CARMUSTINE
(kar-mus'teen)
BCNU, BiCNU, Gliadel
Classifications: antineoplastic; alkylating agent
Prototype: Cyclophosphamide
Pregnancy Category: D

Availability

100 mg injection; 7.7 mg wafer

Actions

Highly lipid-soluble nitrosourea derivative with cell-cycle-nonspecific activity against rapidly proliferating cell populations. Produces cross-linkage of DNA strands, thereby blocking DNA, RNA, and protein synthesis. Major toxic effect is bone marrow suppression.

Therapeutic Effects

Drug metabolites thought to be responsible for antineoplastic activities. Full or partial activity against a variety of cancers resulting in reduction or stabilization of tumor size and increased survival rates.

Uses

As single agent or in combination with other antineoplastics in treatment of Hodgkin's disease and other lymphomas, melanoma, primary and metastatic tumors of brain, and GI tract malignancies.

Unlabeled Uses

Treatment of carcinomas of breast and lungs, Ewing's sarcoma, Burkitt's tumor, malignant melanoma, and topically for mycosis fungoides.

Contraindications

History of pulmonary function impairment; recent illness with or exposure to chickenpox or herpes zoster; infection, decreased circulating platelets, leukocytes, or erythrocytes; pregnancy (category D), lactation.

Cautious Use

Hepatic and renal insufficiency; patient with previous cytotoxic medication, or radiation therapy.

Route & Dosage

Previously Untreated Patients—Carcinoma
Adult: IV 150–200 mg/m2 q6wk in one dose or given over 2 d
Child: IV 200–250 mg/m2 q4–6wk as single dose. Doses adjusted based on hematologic parameters.

Mycosis Fungoides
Adult: Topical 0.05–0.4% solution in 30% alcohol to paint entire body (60 mLs) or ointment 1–2 times/d for 6–8 wk (10 mg/d) (must be specially compounded)

Administration

Note: When administering IV to infants and children, verify correct IV concentration and rate of infusion with physician.

Intravenous

PREPARE: IV Infusion: Wear disposable gloves; contact of drug with skin can cause burning, dermatitis, and hyperpigmentation. Add supplied diluent to the 100 mg vial. Further dilute with 27 mL of sterile water for injection to yield a concentration of 3.3 mg/mL. Each dose is then added to 100–500 mL of D5W or NS. If possible avoid using PVC IV tubing and bags.  

ADMINISTER: IV Infusion: Infuse a single dose over at least 1 h. Slow infusion over 1–2 h and adequate dilution will reduce pain of administration. Avoid starting infusion into dorsum of hand, wrist, or the antecubital veins; extravasation in these areas can damage underlying tendons and nerves leading to loss of mobility of entire limb.  

INCOMPATIBILITIES Solution/additive: Sodium bicarbonate. Y-site: Allopurinol.

  • Frequently check rate of flow and blood return; palpate injection site for extravasation. If there is any question about patency, line should be restarted.

Adverse Effects (1%)

Hematologic: Delayed myelosuppression (dose-related); thrombocytopenia. CNS: Dizziness, ataxia. Respiratory: Pulmonary infiltration or fibrosis. Skin: Skin flushing and burning pain at injection site, hyperpigmentation of skin (from contact). Special Senses: (with high doses) Eye infarctions, retinal hemorrhage, suffusion of conjunctiva. GI: Stomatitis, nausea, vomiting.

Interactions

Drug: Cimetidine may potentiate neutropenia and thrombocytopenia.

Pharmacokinetics

Distribution: Readily crosses blood–brain barrier; CSF concentrations 15–70% of plasma concentrations. Metabolism: Rapidly metabolized; metabolic fate not completely known. Elimination: 60–70% excreted in urine in 96 h; 6% excreted through lungs, 1% in feces; excreted in breast milk.

Nursing Implications

Assessment & Drug Effects

Patient & Family Education


Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug