with caution. The effects may be increased due to slower removal of the medicine from your body.

Along with its needed effects, medicines like carmustine can sometimes cause unwanted effects, such as blood problems, hair loss, and other side effects described below. Also, because of how these medicines work in the body, there is a chance that they might cause other unwanted effects that may not happen until months or years after the medicine is used. These delayed effects may include certain types of cancer, such as leukemia. Talk to your doctor about these possible effects.

Along with its needed effects, a medicine may cause some unwanted effects. Not all side effects may occur, but if they do, they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

• Cough
• Pain or redness at the injection site
• Trouble breathing

Less common

• Black, tarry stools
• Blood in the urine or stools
• Cough or hoarseness, accompanied by fever or chills
• Fever or chills
• Flushing of the face
• Lower back or side pain, accompanied by fever or chills
• Painful or difficult urination, accompanied by fever or chills
• Pinpoint red spots on the skin
• Sores in the mouth or on the lips
• Unusual bleeding or bruising
• Unusual tiredness or weakness

Rare

• Decrease in urination
• Swelling of the feet or lower legs

Incidence not known

• Severe abdominal or stomach pain
• Bleeding gums
• Bone pain
• Chest pain
• Cloudy urine
• Confusion
• Dark urine
• Decreased frequency or amount of urine
• Difficulty swallowing
• Dizziness
• Dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• Dry mouth
• Fast, pounding, or irregular heartbeat or pulse
• Feeling of warmth
• Hives, itching, or skin rash
• Increased blood pressure
• Increased thirst
• Loss of appetite
• Nausea or vomiting
• Pain in the lower back or side
• Pale skin
• Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• Redness of the face, neck, arms, and occasionally, upper chest
• Seizures
• Sore throat
• Sweating
• Swelling of the face, fingers, or lower legs
• Swollen glands
• Thirst
• Tightness in the chest
• Troubled breathing with exertion
• Weight gain
• Yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Your healthcare professional may also be able to tell you ways to prevent or reduce some of these side effects. Check with your healthcare professional if any of the following side effects continue, are bothersome, or if you have any questions about them:

Less common

• Diarrhea
• Discoloration of the skin along the injection site

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

In the U.S.

• Bicnu

Available Dosage Forms:

• Powder for Solution

Therapeutic Class: Antineoplastic Agent

Pharmacologic Class: Alkylating Agent

Chemical Class: Nitrosourea

Medicines used to treat cancer are very strong and can have many side effects. Before receiving this medicine, make sure you understand all the risks and benefits. It is important for you to work closely with your doctor during your treatment.

A nurse or other trained health professional will give you this medicine in a hospital. This medicine is given through a needle placed in one of your veins.

This medicine is usually given every 6 weeks. This maybe given as a single dose or divided into daily injections on 2 consecutive days.

Carmustine is sometimes given together with certain other medicines. If you are using a combination of medicines, it is important that you receive each one at the proper time. If you are taking some of these medicines by mouth, ask your doctor to help you plan a way to take them at the right times.

This medicine often causes nausea and vomiting, which usually last no longer than 4 to 6 hours. It is very important that you continue to receive the medicine, even if you begin to feel ill. Ask your doctor for ways to lessen these effects.