carmustine

High Alert

Brain tumors.
Multiple myeloma (in combination with prednisone).
Relapsed or refractory Hodgkin's lymphoma (in combination with other agents).
Relapsed or refractory non-Hodgkin's lymphoma (in combination with other agents).

Contraindicated in:

Hypersensitivity;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Infection;
Depressed bone marrow reserve;
Lung disease (↑ risk of pulmonary fibrosis);
Renal impairment;
Hepatic impairment;
Rep: 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 , renal failure

Hemat: anemia, LEUKOPENIA, THROMBOCYTOPENIA

Local: pain (at IV site)

Resp: PULMONARY FIBROSIS

Drug-drug:

↑bone marrow depression with other antineoplastics or radiation therapy.
May ↓ antibody response to live-virus vaccines and ↑ risk of adverse reactions.

(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).

Therapeutic effects:

Death of rapidly replicating cells, especially malignant ones.

Therapeutic Classification: antineoplastics

Pharmacologic Classification: alkylating agents

Absorption: IV administration results in complete bioavailability; following implantation, action is primarily local.

Distribution: Highly lipid soluble; readily penetrates CSF.

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

Half-Life: 15–75 min.

(effect on platelet counts)

ROUTE	ONSET	PEAK	DURATION
IV	days	4–5 wk	6 wk

Explain the purpose and side effects of carmustine. Do not stop receiving drug without consulting health care provider. If an appointment is missed, reschedule as soon as possible.
Instruct patient to notify health care provider 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 provider if shortness of breath or ↑ cough occurs.
Emphasize need for periodic lab tests to monitor for side effects.
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 provider.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Rep: May cause fetal harm. Advise women of reproductive potential of the need for highly effective contraception during and for ≥6 mo after completion of therapy or implantation of wafer and to avoid breastfeeding during and for ≥7 days therapy or wafer implantation. Advise men with female partners of reproductive potential to use highly effective contraception during and for ≥3 mo after final dose of therapy or wafer implantation . May impair fertility in men.

kar-MUS-teen

NDC Code

0781- Sandoz Inc.
- 0781-3474- CARMUSTINE
  - 0781-3474-32- 1 KIT in 1 CARTON (0781-3474-32) * 30 mL in 1 VIAL, SINGLE-DOSE (0781-3470-90) * 3 mL in 1 VIAL (0781-3473-93)

10702- KVK-Tech, Inc.
- 10702-361- Carmustine
  - 10702-361-99- 1 KIT in 1 CARTON (10702-361-99) * 30 mL in 1 VIAL, SINGLE-DOSE (10702-366-03) * 3 mL in 1 VIAL (10702-365-03)

14593- Emcure Pharmaceuticals Limited
- 14593-823-
  - 14593-823-01- 15000 g in 1 DRUM (14593-823-01)

14593- Emcure Pharmaceuticals Limited
- 14593-823-
  - 14593-823-02- 50000 g in 1 DRUM (14593-823-02)

14593- Emcure Pharmaceuticals Limited
- 14593-823-
  - 14593-823-03- 5000 g in 1 JAR (14593-823-03)

14593- Emcure Pharmaceuticals Limited
- 14593-823-
  14593-823-04- 130 g in 1 BOTTLE (14593-823-04)

23155- Heritage Pharmaceuticals Inc. d/b/a Avet Pharmaceuticals Inc.
- 23155-649- CARMUSTINE
  23155-649-41- 1 KIT in 1 CARTON (23155-649-41) * 3 mL in 1 VIAL (23155-648-31) * 30 mL in 1 VIAL, SINGLE-DOSE (23155-647-31)

23155- Heritage Pharmaceuticals Inc. d/b/a Avet Pharmaceuticals Inc.
- 23155-790- CARMUSTINE
  - 23155-790-41- 1 KIT in 1 CARTON (23155-790-41) * 3 mL in 1 VIAL (23155-789-31) * 30 mL in 1 VIAL, SINGLE-DOSE (23155-788-31)

24338- Azurity Pharmaceuticals, Inc.
- 24338-050- Gliadel
  - 24338-050-08- 8 POUCH in 1 BOX (24338-050-08) / 1 WAFER in 1 POUCH

43598- Dr. Reddy's Laboratories Inc.
- 43598-628- carmustine
  - 43598-628-57- 1 KIT in 1 CARTON (43598-628-57) * 3 mL in 1 VIAL (43598-860-11) * 30 mL in 1 VIAL, SINGLE-DOSE (43598-861-11)

46708- Alembic Pharmaceuticals Limited
- 46708-659- Carmustine
  - 46708-659-02- 1 KIT in 1 CARTON (46708-659-02) * 30 mL in 1 VIAL, SINGLE-DOSE (46708-658-31) * 3 mL in 1 VIAL (46708-660-03)

50137- Veranova, L.P.
- 50137-0686-
  - 50137-0686-1- 5 POWDER in 1 BAG (50137-0686-1)

50683- American Pacific Corporation
- 50683-0017-
  50683-0017-2- 1 kg in 1 CAN (50683-0017-2)

