In the U.S.—

In Canada—

Another commonly used name is BCNU.

• Antineoplastic

Carmustine ( kar-MUS-teen) belongs to the group of medicines known as alkylating agents. It is used to treat cancer of the lymph system, cancerous brain tumors, and a certain type of cancer in the bone marrow. It may also be used to treat other kinds of cancer, as determined by your doctor.

Carmustine interferes with the growth of cancer cells, which are eventually destroyed. Since the growth of normal body cells may also be affected by carmustine, other effects will also occur. Some of these may be serious and must be reported to your doctor. Other effects, like hair loss, may not be serious but may cause concern. Some effects may not occur for months or years after the medicine is used.

Before you begin treatment with carmustine, you and your doctor should talk about the good this medicine will do as well as the risks of using it.

Carmustine is to be administered only by or under the immediate supervision of your doctor. It is available in the following dosage form:

Parenteral
• Injection (U.S. and Canada)

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For carmustine, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to carmustine.

Pregnancy—There is a chance that this medicine may cause birth defects if either the male or female is taking it at the time of conception or if it is taken during pregnancy. Carmustine causes toxic or harmful effects in the fetus of rats and rabbits and causes birth defects in rats at doses about the same as the human dose. In addition, many cancer medicines may cause sterility which could be permanent. Although this has only been reported in animals with this medicine, the possibility should be kept in mind.

Be sure that you have discussed this with your doctor before receiving this medicine. It is best to use some kind of birth control while you are receiving carmustine. Tell your doctor right away if you think you have become pregnant while receiving carmustine.

Breast-feeding—Because carmustine may cause serious side effects, breast-feeding is generally not recommended while you are receiving it.

Children—Although there is no specific information comparing use of carmustine in children with use in other age groups, this medicine is not expected to cause different side effects or problems in children than it does in adults.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of carmustine in the elderly with use in other age groups.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving carmustine, it is especially important that your health care professional know if you are taking any of the following:

• Amphotericin B by injection (e.g., Fungizone) or
• Antithyroid agents (medicine for overactive thyroid) or
• Azathioprine (e.g., Imuran) or
• Chloramphenicol (e.g., Chloromycetin) or
• Colchicine or
• Flucytosine (e.g., Ancobon) or
• Ganciclovir (e.g., Cytovene) or
• Interferon (e.g., Intron A, Roferon-A) or
• Plicamycin (e.g., Mithramycin) or
• Zidovudine (e.g., AZT, Retrovir) or
• If you have ever been treated with radiation or cancer medicines—Carmustine may increase the effects of these medicines or radiation therapy on the blood

• Chickenpox (including recent exposure) or
• Herpes zoster (shingles)—Risk of severe disease affecting other parts of the body

• Infection—Carmustine decreases your body's ability to fight infection

• Kidney disease—Effects of carmustine may be increased because of slower removal from the body

• Liver disease—Carmustine may cause side effects to the liver

• Lung disease—Risk of lung problems caused by carmustine may be increased

Smoking

Increased risk of lung problems.

Carmustine is sometimes given together with certain other medicines. If you are using a combination of medicines, it is important that you receive each one at the proper time. If you are taking some of these medicines by mouth, ask your health care professional to help you plan a way to take them at the right times.

This medicine often causes nausea and vomiting, which usually last no longer than 4 to 6 hours. It is very important that you continue to receive the medicine, even if you begin to feel ill. Ask your health care professional for ways to lessen these effects.

Dosing—

The dose of carmustine will be different for different patients. The dose that is used may depend on a number of things, including what the medicine is being used for, the patient's size, and whether or not other medicines are also being taken. If you are receiving carmustine at home, follow your doctor's orders or the directions on the label. If you have any questions about the proper dose of carmustine, ask your doctor.

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to check for unwanted effects.

While you are being treated with carmustine, and after you stop treatment with it, do not have any immunizations (vaccinations) without your doctor's approval. Carmustine may lower your body's resistance and there is a chance you might get the infection the immunization is meant to prevent. In addition, other persons living in your household should not take oral polio vaccine since there is a chance they could pass the polio virus on to you. Also, avoid persons who have taken oral polio vaccine within the last several months. Do not get close to them, and do not stay in the same room with them for very long. If you cannot take these precautions, you should consider wearing a protective face mask that covers the nose and mouth.

Carmustine can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

• If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
• Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in urine or stools; or pinpoint red spots on your skin.
• Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
• Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
• Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
• Avoid contact sports or other situations where bruising or injury could occur.

If carmustine accidentally seeps out of the vein into which it is injected, it may damage some tissues and cause scarring. Tell the doctor or nurse right away if you notice redness, pain, or swelling at the place of injection.

Along with its needed effects, a medicine may cause some unwanted effects. Some side effects will have signs or symptoms that you can see or feel. Your doctor may watch for others by doing certain tests. Some of the unwanted effects that may be caused by carmustine are listed below. Although not all of these effects may occur, if they do occur, they may need medical attention.

Also, because of the way these medicines act on the body, there is a chance that they might cause other unwanted effects that may not occur until months or years after the medicine is used. These delayed effects may include certain types of cancer, such as leukemia. Discuss these possible effects with your doctor.

Check with your doctor or nurse immediately if any of the following side effects occur:

• More common
  • Cough;  pain or redness at place of injection ;  shortness of breath 
  
  

• Less common
  • Black, tarry stools;  blood in urine or stools;  cough or hoarseness, accompanied by fever or chills;  fever or chills;  lower back or side pain, accompanied by fever or chills;  painful or difficult urination, accompanied by fever or chills;  pinpoint red spots on skin;  unusual bleeding or bruising 
  
  

• Decrease in urination;  swelling of feet or lower legs 

Check with your health care professional as soon as possible if any of the following side effects occur:

• Less common
  • Flushing of face;  sores in mouth and on lips;  unusual tiredness or weakness 
  
  

This medicine may also cause the following side effects that your doctor will watch for:

• More common
  • Low red blood cell count;  low white blood cell count;  lung problems 
  
  

• Rare
  • Liver problems 
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

• More common
  • Nausea and vomiting (usually lasting no longer than 4 to 6 hours)  
  
  

• Less common
  • Diarrhea;  discoloration of skin along vein of injection;  dizziness;  loss of appetite;  skin rash and itching;  trouble in swallowing;  trouble in walking  
  
  

This medicine may cause a temporary loss of hair in some people. After treatment with carmustine has ended, normal hair growth should return.

Side effects that affect your lungs (for example, cough and shortness of breath) may be more likely to occur if you smoke.

After you stop receiving carmustine, it may still produce some side effects that need attention. During this period of time check with your health care professional if you notice any of the following:

• Black, tarry stools;  blood in urine or stools;  cough or hoarseness, accompanied by fever or chills;  fever or chills;  lower back or side pain, accompanied by fever or chills;  painful or difficult urination, accompanied by fever or chills;  pinpoint red spots on skin;  shortness of breath;  unusual bleeding or bruising 

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your health care professional.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, carmustine is used in certain patients with the following conditions:

• Cancer of the colon and rectum
• Cancer of the stomach
• Malignant melanoma (a type of skin cancer)
• Mycosis fungoides (tumors on the skin)
• Waldenström's macroglobulinemia (a certain type of cancer of the blood)

Other than the above information, there is no additional information relating to proper use, precautions, or side effects for these uses.