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Busulphan (Busulfan)
⚠️ Safety Alert: Patients on busulfan should seek urgent medical advice if their temperature rises above 37.5°C (99.5°F) or 38°C (100.4°F), or if they feel unwell (e.g., chills, sore throat, cough, diarrhoea, frequent urination). 👉 Even mild infections can rapidly become serious due to immunosuppression.
💊 About
- Busulfan is an alkylating agent used in haematological malignancies.
- Causes DNA cross-links and breaks → inhibits replication and triggers apoptosis.
- Always check the BNF entry before prescribing.
⚙️ Mode of Action
- Forms covalent bonds with DNA, causing double-strand breaks and cross-linking.
- Non–cell cycle specific but most active in rapidly dividing cells.
🎯 Indications / Dose
- Chronic myeloid leukaemia (CML).
- Multiple myeloma.
- Part of conditioning regimens before haematopoietic stem cell transplantation.
🤝 Interactions
- See BNF for full list.
- Notably interacts with paracetamol (alters clearance) and phenytoin (induces metabolism).
⚠️ Cautions
- High risk of dosing errors with oral anti-cancer medicines → must follow protocols strictly.
- Seizure risk: prophylactic anticonvulsants (e.g., levetiracetam) often recommended in transplant regimens.
- Monitor blood counts, LFTs, and pulmonary function closely.
🚫 Contraindications
- Acute porphyrias.
- Severe hepatic impairment (relative contraindication).
❗ Side Effects
- Bone marrow suppression → neutropenia, anaemia, thrombocytopenia.
- Pulmonary toxicity (“busulfan lung”: interstitial fibrosis, restrictive lung disease).
- Hepatic veno-occlusive disease (especially post-transplant conditioning).
- Skin pigmentation (“busulfan tan”).
- Nausea, vomiting, mucositis.
- Seizures at high doses.
📚 References
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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