Carmustine, Injection/Wafer Implant

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KEY POINTS

• This medicine is given by IV to treat brain tumors, multiple myeloma, Hodgkin's disease, non-Hodgkin's lymphomas, and other kinds of cancer. This medicine also comes in a wafer form that is put in during surgery to remove a brain tumor.
• You may get infections or bleed more easily when you are taking this medicine. Be careful while shaving, cutting fingernails or toenails, or when using sharp objects.
• Keep all appointments for tests to see how this medicine affects you.
• This medicine may cause severe lung damage or other unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: antineoplastic (anticancer)

Generic and brand names: carmustine, injection; carmustine, wafer implant; BCNU, injection; BCNU, wafer implant; BiCNU; Gliadel

What is this medicine used for?

This medicine is given by IV infusion (slow drip through a needle into a large vein) to treat brain tumors, multiple myeloma, Hodgkin's disease, and non-Hodgkin's lymphomas. It may also be used to treat other kinds of cancer, as determined by your healthcare provider. It may be used with other drugs.

This medicine also comes in a wafer form that is implanted during surgery to remove a brain tumor.

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine
• Breathing problems or lung disease such as asthma or COPD
• Liver or kidney disease
• Seizures

Males: This medicine may make you sterile (unable to have children). If you plan to have children someday, talk with your healthcare provider before you start treatment.

Females of childbearing age: This medicine is not usually given to pregnant women because it can harm the baby. If you are pregnant, tell your healthcare provider. Do not become pregnant during treatment with this medicine. If you become pregnant, contact your healthcare provider right away. Do not breast-feed while you are receiving this medicine.

How do I take it?

The infusions are given by a healthcare provider. Each infusion takes at least 2 hours. Your provider will determine your dose and how often it will be given. Keep all your appointments for infusions. If your healthcare provider prescribes a medicine to be taken by mouth, take it exactly as prescribed.

The dime-sized wafer implants are put in place during surgery to remove a brain tumor. Wafers dissolve and release medicine directly into the area of the brain tumor.

What should I watch out for?

You may get infections more easily when you are taking this medicine. Stay away from people with colds, flu, or other infections. Also, do not have any vaccines without getting your healthcare provider's approval first.

You may need to have blood tests regularly to see how this medicine affects you. Keep all appointments for these tests.

The injection form of this medicine may cause severe lung damage, even years after treatment. Contact your healthcare provider right away if you develop a cough or breathing problems.

The injection form of this medicine may cause you to bleed more easily. Be careful when brushing your teeth or shaving. Report any unusual bruising or bleeding to your healthcare provider. Do not drink alcohol or take aspirin while receiving this medicine unless your healthcare provider approves. It may increase the risk of bleeding.

This medicine may make your mouth sore. Use a soft bristle brush or mouth swab to brush your teeth.

Within 2 hours after an injection, this medicine may cause nausea and vomiting that may last for 4 to 6 hours. Your healthcare provider may prescribe a medicine to relieve or help prevent vomiting. Eating small, frequent meals and drinking plenty of water while you are being treated with this medicine may help.

There is a small risk that this medicine may cause a second cancer some years after you finish treatment. Talk with your provider about this.

This medicine may make you dizzy or drowsy. Do not drive or operate machinery unless you are fully alert.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (Report these to your healthcare provider right away.): Fever, sore throat, new or worsening cough, stiff neck, mouth sores, trouble breathing, change in vision, confusion, unusual bruising or bleeding, severe nausea and vomiting, yellowing of the skin or eyes, severe stomach pain, pain or burning at the injection site, severe dizziness or fainting, seizures, severe headache, trouble walking or talking, unexplained tiredness or weakness, decrease in urination, fast heartbeat.

Other: Diarrhea, constipation mild nausea or vomiting, loss of appetite, hair loss, back pain, stomach pain, tiredness, depression, trouble sleeping, nervousness.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• Anagrelide (Agrylin)
• Antiseizure medicines such as fosphenytoin (Cerebyx) and phenytoin (Dilantin, Phenytek)
• Arthritis medicines such as leflunomide (Arava) and tofacitinib (Xeljanz)
• Aspirin and other salicylates
• Cimetidine (Tagamet)
• Digoxin (Lanoxin)
• Echinacea
• Fingolimod (Gilenya)
• Medicines to treat or prevent blood clots such as abciximab (ReoPro), apixaban (Eliquis), argatroban, bivalirudin (Angiomax), clopidogrel (Plavix), dabigatran (Pradaxa), dipyridamole (Persantine), enoxaparin (Lovenox), heparin, lepirudin (Refludan), pentosan (Elmiron), rivaroxaban (Xarelto), ticagrelor (Brilinta), tirofiban (Aggrastat), and warfarin (Coumadin)
• Natalizumab (Tysabri)
• Natural remedies such as cat's claw, dong quai, evening primrose, fenugreek, feverfew, fish oil, garlic, ginger, ginkgo biloba, ginseng, green tea, horse chestnut, red clover, and turmeric
• Nonsteroidal anti-inflammatory medicines (NSAIDs) such as diclofenac (Cambia, Voltaren, Zipsor), ibuprofen (Advil, Motrin), indomethacin (Indocin), ketoprofen, ketorolac, nabumetone (Relafen), naproxen (Aleve, Anaprox, Naprelan), oxaprozin (Daypro), piroxicam (Feldene), and sulindac (Clinoril)
• Vaccines

Do not drink alcohol while you are receiving this medicine unless your healthcare provider approves.

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.