Nitrosourea alkylating agent (specialist)
Carmustine
Brand names: BiCNU, Gliadel
Adult dose
Dose: IV: 150–200mg/m² q6w; Gliadel wafer: implanted in glioma resection cavity
Route: IV / Implant
Frequency: q6w (IV)
Clinical pearls
- NICE TA121 (Gliadel): high-grade glioma
- Conditioning regimen for HSCT (BEAM)
- ESMO neuro-oncology / BSH lymphoma
Contraindications
- Severe myelosuppression
- Severe hepatic/renal impairment
- Pregnancy
- Hypersensitivity
Side effects
- Myelosuppression (delayed, prolonged)
- Pulmonary fibrosis (cumulative dose-related)
- Hepatotoxicity
- Renal toxicity
- Severe nausea/vomiting
- Secondary malignancies
- Local effects (Gliadel: oedema, seizures, infection)
Interactions
- Cimetidine (myelosuppression)
- Phenytoin (reduced levels)
Monitoring
- FBC
- LFTs
- Renal
- Pulmonary function
- Cumulative dose
Reference: BNF; NICE TA121; ESMO; BSH; SmPC; https://bnf.nice.org.uk/drugs/carmustine-specialist-drug/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.