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Carmustine (BiCNU)
(kar- MUS-teen)
Pregnancy Category: D BiCNU (Abbreviation: BCNU) Gliadel (Rx)

Classification: Antineoplastic, alkylating agent

See Also: See also Antineoplastic Agents and Alkylating Agents .

Action/Kinetics: Alkylates DNA and RNA, as well as inhibits several enzymes by carbamoylation of amino acids in proteins. Cell-cycle nonspecific. Not cross-resistant with other alkylating agents. Rapidly cleared from plasma and metabolized. Crosses blood-brain barrier (concentration in CSF at least 50% greater than in plasma). t 1/2: 15-30 min. Thirty percent excreted in urine after 24 hr, 60%-70% after 96 hr. Wafers are biodegradable in the brain when implanted into the cavity after tumor resection. Released carmustine diffuses into the surrounding brain tissue.

Uses: Injection: Alone or in combination with other antineoplastic agents for palliative treatment of primary (e.g., brain stem glioma, astrocytoma, glioblastoma, ependymoma, medulloblastoma) and metastatic brain tumors, multiple myeloma (in combination with prednisone). Advanced Hodgkin's disease and non-Hodgkin's lymphomas (not the drug of choice) in those who relapse or who fail to respond to primary therapy. Investigational: GI cancer, malignant melanoma, mycosis fungoids. Wafer: Adjunct to surgery to prolong survival in recurrent glioblastoma multiforme when surgical resection is indicated.

Contraindications: Lactation.

Special Concerns: Delayed bone marrow toxicity may be observed. Safety and effectiveness have not been established in children.

Additional Side Effects: GI: N&V within 2 hr after administration, lasting 4-6 hr. GU: Renal failure, azotemia, decrease in kidney size. Hepatic: Reversible increases in alkaline phosphatase, bilirubin, and transaminase. Other: Rapid IV administration may produce transitory intense flushing of skin and conjunctiva (onset: after 2 hr; duration: 4 hr). Pulmonary fibrosis ocular toxicity including retinal hemorrhage.

Drug Interactions: Cimetidine / Additive bone marrow suppression Digoxin / Serum levels of digoxin effect Mitomycin / Corneal and conjunctival epithelial damage Phenytoin / Serum levels of phenytoin effect

How Supplied: Wafer Implant: 7.7 mg; Powder for injection: 100 mg

?IV In previously untreated clients.
150-200 mg/m 2 q 6 weeks as a single dose. Alternate dosing schedule: 75-100 mg/m 2 on 2 successive days q 6 weeks. Reduce subsequent dosage if platelet levels are less than 100,000/mm 3 and leukocyte levels are less than 4,000/mm 3.
?Wafer Implant Recurrent glioblastoma multiforme.
Eight wafers placed in the resection cavity if size and shape of the cavity allow. If this is not possible, see the maximum number of wafers allowed.

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