• Alone or with other treatments (surgery, radiation) in the management of:
  • Brain tumors,
  • Multiple myeloma,
  • Hodgkin’s disease,
  • Other lymphomas.

Contraindicated in:

• Hypersensitivity
• OB: Pregnancy (may cause fetal harm)
• Lactation: Lactation.

Use Cautiously in:

• Infections
• Depressed bone marrow reserve
• Impaired pulmonary, hepatic, or renal function
• Other chronic debilitating illnesses
• Women of reproductive potential or men with female partners of reproductive potential
• Geri: Consider age related ↓ in body mass, renal/hepatic/cardiovascular function, concurrent medications and chronic illnesses.

Derm: alopecia.

GI: hepatotoxicity, nausea, vomiting, anorexia, diarrhea, esophagitis.

GU: ↓ fertility (males), renal failure.

Hemat: anemia, LEUKOPENIA, THROMBOCYTOPENIA.

Local: pain at IV site.

Resp: PULMONARY FIBROSIS, pulmonary infiltrates.

Drug-Drug:

• ↑ bone marrow depression with other antineoplastics or radiation therapy.
• Smoking ↑ risk of pulmonary toxicity.
• May ↓ antibody response to live-virus vaccines and ↑ risk of adverse reactions.
• Myelosuppression may be ↑ by cimetidine.

(Generic available)

• Lyophilized powder for injection: 100 mg/vial;
• Intracavitary wafer: 7.7 mg;

• IV (Adults and Children): 150–200 mg/m² every 6–8 wk or 75–100 mg/m²/day for 2 days every 6 wk or 40 mg/m²/day for 5 days every 6 wk.
• Intracavitary (Adults): 61.6 mg (8 wafers) placed in cavity created during surgical resection of brain tumor.

BiCNU, Gliadel

• Inhibits DNA and RNA synthesis (cell-cycle phase–nonspecific).

• Death of rapidly replicating cells, especially malignant ones.

Therapeutic Classification: antineoplastics

Pharmacologic Classification: alkylating agents

Absorption: Following IV administration, absorption is complete. Following implantation, action is primarily local.

Distribution: Highly lipid soluble; readily penetrates CSF. Enters breast milk.

Metabolism/Excretion: Rapidly metabolized. Some metabolites have antineoplastic activity.

Half-life: Biologic: 15–30 min; chemical: 5 min.

(effect on platelet counts)

• Instruct patient to notify health care professional if fever; chills; sore throat; signs of infection; lower back or side pain; difficult or painful urination; bleeding gums; bruising; petechiae; or blood in urine, stool, or emesis occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor. Patients should be cautioned not to drink alcoholic beverages or to take products containing aspirin or NSAIDs.
• Instruct patient to notify health care professional if shortness of breath or increased cough occurs. Encourage patient not to smoke; smokers are at greater risk for pulmonary toxicity.
• Instruct patient to inspect oral mucosa for redness and ulceration. If mouth sores occur, advise patient to use sponge brush and rinse mouth with water after eating and drinking. Stomatitis may require treatment with opioid analgesics.
• Discuss with patient the possibility of hair loss. Explore coping strategies.
• Instruct patient not to receive any vaccinations without advice of health care professional.
• May be teratogenic. Advise female patient of reproductive potential of the need for highly effective contraception during and for at least 6 mo after completion of therapy or implantation of wafer and to avoid breastfeeding during and for at least 7 days therapy or wafer implantation. Advise male patients with female partners of reproductive potential to use highly effective contraception during and for at least 3 mo after final dose of therapy or wafer implantation. Inform male patient that carmustine may impair fertility.
• Emphasize need for periodic lab tests to monitor for side effects.

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