Adult: As an adjunct to surgery and radiation in newly diagnosed high-grade malignant glioma, and as adjunct to surgery in recurrent glioblastoma multiforme: Each wafer implant contains 7.7 mg carmustine: Following tumour resection and confirmation of tumour pathology, when haemostasis is established, up to a Max of 8 wafers (61.6 mg) are implanted intracranially to cover as much of the resection cavity as possible. If the size and shape of the resected cavity cannot accommodate 8 wafers, place the Max number of wafers feasible within the cavity. Slight overlap of wafers during placement is permissible. Wafers broken in half may be used; discard wafers broken into >2 pieces. Oxidised regenerated cellulose may be placed over the wafer implants to secure them against the surface of the cavity.
Intravenous Brain tumour
Adult: For brain tumours, including glioblastoma, brainstem gliomas, medulloblastoma, astrocytoma, ependymoma, and brain metastases: 150-200 mg/m2 given as a single dose or divided into daily doses of 75-100 mg/m2 on 2 successive days via IV infusion over 1-2 hours. Doses may be repeated every 6 weeks provided that blood counts have recovered to acceptable levels (platelets >100,000/mm3, leucocytes >4,000/mm3, ANC >1,000/mm3). Lower doses are recommended when given with other myelosuppressive agents or in patients with depleted bone marrow reserve. Premedication with antiemetics is recommended. Dose reduction, dosing interruption or discontinuation may be required according to the patient's haematological response and tolerance (refer to detailed product guidelines or local treatment protocols).
Intravenous Multiple myeloma
Adult: In combination with prednisone: 150-200 mg/m2 given as a single dose or divided into daily doses of 75-100 mg/m2 on 2 successive days via IV infusion over 1-2 hours. Doses may be repeated every 6 weeks provided that blood counts have recovered to acceptable levels (platelets >100,000/mm3, leucocytes >4,000/mm3, ANC >1,000/mm3). Lower doses are recommended when given with other myelosuppressive agents or in patients with depleted bone marrow reserve. Premedication with antiemetics is recommended. Dose reduction, dosing interruption or discontinuation may be required according to the patient's haematological response and tolerance (refer to detailed product guidelines or local treatment protocols).
Adult: As secondary treatment for relapsed or refractory cases, in combination with other approved drugs: 150-200 mg/m2 given as a single dose or divided into daily doses of 75-100 mg/m2 on 2 successive days via IV infusion over 1-2 hours. Doses may be repeated every 6 weeks provided that blood counts have recovered to acceptable levels (platelets >100,000/mm3, leucocytes >4,000/mm3, ANC >1,000/mm3). Lower doses are recommended when given with other myelosuppressive agents or in patients with depleted bone marrow reserve. Premedication with antiemetics is recommended. Dose reduction, dosing interruption or discontinuation may be required according to the patient's haematological response and tolerance (refer to detailed product guidelines or local treatment protocols).
Reconstitution
Intravenous: Lyophilised powder for reconstitution: Reconstitute vial labelled as containing 100 mg carmustine with 3 mL of the provided diluent (absolute ethanol), then add 27 mL of sterile water for inj to prepare a concentration of 3.3 mg/mL in ethanol 10%. IV infusion: Further dilute the reconstituted solution with 500 mL NaCl 0.9% or dextrose 5% in water to make a final concentration of 0.2 mg/mL. Use non-polyvinyl chloride (PVC) containers (e.g. glass, polypropylene, polyolefin) for preparation and administration.
Special Precautions
Patient with reduced lung function or risk factors for pulmonary toxicity (e.g. history of pulmonary disease, baseline <70% of predicted forced vital capacity or carbon monoxide diffusing capacity). Avoid extravasation during IV administration. When using the implant, avoid communication between the resection cavity and ventricular system to prevent wafer migration; close any communication larger than the diameter of the wafer before implantation. Renal impairment. Pregnancy and lactation.
Adverse Reactions
Significant: IV: Bone marrow suppression, including leucopenia and thrombocytopenia (cumulative and delayed); hepatotoxicity manifested by reversible increases in bilirubin, alkaline phosphatase and transaminases (high IV dose therapy); intensive skin flushing and suffusion of the conjunctiva due to rapid IV infusion (onset within 2 hours and lasting for approx 4 hours); inj site burning and local tissue reactions, including erythema, pain, swelling and necrosis; secondary malignancies such as acute leukaemia and bone marrow dysplasia (long-term use). Implant: New or worsening (treatment-emergent) seizures; meningitis; brain oedema, including intracranial mass effect unresponsive to corticosteroids leading to brain herniation; impaired neurosurgical wound healing, including wound dehiscence, delayed healing, and subdural, subgaleal, or wound effusions; CSF leaks. Blood and lymphatic system disorders: Anaemia; thrombocytopenia, leucocytosis (implant). Endocrine disorders: Diabetes mellitus (implant). Eye disorders: Retinal haemorrhage, ocular toxicity (IV); conjunctival oedema, vision disorders, eye pain (implant). Gastrointestinal disorders: Nausea, vomiting, constipation, diarrhoea; stomatitis (IV); abdominal pain, faecal incontinence, dysphagia (implant). General disorders and administration site conditions: Asthenia, fever, pain, oedema, injury, chest pain (implant). Infections and infestations: Abscess (implant). Metabolism and nutrition disorders: Anorexia (IV); hyponatraemia, hyperglycaemia, hypokalaemia (implant). Musculoskeletal and connective tissue disorders: Back pain (implant). Nervous system disorders: Headache, dizziness, ataxia; encephalopathy (high-dose IV therapy); amnesia, confusion, speech disorder, tremor, stupor, neuropathy, coma (implant). Psychiatric disorders: Depression, anxiety, abnormal thinking, hallucinations, insomnia, personality disorder (implant). Renal and urinary disorders: Renal failure, progressive azotaemia, reduced kidney size (IV); UTI, urinary incontinence (implant). Reproductive system and breast disorders: Gynaecomastia (IV). Respiratory, thoracic and mediastinal disorders: Pulmonary embolism, pneumonia (implant). Skin and subcutaneous tissue disorders: Alopecia; hyperpigmentation (IV); rash (implant). Vascular disorders: Thrombophlebitis, haemorrhage, hypertension, hypotension (implant). Potentially Fatal: IV: Dose-related pulmonary toxicity characterised by pulmonary infiltrates and/or fibrosis (cumulative and may have a delayed onset).
