Carmustine is an anti-cancer medication that belongs to the class of alkylating agents approved on 25 February 2003 for treating various types of cancer.

Carmustine has the ability to penetrate the CNS, so they are primarily used in the treatment of brain tumors. It is indicated as palliative therapy as a single agent or combined with other anti-cancer medicines as a secondary therapy for treating various cancers. It is used in brain tumors such as glioblastoma (cancer affecting the brain and spine), brainstem glioma, medulloblastoma (the most common type of brain cancer that affects the cerebellum, a part of the brain), astrocytoma (a type of brain tumor originate from star-shaped brain cells in the cerebrum called astrocytes), ependymoma ( Brain tumor begins in the ependymal cells in the brain and spinal cord), and metastatic brain tumors. Carmustine is also used to treat multiple myeloma in combination with prednisone. It is also used to treat Hodgkin lymphoma and non-Hodgkin lymphoma with other drugs in patients whose disease has not improved with other treatments or has recurred.

Carmustine injection comes in a powder form to be added to fluid and as a wafer (implant). The drug will be administered by the healthcare professional. Your physician will decide on the dose and frequency of the injection. Generally, for treating brain tumors, multiple myeloma, hodgkin's disease, and non-hodgkin’s disease, the dose ranges from 150-200 mg/m² injected intravenously (IV)  as a single dose or divided in two days for every 6 Weeks or 75-100 mg/m²/day intravenously (IV) for 2 days every 6 Weeks. Carmustine must be given slowly, and the infusion can take at least 2 hours to complete. The dose indicated for recurrent glioblastoma is up to 8 wafers placed in the surgical resection cavity of the brain in addition to the surgery. The dose of newly-diagnosed high-grade glioma, in addition to surgery and radiation, is up to 8 wafers placed in the surgical resection cavity of the brain. 

Common side effects of Carmustine are bleeding, bruising, tiredness, nausea, vomiting, breathing problems, decrease in blood cells, lack of voluntary coordination of muscle movements, Dizziness, Headache, redness in the eye, blurred vision due to retinal bleeding, decreased blood pressure, inflammation of the veins associated with pain, swelling, redness, and tenderness. Some serious side effects are chest pain, lung failure, liver toxicity, severe anemia, and renal failure. There may be side effects during the drug infusion, such as itching in the skin, redness at the site of administration, and shortness of breath. Inform your physician if you face any of the symptoms. 

Carmustine causes suppression of blood cell formation in the bone marrow and decreases the number of your platelets, white blood cells (leucocytes), or red blood cells (erythrocytes) either as a result of chemotherapy or other causes. It is advisable to monitor your blood counts periodically before, during, and after the treatment. The major side effect of this medicine is delayed bone marrow suppression and lung toxicity, which may show as tiredness, bleeding from the skin and mucous membranes, as well as infections, difficulty in breathing, seizure, and fever due to changes in the blood. If you notice any of these symptoms, inform the healthcare professional immediately. The use of Carmustine can lead to lung damage; an X-ray of the chest region and lung function tests will be conducted before treatment is started. 

The drug may cause allergic reactions; notify your doctor if you see any signs of rash, itchy skin, redness in the skin, Swelling of your lips or tongue, sudden cough, and low blood pressure. Inform your physician if you have any kidney disease, liver disease, lung disease, or infection and about all the other prescribed, over-the-counter medicines, vitamins, nutritional supplements, or herbal medications you take. Tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. You should not become pregnant while receiving a carmustine injection or implant.

Your healthcare provider will administer the drug to you. Do not self-administer. Store the medicine in the refrigerator; Do not freeze it.  This medicine may make you bleed, bruise, or get infections more easily. Take precautions to prevent illness and injury. This drug may make you dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely.

1. BiCNU, Gliadel (carmustine) dosing, indications, interactions, adverse effects, and more. reference.medscape.com. (Accessed December 21, 2022). https://reference.medscape.com/drug/bicnu-gliadel-carmustine-342194#5
2. Carmustine injection/implant Uses, Side Effects & Warnings. Drugs.com. Accessed December 21, 2022. https://www.drugs.com/mtm/carmustine-injection-implant.html
3. Micromedex Products: Micromedexsolutions.com. Published 2019. (Accessed 21, December 2022) s://www.micromedexsolutions.com/micromedex2/librarian/PFDefaultActionId/evidencexpert.DoIntegratedSearch?navitem=topHome&isToolPage=true#
4. Tripathi KD. Essentials of Medical Pharmacology. Jaypee Brothers Medical Publishers; 2019:920-921. Accessed December 21, 2022. file:///C:/Users/BIS/Downloads/Essentials%20of%20Medical%20Pharmacology%20(%20PDFDrive%20).pdf
5. Chaichana KL, Zaidi H, Pendleton C, McGirt MJ, Grossman R, Weingart JD, Olivi A, Quiñones-Hinojosa A, Brem H. The efficacy of carmustine wafers for older patients with glioblastoma multiforme: prolonging survival. Neurol Res. 2011 Sep;33(7):759-64. doi: 10.1179/1743132811Y.0000000006. PMID: 21756557; PMCID: PMC4612577 (Accessed December 21, 2022).

The drug information on this page is not a substitute for medical advice. It is meant for educational purposes only. For further details, consult your doctor about your medical condition to know if you can receive this treatment.