Carmustine 💊
📘 About
- Always check the BNF for latest prescribing advice.
- Carmustine is an alkylating nitrosourea chemotherapy agent used in the treatment of brain tumours, lymphomas, and multiple myeloma.
- It is highly lipophilic and crosses the blood–brain barrier, making it valuable in CNS malignancies.
⚙️ Mode of Action
- Belongs to the nitrosourea class of alkylating agents.
- Alkylates DNA and RNA by forming cross-links → inhibits DNA replication and transcription.
- Also carbamoylates proteins → interferes with essential enzymes involved in DNA repair.
- Lipophilicity allows penetration into CNS tissue → useful in brain tumours.
💊 Indications
- Primary and secondary brain tumours (including gliomas, medulloblastoma, astrocytoma).
- Recurrent glioblastoma multiforme – as an adjunct to surgery.
- High-grade malignant glioma – adjunctive treatment with surgery and radiotherapy.
- Multiple myeloma.
- Non-Hodgkin’s lymphoma and Hodgkin’s disease.
See BNF or local oncology protocols for exact dosing schedules, which vary depending on regimen and indication.
🔄 Interactions
- See BNF for detailed list.
- Additive bone marrow suppression if combined with other myelosuppressive agents.
- May increase pulmonary toxicity when given with prior/future chest radiotherapy or other pneumotoxic drugs (e.g., bleomycin).
⚠️ Cautions
- Monitor blood counts closely (risk of delayed myelosuppression, typically 4–6 weeks post-dose).
- Pulmonary fibrosis risk – especially with cumulative doses > 1,200–1,500 mg/m².
- Use with caution in hepatic or renal impairment (reduced clearance).
- Specialist use only in oncology/haematology settings.
🚫 Contraindications
- Pregnancy and breastfeeding.
- Acute porphyrias.
- Severe bone marrow suppression.
💥 Side Effects
- Haematological: Delayed myelosuppression (thrombocytopenia, leukopenia, anaemia).
- GI: Nausea, vomiting, constipation, diarrhoea.
- Neurological: Dizziness, headache, ataxia, seizures.
- Dermatological: Alopecia, skin rash.
- Respiratory: Pulmonary fibrosis with prolonged/cumulative use.
- Hepatic/renal: Elevated LFTs, nephrotoxicity (rare).
📖 References
- BNF – Carmustine
- Rang & Dale’s Pharmacology – Alkylating agents.
- EMA Summary of Product Characteristics – Carmustine.
