Drug Interaction:
Interacting drugs- summary
+ Carmustine
Cimetidine
may enhance the myelosuppressive effects of carmustine, possibly to thre point of toxicity
Digoxin
digoxin serume levels may be reduced and its actions may be decreased by a combination therapy regimen including carmustine
Phenytoin
serum conc. may be decreased by a combination chemotherapy regimen including carmustine
Indication:
U.S.FDA APPROVED DRUGS FROM 01-01-08 TO 31-12-08
Drug name Indication Date of Approval
62. Carmustine (prolifeprosan 20 with 31-01-08
carmustine Implant (Wafer)
i. In newly diagnosed grade malignant
glioma patients in as adjunct to surgery
and radiation
ii. In recurrent glioblastoma multiforme
patients as an adjunct to surgery
Brain tumors Multiple myeloma
Hodgkins disease and non- Hodgkins lymphomas
New drugs approved For Marketing by Drug Controller General of India(DCGI )
during the period January 1988 to November 2014
(Ref- IDMA Annual Publication 2015)
Name of Drug Indication Date of Approval
1. Carmustine (polifeprosan 20 with carmustine 31-01-2008
inplant (wafer)
i.In newly diagnosed high grade malignant glioma patients as an
adjunct to surgery and radiation
ii. In recurrent glioblatoma multiforme patients as an adjunct to
surgery
2. Carmustine for Inj 100mg 10-06-2010
Indicated as palliative therapy as a single agent or in established
combination therapy with other approved chemotherapeutic agents
in the following -
i. Brain tumors , Glioblastoma, brainstem Glioma, Medulloblastoma,
Astrocytoma,Ependymona, and Metastatic brain tumors
ii. Multiple myeloma- in combination with prednisone
iii. Hodgkins disease - as secondary therapy in combination with
other approved drugs in patients who relapse while being treated
with primary therapy or who fail to respond to primary therapy
Adverse Reaction:
Nausea, vomiting.
Decreased in kidney size, progressive azotemia and renal failure have occured in patients who received large cumulative doses after prolonged therapy.
Burning at the site of infection.
Contra-Indications:
Hypersens to carmustine
Special precautions:
Monitor blood counts weekly for at least 6 weeks after a dose.
Myelosuppression may be produced by carmustine
Dosages/ Overdosage Etc:
Indication-
Brain tumors
Multiple myeloma
Hodgkins disease and non- Hodgkins lymphomas
Dosage:
150 to 200mg/m2 IV every 6 weeks.
Give as a single dose or divided daily injections(75 to 100mg/m2 on successive days.
Patient Information:
Carmustine- Systemic
1.Allergies-
Tell your doctor if you are have ever had any unusual or allergic reaction to
carmustine.
2.Pregnancy-
There is a chance that this medicine may cause birth defects if either the male
or the female is taking it at the time of conception or if it is taken during pregnancy.
Carmustine causes toxic or harmful effects and birth defects in rats and rabbits
about dose 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
It is to best use some kind of birth control while you are receiving carmustine.
Tell your doctor right awayif you think you have become pregnant while receiving
carmustine
3. Breast-feeding-
Because carmustine may cause serious side efffects, breast-feeding is generally
not recommended while receiving it
4.Children-
Although there is no specific information comparing carmustine in children with use
in other age groups, this medicine is not expected to show different side effects or
problems than it does in adults.
5.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 than 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
6. 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 such 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 doctor
know if you taking any of the following-
Amphotericin B by injection or
Antithyroid agents ( medicines for overactive thyroid) or
Azathioprine or
Chloramphenicol or
Cochicine or
Flucytosine or
Gangiclovir or
Interferon or
Plicamycin or
Zidovudine -
If you have been treated with radiation or cancer medicines- Carmustine may
increase the effects f these medicines or radiation therapy on the blood
radiation on the blood
7. Other medical problems-
The presence of other medical problems may affect the use of carmustine.
Make sure you tell your doctor if you have any other medical problems
especially-
Chickenpox (recent exposure) or
Herpes Zoster ( shingles) -risk of severe disease affecting other parts
of the body
Infection- carmustine n decreases the bodys ability to fight infection
Kidney disease- effects of carmustine may be increased because of slower
removal from the body
Liver disease -risk of lung problems caused by carmustine may be increased
Smoking- increased risk of lung problems
Pharmacology/ Pharmacokinetics:
Pharmacology:
Carmustine alkylates deoxyribonucleic acid (RNA) and also inhibits several enzymes by carbamoylation of amino acids in proteins. Carbamoylation is not cross resistent with alkylators.
Pharmacokinetics:
Following IV admin, it is rapidly degraded with biological half-life of 15 to 30 minutes, the plasma half-life of radiolabelled metabolites is 67 hrs.
Pregnancy and lactation:
Pregnancy:
Advise the patient of the potential hazard to the fetus, and advise women of childbearing potential to avoid becoming pregnant
Lactation:
Excercise caution, and advise either to discontinue nursing or discontinue the drug depending on the importance of the drug to the mother.
Manufacturer Details