Carmustine (BCNU, BiCNU®)
Pronounce: CAR-mus-teen
Classification: Alkylating Agent
About Carmustine (BCNU, BiCNU®)
Alkylating medications damage the DNA of some cells. This stops them from dividing and growing, and instead, the cells die. Cancer cells can divide and grow quickly, and some are affected by alkylating medications.
How to Take Carmustine
Carmustine is most often given through intravenous (IV, into a vein) infusion. The dose depends on your size and the tumor type being treated.
Even when carefully and correctly administered by trained personnel, this drug may cause a feeling of burning and pain. There is a risk that this drug may leak out of the vein at the injection site, rcausing tissue damage that can be severe. If the area of injection becomes red, swollen, or painful at any time during or after the injection, tell your care team right away. Do not apply anything to the site unless told to do so by your provider.
Your blood count levels can be affected if you take carmustine and cimetidine (Tagamet®) at the same time. Your provider or pharmacist can recommend a different medication to take instead of cimetidine. The blood levels of this medication can be affected by certain foods and medications, so they should be avoided. These include phenobarbital and phenytoin, among others. Be sure to tell your healthcare provider about all medications and supplements you take.
Carmustine comes in a few other formulatons, such as a wafer (called Gliadel wafer), that is placed into a surgical cavity after the removal of a brain tumor. It can also be placed directly into an artery, called the intraarterial intracarotid route, that leads to your brain. This type of treatment is still being investigated and can cause problems with your hearing. Carmustine can also be used in a topical formula that is applied to the skin in the treatment of cutaneous lymphoma. The medication stays in the area around the wafer or the application area, so these patients are often not at risk for the following side effects.
Possible Side Effects
These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.
Low White Blood Cell Count (Leukopenia or Neutropenia)
White blood cells (WBC) help your body fight infection. While you are having treatment for cancer, your WBC count can drop, putting you at a higher risk of an infection. Tell your provider right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips for preventing infection:
- Hand washing: both yours and your visitors is the best way to prevent the spread of infection.
- Avoid large crowds and people who are sick (those who have a cold, fever, or cough, or live with someone with these symptoms).
- When working outside, wear clothes that protect you, like long pants and gloves.
- Do not handle pet waste.
- Keep all cuts and scratches clean.
- Shower or bathe daily.
- Brush your teeth at least twice a day.
- Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
- Ask your providers before scheduling dental appointments or procedures.
- Ask your providers before you or someone you live with has any vaccines.
Lung Changes
This medication may cause serious pneumonitis and pulmonary fibrosis (a scarring and stiffening of the lung tissue), especially when you have received high doses. These problems can happen months to years after treatment and may be more common in people with pre-existing lung problems. You may have breathing tests (pulmonary function tests) performed every so often. Call your provider right away if you have shortness of breath, cough, wheezing, aching joints and muscles, clubbing of the fingers or toes (enlarged tips and changes in nails), or have a hard time breathing.
Low Red Blood Cell Count (Anemia)
Anemia is when your red blood cell count is lower than normal. Red blood cells carry oxygen to the tissues in your body. When your red cell count is low, you may feel tired or weak. Tell your providers if you have shortness of breath, trouble breathing, or pain in your chest. If your count gets too low, you may receive a blood transfusion.
Low Platelet Count (Thrombocytopenia)
Platelets are blood cells that help your blood clot. Thrombocytopenia is when your platelet count is lower than normal, and you are at a higher risk of bleeding. Tell your providers if you have any bruising or bleeding, including nose bleeds, bleeding gums, or blood in your urine or stool. If your count gets too low, you may receive platelets from a donor.
- Do not use a razor (an electric razor is fine).
- Do not do activities that can cause injury or bleeding.
- Talk to your provider before taking any non-steroidal, anti-inflammatory medications (NSAIDs) like Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), and others. These can raise the risk of bleeding.
- Use a soft-bristle toothbrush to brush your teeth. Ask your provider about flossing or using toothpicks.
Nausea and/or Vomiting
Talk to your providers if you have nausea and/or vomiting. They can prescribe medications to help you. Making changes to your diet can also help. Avoid things that make your symptoms worse, like heavy or greasy/fatty foods and spicy or acidic foods, like tomatoes, lemons, and oranges. Try saltines or ginger ale to help your symptoms.
Call your providers if you cannot keep fluids down for more than 12 hours or if you feel lightheaded or dizzy.
Infusion-Related Side Effects
Some people may have a reaction during infusion of this medication. These can be:
- Chills.
- Fever.
- Low blood pressure.
- Nausea.
- Vomiting.
Your provider will monitor you for symptoms of infusion-related reactions.
Kidney Problems
This medication can cause kidney problems, like an increased creatinine level. Your provider may monitor for kidney problems with blood tests. Symptoms may be:
- Less urine output than normal.
- Blood in the urine.
- Swelling in the ankles.
- Loss of appetite.
Tell your provider if you have any of these symptoms.
Liver Toxicity
This medication can cause liver toxicity, or liver problems, which your provider may monitor for with blood tests called liver function tests. Symptoms may be:
- Yellowing of your skin or eyes.
- Dark or brown urine.
- Pain in your abdomen (belly).
Tell your provider if you have any of these symptoms.
Seizures
A seizure is caused by abnormal electrical activity in the brain and can lead to uncontrollable shaking of the body, loss of consciousness, and convulsions. The length and severity of the seizure may vary. If you are experiencing a seizure have someone call 911.
Secondary Malignancies
There is a low risk of developing leukemia or other types of cancer due to treatment with this medication, which can happen many years after your last dose. This is most often linked with having a lot of treatments or high doses. Your provider will give instructions on how to best follow up and be monitored for this.
Sexual and Reproductive Concerns
There is a higher risk of health problems for your baby if you are pregnant, become pregnant, or get someone pregnant while on this medication. To lower the risk of birth defects, you should use birth control (contraception) to avoid pregnancy.
Talk with your provider about what kind of birth control is safest for you and your partner.
If you can become pregnant, you will need to use effective birth control during treatment and for 6 months after the last dose of this medication, even if your menstrual cycle has stopped or changed.
If you can get someone pregnant, you will need to use effective birth control during treatment and for 3 months after the last dose of this medication, even if you believe you are not producing sperm.
You should not breastfeed during treatment with this medication.