Drug reference

Busulfan

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 964, 965

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Chronic myeloid leukaemia, induction of remission ▶BY MOUTH ▶Adult: 60 micrograms/kg daily (max. per dose 4 mg); maintenance 0.5–2 mg daily Conditioning treatment before haematopoietic progenitor cell transplantation ▶BY MOUTH, OR BY INTRAVENOUS INFUSION ▶Adult: (consult local protocol) Conditioning treatment before haematopoietic progenitor cell transplantation in patients who are candidates for a reduced-intensity conditioning (RIC) regimen ▶BY INTRAVENOUS INFUSION ▶Adult: (consult local protocol) DOSES AT EXTREMES OF BODY-WEIGHT ▶Dose may need to be calculated based on body surface area or adjusted ideal body weight in obese patients— consult product literature.

PDF pages 964, 965

Cautions

Avoid in Acute porphyrias p. 1120. high dose (antiepileptic prophylaxis required). history of seizures (antiepileptic prophylaxis required). ineffective once in blast crisis phase. previous progenitor cell transplant (increased risk of hepatic veno-occlusive disease). previous radiation therapy (increased risk of hepatic veno- occlusive disease). risk of second malignancy. three or more cycles of chemotherapy (increased risk of hepatic veno-occlusive disease)

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Safety

Important Safety Information

RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES See Cytotoxic drugs p. 938.

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Interactions

→Appendix 1: alkylating agents

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Side Effects

GENERAL SIDE-EFFECTS ▶Common or very common Alopecia. diarrhoea. hepatic disorders. nausea. respiratory disorders. sinusoidal obstruction syndrome. skin reactions. thrombocytopenia. vomiting ▶Uncommon Seizure ▶Rare or very rare Cataract. eye disorders SPECIFIC SIDE-EFFECTS ▶Common or very common ▶With intravenous use Anaemia. anxiety. appetite decreased. arrhythmias. arthralgia. ascites. asthenia. asthma. cardiomegaly. chest pain. chills. confusion. constipation. cough. depression. dizziness. dyspnoea. dysuria. electrolyte imbalance. embolism and thrombosis. fever. gastrointestinal discomfort. gastrointestinal disorders. haemorrhage. headache. hiccups. hyperglycaemia. hypersensitivity. hypertension. hypoalbuminaemia. hypotension. increased risk of infection. insomnia. mucositis. myalgia. nervous system disorder. neutropenia . oedema. pain. pancytopenia. pericardial effusion. pericarditis. reactivation of infections. renal disorder. renal impairment. stomatitis. vasodilation. weight increased ▶With oral use Amenorrhoea (may be reversible). azoospermia. bone marrow disorders. cardiac tamponade. delayed puberty. hyperbilirubinaemia. infertility male. leucopenia. leukaemia. menopausal symptoms. oral disorders. ovarian and fallopian tube disorders. testicular atrophy ▶Uncommon ▶With intravenous use Capillary leak syndrome. delirium. encephalopathy. hallucination. hypoxia. intracranial haemorrhage ▶Rare or very rare ▶With oral use Dry mouth. erythema nodosum. gynaecomastia. myasthenia gravis. radiation injury. Sjögren’s syndrome ▶Frequency not known ▶With intravenous use Hypogonadism. ovarian failure. premature menopause. sepsis SIDE-EFFECTS, FURTHER INFORMATION Lung toxicity Discontinue if lung toxicity develops. Secondary malignancy Use of busulfan is associated with an increased incidence of secondary malignancy.

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Conception And Contraception

Manufacturers advise effective contraception during and for 6 months after treatment in men or women. See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.

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Pregnancy

Avoid (teratogenic in animals). See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.

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Breast Feeding

Discontinue breast-feeding. Immune system and malignant disease

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Hepatic Impairment

Manufacturer advises caution (no information available)—monitor hepatic function, especially following transplant (consult product literature).

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Monitoring Requirements

▶Monitor cardiac and liver function. ▶Frequent blood tests are necessary because excessive myelosuppression may result in irreversible bone-marrow aplasia.

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Dose and formulations

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: capsule, oral suspension, oral solution Tablet ▶Busulfan (Non-proprietary) Busulfan 2 mg Busulfan 2mg tablets | 25 tablet P £69.02 DT = £69.02 Solution for infusion ▶Busulfan (Non-proprietary) Busulfan 6 mg per 1 ml Busulfan 60mg/10ml concentrate for solution for infusion vials | 8 vial P £1,529.50–£2,157.52 (Hospital only) ▶Busilvex (Pierre Fabre Ltd) Busulfan 6 mg per 1 ml Busilvex 60mg/10ml concentrate for solution for infusion ampoules | 8 ampoule P £1,610.00 (Hospital only)

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Dose text by age group

Adult

60 micrograms/kg daily (max. per dose 4 mg);

First-line fragment. Read the complete Indications and Dose section above.

PDF page 964

Adult

(consult local protocol)

First-line fragment. Read the complete Indications and Dose section above.

PDF page 965

Adult

(consult local protocol)

First-line fragment. Read the complete Indications and Dose section above.

PDF page 965

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Busulfan

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 964, 965

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF pages 964, 965

Cautions

PDF page 965

Safety

Important Safety Information

RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES See Cytotoxic drugs p. 938.

PDF page 965

Interactions

→Appendix 1: alkylating agents

PDF page 965

Side Effects

PDF page 965

Conception And Contraception

Manufacturers advise effective contraception during and for 6 months after treatment in men or women. See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.

PDF page 965

Pregnancy

Avoid (teratogenic in animals). See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.

PDF page 965

Breast Feeding

Discontinue breast-feeding. Immune system and malignant disease

PDF page 965

Hepatic Impairment

Manufacturer advises caution (no information available)—monitor hepatic function, especially following transplant (consult product literature).

PDF page 965

Monitoring Requirements

▶Monitor cardiac and liver function. ▶Frequent blood tests are necessary because excessive myelosuppression may result in irreversible bone-marrow aplasia.

PDF page 965

Dose and formulations

Medicinal Forms

PDF page 965

Dose text by age group

Adult

60 micrograms/kg daily (max. per dose 4 mg);

First-line fragment. Read the complete Indications and Dose section above.

PDF page 964

Adult

(consult local protocol)

First-line fragment. Read the complete Indications and Dose section above.

PDF page 965

Adult

(consult local protocol)

First-line fragment. Read the complete Indications and Dose section above.

PDF page 965

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.