Patient Counseling Information
Women of childbearing potential must use proven birth control methods during therapy and for at least 6 months after stopping the treatment. Males with female partners of childbearing potential must also use effective contraception during treatment and for at least 3 months after the last dose. Discontinue breastfeeding during IV therapy and for at least 7 days after the implantation.
Monitoring Parameters
Verify pregnancy status of women of childbearing potential before treatment initiation. IV: Monitor CBC with differential and platelet count (weekly for at least 6 weeks after each dose), pulmonary function tests (baseline and frequently during therapy), LFTs such as transaminases and bilirubin (periodically), kidney function tests (periodically); blood pressure and vital signs (during infusion). Closely monitor the infusion site for inj site reactions or possible infiltration. Assess for signs and symptoms of pulmonary toxicity and for development of secondary malignancies. Implant: Closely monitor for seizures, intracranial infection, abnormal wound healing, and intracranial hypertension related to brain oedema, inflammation, or necrosis of brain tissue surrounding resection. Assess for signs and symptoms of obstructive hydrocephalus and meningitis.
Drug Interactions
IV: May enhance myelosuppressive effects (e.g. neutropenia, leucopenia) with cimetidine. Increased risk of pulmonary toxicity with melphalan. May decrease serum level with phenobarbital. Concomitant use with digoxin may result in reduced digoxin absorption and efficacy. May decrease the serum concentration and antiepileptic activity of phenytoin.
Action
Description: Overview: Carmustine, a nitrosourea derivative alkylating agent, is a cell cycle non-specific antineoplastic agent. Mechanism of Action: The mechanism of action of carmustine has not been fully elucidated; however, it is believed to act by alkylating reactive sites on nucleic acids and cell proteins, forming DNA-DNA or DNA-protein crosslinks, thus inhibiting DNA replication, RNA transcription, and nucleic acid function. Additionally, isocyanates are formed during carmustine decomposition, which can react by carbamoylating lysine residues on proteins, resulting in irreversible inactivation of enzymes, including glutathione reductase. Pharmacokinetics: Absorption: Time to peak plasma concentration (systemic): Approx 3 hours after wafer insertion. Distribution: Readily crosses the blood-brain barrier after IV inj; diffuses from polymer implants into surrounding brain tissue. Metabolism: Rapidly metabolised in the liver to form active metabolites (IV). Excretion: Mainly via urine (approx 60-70%); lungs (approx 10% as carbon dioxide). Elimination half-life: 15-75 minutes (IV).
Chemical Structure
Carmustine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 2578, Carmustine. https://pubchem.ncbi.nlm.nih.gov/compound/Carmustine. Accessed Jan. 29, 2026.
Storage
Intravenous: Intact vial: Store between 2-8°C. Protect from light. Diluted solution for IV infusion: May store at room temperature for up to 8 hours or between 2-8°C for up to 24 hours when protected from light.
Intracavitary: Wafer implant: Store at or below -20°C. Unopened foil pouches may be kept at ambient room temperature or temperature of not more than 22°C for a Max of 6 hours. The pouches may be refrozen if not yet opened and have been kept for Max of 6 hours at temperature of not more than 22°C. Refrozen foil pouches must be used within 30 days.
This is a cytotoxic drug. Follow applicable procedures for receiving, handling, administration, and disposal. Storage recommendations may vary among countries and between individual products (refer to specific product guidelines).
L01AD01 - carmustine ; Belongs to the class of alkylating agents, nitrosoureas. Used in the treatment of cancer.
References
Brayfield A, Cadart C (eds). Carmustine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/11/2025.Carmustine Injection (Heritage Pharmaceuticals Inc. d/b/a Avet Pharmaceuticals Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 07/11/2025.Carmustine Medac 100 mg Powder and Solvent for Concentrate for Solution for Infusion (Medac Gesellschaft für klinische Spezialpräparate mbH). MHRA. https://products.mhra.gov.uk. Accessed 07/11/2025.Carmustine, BCNU. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 07/11/2025.Carmustine. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 07/11/2025.Carmustine. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 07/11/2025.Emcure NZ Limited. BiCNU, 100 mg, Solution for Injection data sheet 29 April 2020. Medsafe. http://www.medsafe.govt.nz. Accessed 07/11/2025.Gliadel 7.7 mg Implant (Clinigen Healthcare Ltd.). MHRA. https://products.mhra.gov.uk. Accessed 07/11/2025.Gliadel Wafer (Azurity Pharmaceuticals, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 07/11/2025.Joint Formulary Committee. Carmustine. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/11/2025.
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