carmustine at a glance
Medicine class
Nitrosourea alkylating chemotherapy
Available forms
Intravenous infusion or biodegradable implant placed during brain surgery
Usual roles
Selected brain tumours, lymphomas, multiple myeloma and conditioning before autologous stem-cell transplantation
What is carmustine used for?
UK-licensed uses represented by the selected products are:
Intravenous treatment of selected primary brain tumours and brain metastases.
Secondary treatment of Hodgkin lymphoma and non-Hodgkin lymphoma.
Conditioning before autologous haematopoietic progenitor-cell transplantation for Hodgkin or non-Hodgkin lymphoma.
Treatment of multiple myeloma in combination with a glucocorticoid.
An implant alongside surgery and radiotherapy for adults with newly diagnosed high-grade malignant glioma.
An implant alongside surgery for adults with recurrent, histologically confirmed glioblastoma when surgical resection is indicated.
How does carmustine work?
Carmustine forms irreversible cross-links within DNA, disrupting its copying, transcription and repair. Its lipid solubility helps intravenously administered carmustine cross the blood–brain barrier; the implant releases it locally into tissue surrounding the tumour-removal cavity.
carmustine preparations and strengths
Implant
Route: Implant
Strengths: 7.7 mg
Solution for infusion
Route: Intravenous
Strengths: 100 mg
How to take carmustine
Carmustine is administered by specialist hospital teams; it is not taken by mouth.
The infusion is prepared, diluted and given slowly into a vein, protected from light. Staff monitor the injection site because leakage or rapid administration can cause severe burning and tissue injury.
The biodegradable implant is placed directly into the tumour-removal cavity by a neurosurgeon during surgery.
Food does not affect administration because neither formulation is swallowed.
carmustine side effects
Common or expected effects
- Intravenous treatment: delayed reduction in blood cells, nausea and vomiting, headache, dizziness, poor coordination, vein inflammation, mouth soreness, constipation or diarrhoea, hair loss, flushing and injection-site reactions.
- Intravenous treatment can cause lung inflammation or fibrosis; risk increases with cumulative exposure and other pulmonary risk factors.
- Implant treatment: seizures, headache, brain swelling, weakness, confusion or drowsiness, nausea, vomiting, constipation, fever, infection, rash and wound-healing problems. Some effects may also result from the tumour or brain surgery.
Get urgent medical advice
- Severe allergic reaction with wheezing, facial or throat swelling, widespread rash or faintness.
- Low blood-cell complications, including serious infection or unusual bleeding.
- New or worsening cough, breathlessness or other evidence of lung injury.
- Severe infusion-site pain, burning or swelling suggesting leakage into surrounding tissue.
- After an implant: brain swelling or raised intracranial pressure, seizure, cerebrospinal-fluid leak, intracranial infection, cerebral bleeding or new neurological impairment.
carmustine in pregnancy
Intravenous carmustine should not normally be used during pregnancy, and the implant is not recommended because carmustine may harm a developing baby. Effective contraception is required: the selected products specify at least six months for women; advice for men differs between the infusion and implant. Pregnancy during or after treatment requires prompt specialist review, and genetic advice is recommended following pregnancy after an implant.
carmustine while breastfeeding
Breastfeeding is contraindicated with both selected formulations because transfer into milk is unknown and serious effects in a nursing infant cannot be excluded. Ask the specialist team when breastfeeding may safely begin or resume.
carmustine interactions
Give the specialist team a complete list of prescribed, non-prescribed and complementary products. Relevant product-specific considerations include:
Phenytoin and other antiseizure medicines
Anticancer combinations may reduce antiseizure activity, so seizure control may require review.
Cimetidine
May inhibit carmustine metabolism and increase or prolong toxicity.
Digoxin
Carmustine may reduce digoxin absorption and therefore its effect.
Common questions about carmustine
Answers are fully visible for fast scanning and source review.
Is carmustine chemotherapy?
Yes. It is a nitrosourea alkylating chemotherapy that damages DNA and prevents cancer cells from copying and repairing it normally.
Why is carmustine used for brain tumours?
Intravenous carmustine is lipid-soluble and crosses the blood–brain barrier. The implant can also release carmustine directly into tissue around the tumour-removal cavity.
Are carmustine and Gliadel the same treatment?
Gliadel contains carmustine, but it is a biodegradable implant placed during brain surgery. It is not interchangeable with intravenous carmustine.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.