Deepika vegiraju at 07:47, 15 June 2022

2022-06-15T07:47:56Z

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== '''What is Carmustine?''' ==

* Carmustine ('''BiCNU''') is '''a nitrosourea''' used alone and in combination with other [[antineoplastic agents]] in the treatment of several forms of cancer including [[leukemias]], [[lymphomas]], and breast, testicular, ovarian, gastric and [[pancreatic cancer]].

[[File:Carmustine.svg|thumb|Carmustine]]

[[File:Carmustine ball-and-stick.png|thumb|Carmustine ball-and-stick]]

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== '''What are the uses of this medicine?''' ==

Carmustine ('''BiCNU''') is used as [[palliative therapy]] as a single agent or in established combination therapy in the following:
* Brain tumors [[glioblastoma]], [[brainstem glioma]], [[medulloblastoma]], [[astrocytoma]], [[ependymoma]], and metastatic [[brain tumors]].
* [[Multiple myeloma]] in combination with [[prednisone]].
* Relapsed or refractory [[Hodgkin's lymphoma]] in combination with other approved drugs.
* Relapsed or refractory [[Non-Hodgkin's lymphomas]] in combination with other approved drugs.

== '''How does this medicine work?''' ==

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* Carmustine (kar mus' teen), which is also known as BICNU, is '''a nitrosourea''' that '''acts as an alkylating agent''' and is used in the therapy of several forms of [[leukemia]], [[lymphoma]] and solid organ cancer.
* Like [[cyclophosphamide]], '''carmustine requires activation in the liver''' to form its active intermediates '''which act by modifying and cross linking purine bases in DNA, thus inhibiting DNA, RNA and protein synthesis and leading to cell death in rapidly dividing cells'''.
* Carmustine '''also forms adducts with intracellular proteins'''.

== '''Who Should Not Use this medicine ?''' ==

This medicine cannot be used in patients with:
* previous [[hypersensitivity]] to BiCNU or its components.

== '''What drug interactions can this medicine cause?''' ==

* Greater [[myelosuppression]] (e.g., [[leukopenia]] and [[neutropenia]]) has been reported when oral cimetidine has been coadministered with carmustine. Consider alternative drugs to [[cimetidine]].
* [[Phenobarbital]] induces the metabolism of carmustine and may compromise antitumor activity of BiCNU.
* BiCNU when coadministered with [[phenytoin]] may reduce phenytoin serum concentrations. Consider alternative drugs to phenytoin.

== '''Is this medicine FDA approved?''' ==

* Carmustine was approved for use in the United States in 1977, and its current uses include treatment of breast, gastric, liver, pancreatic, lung, brain, ovarian and testicular cancer, [[malignant melanoma]], Hodgkin and [[non-Hodgkin lymphoma]] and [[multiple myeloma]].
* Carmustine is given [[intravenously]] and is available in liquid formulations (100 mg vials) in generic forms and under the trade names '''Gliadel''' or '''BiCNU'''.

== '''How should this medicine be used?''' ==

'''Recommended dosage:'''
* As a single agent, 150 to 200 mg/m2BiCNU [[intravenously]] every 6 weeks as a single dose or divided into daily injections such as 75 to 100 mg/m2on 2 successive days.
* Adjust dose for combination therapy or in patients with reduced [[bone marrow]] reserve.

'''Administration:'''
* Administer [[reconstituted]] solution only as a slow [[intravenous infusion]] over at least 2 hours.

== '''What are the dosage forms and brand names of this medicine?''' ==

This medicine is available in fallowing doasage form:
* '''As injection:''' 100 mg of carmustine [[lyophilized]] powder in a single-dose vial for reconstitution and a vial containing 3mL sterile diluent (Dehydrated Alcohol Injection, USP).

This medicine is available in fallowing brand namesː
* '''BiCNU''' ; '''Gliadel'''

=='''What side effects can this medication cause?'''==

The most common side effects of this medicine include:
* [[nausea]]
* vomiting
* renal toxicity
* [[pneumonitis]]
* [[pulmonary toxicity]]
* [[myelosuppression]]

==''' What special precautions should I follow?''' ==

* A serious and frequent toxicity of BiCNU is delayed [[myelosuppression]] and usually occurs 4 to 6 weeks after drug administration. Hence, patients should be advised to get blood counts monitored weekly for at least 6 weeks. The bone marrow toxicity of BiCNU is cumulative.
* Advise patients to contact a health care professional immediately for any of the following: shortness of breath, particularly during exercise, dry, hacking cough, fast, shallow breathing, gradual unintended weight loss, tiredness, aching joints and muscles, clubbing (widening and rounding) of the tips of the fingers or toes.
* Injection site reactions may occur during the administration of BiCNU. Rapid [[intravenous infusion]] of BiCNU may produce intensive flushing of the skin and [[suffusion]] of the [[conjunctiva]] within 2 hours, lasting about 4 hours. [[Extravasation]] may occur; monitor infusion site closely during administration.
* Long-term use of [[Nitrosourea|nitrosoureas]], such as BiCNU, has been reported to be associated with the development of secondary [[malignancies]]. Monitor patient periodically for such signs and apprise the patient of the symptoms for which they need to seek medical help.
* Ocular toxicity has occurred when administered via unapproved [[Intraarterial use|intraarterial]] [[Intracarotid infusion|intracarotid]] route. Safety and effectiveness of the intra-arterial route have not been established.
* There are no adequate and well- controlled studies in pregnant women. Advise pregnant women of the potential risk to the fetus. Advise females of reproductive potential to use highly effective [[contraception]] during and after treatment with BiCNU for at least 6 months after therapy.

== '''What to do in case of emergency/overdose?''' ==

Symptoms of overdosage may include:
* [[myeloablation]]

'''Management of overdosage:'''
* No proven antidotes have been established for BiCNU overdosage.

== '''Can this medicine be used in pregnancy?''' ==

* BiCNU (carmustine for injection) can cause fetal harm when administered to a pregnant woman based on the mechanism of action.
* Limited available data with BiCNU use in pregnant women are insufficient to inform a drug-associated risk of major birth defects and miscarriage.

=='''Can this medicine be used in children?'''==

* Safety and effectiveness in children have not been established.

== '''What are the active and inactive ingredients in this medicine?''' ==

'''Active ingredient:'''
* CARMUSTINE

'''Inactive ingredients:'''
* ALCOHOL

== '''Who manufactures and distributes this medicine?''' ==

'''Manufactured by:'''
* Gland Pharma Limited
* Visakhapatnam,
* Andhra Pradesh, India.

'''Manufactured for:'''
* Avet Pharmaceuticals Inc.
* East Brunswick, NJ

== '''What should I know about storage and disposal of this medication?''' ==

* Store product and diluent in a refrigerator (2°-8°C, 36°-46°F).

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[[Category:Orphan drugs]]
[[Category:Ureas]]
[[Category:Nitrosoureas]]
[[Category:Alkylating antineoplastic agents]]
[[Category:IARC Group 2A carcinogens]]
[[Category:Organochlorides]]
[[Category:Cancer treatments]]
[[Category:Chloroethyl compounds]]
[[Category:Multiple Chemboxes|X]]

Carmustine - Revision history

Deepika vegiraju at 07:47, 15 June 2022