Carmustine

Registered South African indications:

• Glioblastoma multiforme
• Glioma

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Pregnancy

Cautions

• Breastfeeding
• Renal impairment

Forms avail. in SA and covered in this monograph: waf

Used for the treatment of

Recurrent glioblastoma multiforme 
- Adjunct to surgery in patients for whom surgical resection is indicated
Glioma
- Newly diagnosed high grade malignant glioma as an adjunct to surgery and radiation

Consult specialist for dosages and regimens

Not established for use in children

Pregnancy

• FDA Pregnancy Category D

Breastfeeding

• Caution; not recommended

Renal Impairment

• Caution; dose adjustment recommended

Hepatic Impairment

• No dose adjustment recommended

Elderly            

• No dose adjustment recommended

Central Nervous System Disorders

• Hemiplegia
• Convulsion
• Confusion
• Brain oedema
• Aphasia
• Depression
• Somnolence
• Speech disorder
• Amnesia
• Intracranial hypertension
• Personality disorder
• Anxiety
• Facial paralysis
• Neuropathy
• Ataxia
• Hypoesthesia
• Paresthesia
• Abnormal thinking 
• Abnormal gait
• Dizziness
• Grand mal convulsions
• Hallucinations
• Insomnia
• Tremor
• Intracranial hypertension
• Meningitis 
• Abscess              
• Cerebral haemorrhage
• Cerebral infarct
• Headache
• Asthenia

Cardiovascular Disorders

• Deep thrombophlebitis
• Hypertension
• Hypotension
• Pulmonary embolism
• Haemorrhage
• Chest pain

Respiratory Disorders

• Pneumonia
• Infection
• Aspiration pneumonia

Gastrointestinal Disorders

• Nausea and vomiting
• Constipation
• Diarrhoea
• Abdominal pain
• Dysphagia
• Gastrointestinal haemorrhage
• Faecal incontinence

Genitourinary Disorders

• Urinary tract infection
• Urinary incontinence

Endocrine and Metabolic Disorders

• Diabetes mellitus

Musculoskeletal Disorders

• Back pain

Skin and Subcutaneous Tissue Disorders

• Peripheral oedema
• Rash
• Alopecia
• Face oedema
• Abscess
• Accidental injury

Immune, Blood and Lymphatic System Disorders

• Anaemia
• Thrombocytopenia
• Leukocytosis
• Abnormal healing
• Sepsis
• Aggravation reaction
• Infection
• Fever
• Pain

Sensory Disorders

• Conjonctival oedema
• Abnormal vision
• Visual field defect
• Eye pain

No information available

• Full blood count with differential
• Pulmonary function test
• Hepatic function
• Renal function
• Vital signs

Carmustine is delivered directly into the surgical cavity created after tumoural resection. On exposure to the aqueous environment of the cavity the anhydride bonds in the copolymer are hydrolysed, releasing carmustine, carboxyphenoxypropane and sebacic acid. The carmustine released from the wafer diffuses into the surrounding brain tissue and produces an antineoplastic effect by alkylating DNA and RNA. Carmustine is spontaneously both degraded and metabolised. The alkylating moiety thus produced and presumed to be chloroethyl carbonium ion, leads to the formation of irreversible DNA cross-links.

Wafer 7.7mg

• Gliadel Wafer (Litha Pharma) originator