54893- MSN Laboratories Private Limited
- 54893-0055-
  54893-0055-2- 30 kg in 1 DRUM (54893-0055-2)

55718- Isomedix Operations, Inc
- 55718-139-
  55718-139-08- 8 POUCH in 1 BOX (55718-139-08) / 1 WAFER in 1 POUCH

57821- Agno Pharma Jiangsu
- 57821-002-
  57821-002-01- 3 kg in 1 DRUM (57821-002-01)

57884- Jiangsu Hengrui Pharmaceuticals Co., Ltd.
- 57884-0032-
  57884-0032-1- 2 kg in 1 CAN (57884-0032-1)

58621- Piramal Pharma Solutions Inc.
- 58621-002-
  58621-002-01- 30 mL in 1 VIAL (58621-002-01)

59651- Aurobindo Pharma Limited
- 59651-168-
  59651-168-37- 50 kg in 1 DRUM (59651-168-37)

59981- Zhejiang ChemPacific Corporation
- 59981-034-
  59981-034-01- 50 g in 1 BAG (59981-034-01)

59981- Zhejiang ChemPacific Corporation
- 59981-034-
  59981-034-02- 100 g in 1 BAG (59981-034-02)

59981- Zhejiang ChemPacific Corporation
- 59981-034-
  59981-034-03- 200 g in 1 BAG (59981-034-03)

59981- Zhejiang ChemPacific Corporation
- 59981-034-
  59981-034-04- 250 g in 1 BAG (59981-034-04)

59981- Zhejiang ChemPacific Corporation
- 59981-034-
  59981-034-05- 300 g in 1 BAG (59981-034-05)

59981- Zhejiang ChemPacific Corporation
- 59981-034-
  59981-034-06- 350 g in 1 BAG (59981-034-06)

59981- Zhejiang ChemPacific Corporation
- 59981-034-
  59981-034-07- 400 g in 1 BAG (59981-034-07)

59981- Zhejiang ChemPacific Corporation
- 59981-034-
  59981-034-08- 450 g in 1 BAG (59981-034-08)

62332- Alembic Pharmaceuticals Inc.
- 62332-659- Carmustine
  62332-659-02- 1 KIT in 1 CARTON (62332-659-02) * 30 mL in 1 VIAL, SINGLE-DOSE (62332-658-31) * 3 mL in 1 VIAL (62332-660-03)

68475- Navinta LLC
- 68475-503- Carmustine
  - 68475-503-01- 1 KIT in 1 CARTON (68475-503-01) * 3 mL in 1 VIAL (68475-502-01) * 30 mL in 1 VIAL, SINGLE-DOSE (68475-500-01)

70121- Amneal Pharmaceuticals LLC
- 70121-1482- carmustine
  - 70121-1482-2- 1 KIT in 1 CARTON (70121-1482-2) * 3 mL in 1 VIAL (70121-3639-1) * 30 mL in 1 VIAL, SINGLE-DOSE (70121-1668-1)

70225- NATCO PHARMA LIMITED
- 70225-1107-
  - 70225-1107-4- 1 kg in 1 DRUM (70225-1107-4)

70710- Zydus Pharmaceuticals USA Inc.
- 70710-1525- carmustine
  70710-1525-9- 1 KIT in 1 CARTON (70710-1525-9) * 3 mL in 1 VIAL (70710-1523-1) * 30 mL in 1 VIAL, SINGLE-DOSE (70710-1524-1)

71288- Meitheal Pharmaceuticals Inc.
- 71288-126- Carmustine
  - 71288-126-90- 1 KIT in 1 CARTON (71288-126-90) * 30 mL in 1 VIAL, SINGLE-DOSE (71288-124-30) * 3 mL in 1 VIAL (71288-125-03)

72205- Novadoz Pharmaceuticals LLC
- 72205-198- Carmustine
  - 72205-198-01- 1 KIT in 1 CARTON (72205-198-01) * 3 mL in 1 VIAL (72205-196-01) * 30 mL in 1 VIAL, SINGLE-DOSE (72205-197-01)

75907- Dr. Reddy's Laboratories Inc.
- 75907-327- carmustine
  - 75907-327-11- 1 KIT in 1 CARTON (75907-327-11) * 3 mL in 1 VIAL (75907-328-11) * 30 mL in 1 VIAL, SINGLE-DOSE (75907-326-11)

76339- Apothecon Pharmaceuticals Pvt Ltd
- 76339-121-
  - 76339-121-00- 1 BAG in 1 DRUM (76339-121-00) / 1 BAG in 1 BAG / .999 kg in 1 BAG

76339- Apothecon Pharmaceuticals Pvt Ltd
- 76339-121-
  76339-121-01- 1 BAG in 1 DRUM (76339-121-01) / 1 BAG in 1 BAG / 4.999 kg in 1 BAG

87072- Vannsh Life Sciences Private Limited
- 87072-0002-
  87072-0002-1- 50 kg in 1 BOTTLE, GLASS (87072-0002-1)

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Indications ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Availability ⬆ ⬇

Route/Dosage ⬆ ⬇

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Classifications ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Pronunciation ⬆ ⬇

Code ⬆