Carmustine

Doctors don't fully understand how carmustine works. It alkylates DNA and RNA, but it is not cross-resistant with other alkylators. Like other nitrosoureas, it may also block several key enzyme processes by carbamoylation of amino acids in proteins. The metabolites of carmustine may add to both its antitumor activity and its toxicities.

Pregnancy

Carmustine injection can harm the unborn baby when it is given to a pregnant woman. This is based on how the medicine works and on what was seen in animals. Only limited data are available from pregnant women, and they are not enough to say what the risk of major birth defects and miscarriage might be. In rats and rabbits, carmustine was embryotoxic. In rats it was also teratogenic, causing thoracoabdominal closure, neural tube and eye defects, and malformations of the skeletal system of the fetus. These effects appeared at doses lower than the maximum cumulative human dose based on body surface area. So when a doctor prescribes Carmustine injection to a pregnant woman, the benefits for the mother should be weighed against the possible risks to the fetus. Bad outcomes in pregnancy happen whatever the mother's health and whether or not she uses medicines. The background risk of major birth defects and miscarriage for the population this medicine is used in is unknown. In the U.S. general population, the estimated background risk in clinically recognized pregnancies is 2 to 4% for major birth defects and 15 to 20% for miscarriage.

Lactation

Nobody knows whether carmustine passes into human milk, what it does to a breastfed infant, or what it does to milk production. Many drugs do pass into human milk, and carmustine can cause serious adverse events (for example carcinogenicity and myelosuppression) in nursing infants. For this reason, breastfeeding should be stopped while taking Carmustine.

Pediatric Use

The safety and effectiveness of Carmustine in children have not been established. A long-term study followed patients who received Carmustine in childhood and early adolescence (1 to 16 years), and it reported delayed pulmonary fibrosis appearing up to 17 years after treatment. Eight out of the 17 patients (47%) who survived childhood brain tumors died of pulmonary fibrosis. This included all 5 patients who were first treated at less than 5 years of age.

Geriatric Use

Clinical studies of Carmustine did not include enough subjects aged 65 and over to show whether they respond differently from younger subjects. Other reported clinical experience has not found differences in response between elderly and younger patients. In general, the dose for an elderly patient should be chosen with caution, usually starting at the low end of the dose range. This reflects the greater frequency of decreased hepatic, renal or cardiac function in older people, and of other diseases or other drug therapy.

Carmustine and its metabolites are known to be substantially excreted by the kidney, so the risk of toxic reactions may be greater in patients with impaired renal function. Elderly patients are more likely to have decreased renal function. Care should be taken in dose selection, and renal function should be monitored.

Keep Carmustine and its diluent in a refrigerator at 2°-8°C. That applies to the unopened vial of dry drug and to the diluent vials as well. If unopened Carmustine vials are stored as recommended, the product stays stable for up to 3 years.