Parenteral Manual

Carmustine

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
BCNU, BiCNU
Classification: 
Antineoplastic, alkylating agent - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
August 2024
Indications: 
  • Brain tumors
  • Non-Hodgkin's lymphoma

THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.

Reconstitution and Stability: 
  • Unopened vials of dry powder should be kept in fridge. Stable 36 days at room temperature. DO NOT use if powder has liquefied.
  • Available as 100 mg vial. Reconstitute using 3 mL vial of absolute alcohol  (supplied sterile diluent) . Shake well and allow to dissolve completely, then add 27 mL sterile water for injection and shake well.
  • Final concentration is 3.3 mg/mL in 10% alcohol
  • Solution should be clear and colorless .  Crystals that form during refrigeration can be redissolved by warming the vial to room temperature and shaking the vial.
  • Further dilute with IV solution to a concentration of 0.2 - 2 mg/mL and dispense in non-PVC bag. Stable 48 hours in refrigerator or 8 hours at room temperature.  Use bag within 4 hours of reconstitution.
  • Protect from light
  • Glass or non-PVC containers  and non-PVC (polyethylene) tubing are recommended for administration
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: ondansetron, filgrastim, granisetron

Incompatible: sodium bicarbonate, allopurinol

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

NO
IV Intermittent Infusion

YES

- use non-PVC bag and tubing
Usual Dilution: 0.2  - 2 mg/mL (minimum 30-50 mL IV fluid) Infusion time: 1-2 hours
IV Continuous Infusion                                    NO, not stable in solution long enough at room temperature
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:

  • 200 - 250 mg/m2 once every 4-6 weeks

Adult:

  • 150 - 200 mg/m2 once every 6 weeks
  • Non-Hodgkin's Lymphoma :  60 mg/m2 every 4 - 6 weeks. 
    Dose reduction in renal failure:  creatinine clearance < 12 mL/min - 25-50% dosing

** dosage may differ according to protocol

Potential hazards of parenteral administration: 

Immediate (within a few minutes to hours):

  • Burning at injection site or along vein - administer slowly according to patient's tolerance - local warm or cold compresses may lessen pain
  • Intense facial flushing, hypotension (from too concentrated or rapid infusion)
  • VESICANT: extravasation may cause tissue necrosis - If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.
  • Nausea and vomiting (moderate-severe) dose-dependent
  • Ataxia, dizziness
  • Metallic taste
  • Hypotension with high dose therapy (due to alcohol content of diluent)

Early (days to weeks):

  • Diarrhea, esophagitis, anorexia
  • Skin discolouration along vein (hyperpigmentation)
  • Myelosuppression
  • Alopecia

Delayed (within a few weeks to months):

  • Myelosuppression - nadir, 8 days, effect on bone marrow is delayed and cumulative and may last many weeks
  • Hepatotoxicity (elevated liver enzymes, bilirubin, VOD [veno-occlusive disease] with very high doses)
  • Transient increase in BUN
  • Pulmonary fibrosis, clinical signs are; dyspnea, tachypnea and a dry hacking cough. Increased risk with increasing cumulative doses (> 1000 mg/m2) and mediastinal irradiation.  Acute lung injury can occur  1-3 months after treatment.  Pulmonary fibrosis may be delayed up to 3 years.

- Treatment for unusual side effects are available through the study chair identified on the front page of the protocol and/or pharmacy

Notes: 
  • Monitor hematological, liver, pulmonary and renal function
  • Avoid contact with skin. Wash spills with copious amounts of water.  Accidental skin contact may cause burning and brown discoloration of the skin.
  • Bone marrow suppression is prolonged
  • Drug interactions with cimetidine, digoxin (oral), phenytoin (oral), and phenobarbital; consult specialized references for details
  • May discolour urine

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