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carmustine (BCNU, BiCNU, Carmubris)
Tradename: BiCNU.
Indications:
1) brain tumors (astrocytoma)
2) multiple myeloma
3) Hodgkin's disease
4) non-Hodgkin's lymphoma
5) melanoma
6) lung cancer
7) stem-cell transplantation [4]
Contraindications:
- pregnancy*
* contraception indicated during therapy
Dosage:
1) 150-200 mg/m2 every 6 weeks
2) max cumulative dose: 1400 mg/m2
3) do NOT mix with solutions containing bicarbonate
4) administer in glass container
Powder for injection: 100 mg
Caution: do not mix with solution containing bicarbonate.
Pharmacokinetics:
1) rapidly distributes to all tissues
2) CSF concentration is about 70 times blood concentration
3) metabolized by liver, removed by kidney
4) 1/2 life is 20 minutes
5) not removed by dialysis
Adverse effects:
1) common (> 10%)
- pain at site of injection
- nausea/vomiting
- occurs within 2-4 hours
- high emetic potential
- increased LFTs (reversible hepatic toxicity)
2) less common (1-10%)
- anemia, stomatitis, facial flushing, alopecia, diarrhea, anorexia
3) uncommon (< 1%)
- myelosuppression: delayed 4-6 weeks
- interstitial pneumonitis & pulmonary fibrosis* (prolonged or high doses)
- hyperpigmentation, dermatitis
- renal failure,
- ocular toxicity & retinal hemorrhages
- ataxia, dizziness
4) other: seizures [3]
* monitor: pulmonary function testing, baseline & periodically, DLCO < 70% predicted indicates high risk
Drug interactions:
1) cimetidine may decrease metabolism of BCNU, thus increasing toxicity
2) amphotericin may enhance cellular uptake of BCNU
3) digoxin
4) phenytoin
Test interactions: increases serum K+
Mechanism of action: alkylating agent
Interactions
drug adverse effects of alkylating agents
General
alkylating agent nitrosourea
Properties
MISC-INFO: elimination route KIDNEY
1/2life 20 MINUTES
elimination by hemodialysis -
pregnancy-category ?
Database Correlations
PUBCHEM cid=2578
References
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Deprecated Reference