Drug reference
Brain tumours | Multiple myeloma | Non-Hodgkin’s lymphomas | Hodgkin’s disease ▶BY INTRAVENOUS INFUSION ▶Adult: (consult product literature) Recurrent glioblastoma multiforme as an adjunct to surgery | High-grade malignant glioma as adjunctive treatment to surgery and radiotherapy ▶BY INTRALESIONAL IMPLANTATION ▶Adult: (consult product literature)
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Avoid in Acute porphyrias p. 1120
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NICE decisions ▶Carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma (June 2007) NICE TA121 Carmustine implants are an option for the treatment of newly diagnosed high-grade (Grade 3 or 4) glioma only for patients in whom at least 90% of the tumour has been resected. Carmustine implants should only be used within specialist centres. www.nice.org.uk/guidance/ta121
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→Appendix 1: alkylating agents
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GENERAL SIDE-EFFECTS ▶Common or very common Alopecia. anaemia. ataxia. constipation. diarrhoea. dizziness. headache. nausea. seizures. vomiting SPECIFIC SIDE-EFFECTS ▶Common or very common ▶When used by implant Abdominal pain. abscess. anxiety. asthenia. chest pain. coma. confusion. conjunctival oedema. depression. diabetes mellitus. drowsiness. dysphagia. electrolyte imbalance. embolism and thrombosis. eye pain. faecal incontinence. fever. gait abnormal. haemorrhage. hallucination. healing impaired . hydrocephalus. hyperglycaemia. hypersensitivity. hypertension. hypotension. increased risk of infection. injury. insomnia. intracranial pressure increased. leucocytosis. memory loss. meningitis. oedema. pain. paralysis. paranoia. peripheral neuropathy. personality disorder. rash. sensation abnormal. sepsis. speech impairment. stupor. thinking abnormal. thrombocytopenia. tremor. urinary incontinence. vision disorders ▶With intravenous use Acute leukaemia. appetite decreased. bone marrow depression. encephalopathy (with high doses). hepatotoxicity. myelodysplastic syndrome (following long term use). ocular toxicity. respiratory disorders. retinal haemorrhage. stomatitis ▶Uncommon ▶When used by implant Cerebral infarction. intracranial Immune system and malignant disease haemorrhage ▶Rare or very rare ▶With intravenous use Gynaecomastia. nephrotoxicity (cumulative). peripheral vascular disease (with high doses) ▶Frequency not known ▶With intravenous use Infertility. myalgia SIDE-EFFECTS, FURTHER INFORMATION Pulmonary toxicity Lung infiltration, pulmonary fibrosis, pneumonitis, and interstitial lung disease have been reported with intravenous use, some of which have been fatal. These appear to be dose-related, cumulative, and may be delayed. Hepatotoxicity Hepatotoxicity has been reported to occur with high intravenous doses, and may be delayed up to 60 days after administration; usually reversible.
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Manufacturer advises effective contraception during treatment in men or women. See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Avoid (teratogenic and embryotoxic in animals). See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Discontinue breast-feeding. l HANDLING AND STORAGE For intravenous infusion, manufacturer advises store in a refrigerator (2–8°C) and protect from light. For intralesional implant, manufacturer advises store in a freezer (–20°C)—consult product literature for further information regarding storage outside freezer.
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There can be variation in the licensing of different medicines containing the same drug. Implant ▶Gliadel (Eisai Ltd) Carmustine 7.7 mg Gliadel 7.7mg implant | 8 device P £5,203.00 (Hospital only)
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(consult product literature)
First-line fragment. Read the complete Indications and Dose section above.
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(consult product literature)
First-line fragment. Read the complete Indications and Dose section above.
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