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Summary
General Info

PubChem

PubChem Compound 151563

PubChem Compound 151563

Name:	Carmustine
PubChem Compound ID:	151563
Description:	A cell-cycle phase nonspecific alkylating antineoplastic agent. It is used in the treatment of brain tumors and various other malignant neoplasms. (From Martindale, The Extra Pharmacopoeia, 30th ed, p462) This substance may reasonably be anticipated to be a carcinogen according to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985). (From Merck Index, 11th ed)
Molecular formula:	C₅H₉Cl₂N₃O₂
Molecular weight:	218.074 g/mol
Synonyms:	1,3-Bis(2-chloro-2,2-dideuterioethyl)-1-nitrosourea; N,N'-Bis(2-chloroethyl-2,2-d2)-N-nitrosourea; Urea, N,N'-bis(2-chloroethyl-2,2-d2)-N-nitroso-; 59099-88-6

DrugBank

Identification

Name:	Carmustine
Name (isomeric):	DB00262
Drug Type:	small molecule
Description:	A cell-cycle phase nonspecific alkylating antineoplastic agent. It is used in the treatment of brain tumors and various other malignant neoplasms. (From Martindale, The Extra Pharmacopoeia, 30th ed, p462) This substance may reasonably be anticipated to be a carcinogen according to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985). (From Merck Index, 11th ed)
Synonyms:	Bischlorethylnitrosurea; BCNU; Carmustin; Bischlorethylnitrosourea
Brand:	Nitrumon, Carmubris, Gliadel, Becenun, Gliadel Wafer, Bi CNU, BiCNU
Category:	Antineoplastic Agents, Antineoplastic Agents, Alkylating
CAS number:	154-93-8

Pharmacology

Indication:	For the treatment of brain tumors, multiple myeloma, Hodgkin's disease and Non-Hodgkin's lymphomas.
Pharmacology:	Carmustine is one of the nitrosoureas indicated as palliative therapy as a single agent or in established combination therapy with other approved chemotherapeutic agents in treatment of brain tumors, multiple myeloma, Hodgkin's disease, and non-Hodgkin's lymphomas. Although it is generally agreed that carmustine alkylates DNA and RNA, it is not cro... show more » Carmustine is one of the nitrosoureas indicated as palliative therapy as a single agent or in established combination therapy with other approved chemotherapeutic agents in treatment of brain tumors, multiple myeloma, Hodgkin's disease, and non-Hodgkin's lymphomas. Although it is generally agreed that carmustine alkylates DNA and RNA, it is not cross resistant with other alkylators. As with other nitrosoureas, it may also inhibit several key enzymatic processes by carbamoylation of amino acids in proteins. show less «
Mechanism of Action:	Carmustine causes cross-links in DNA and RNA, leading to the inhibition of DNA synthesis, RNA production and RNA translation (protein synthesis). Carmustine also binds to and modifies (carbamoylates) glutathione reductase. This leads to cell death.
Absorption:	5 to 28% bioavailability
Protein binding:	80%
Biotransformation:	Hepatic and rapid with active metabolites. Metabolites may persist in the plasma for several days.
Route of elimination:	Approximately 60% to 70% of a total dose is excreted in the urine in 96 hours and about 10% as respiratory CO2.
Half Life:	15-30 minutes
Toxicity:	The oral LD₅₀s in rat and mouse are 20 mg/kg and 45 mg/kg, respectively. Side effects include leukopenia, thrombocytopenia, nausea. Toxic effects include pulmonary fibrosis (20-0%) and bone marrow toxicity.
Affected organisms:	Humans and other mammals

Interactions

Food interaction:

Echinacea

Drug interaction:

Natalizumab	Immunosuppressants such as carmustine may enhance the adverse/toxic effect of natalizumab. Specifically, the risk of concurrent infection may be increased. Patients receiving natalizumab should not use concurrent immunosuppressants.
Cimetidine	Increases myelosuppression caused by carmustine
Tacrolimus	Tacrolimus (Topical) may enhance the adverse/toxic effect of immunosuppressants such as carmustine. Avoid use of tacrolimus ointment in patients receiving immunosuppressants.
Trastuzumab	Trastuzumab may increase the risk of neutropenia and anemia. Monitor closely for signs and symptoms of adverse events.
Leflunomide	Immunosuppressants such as carmustine may enhance the adverse/toxic effect of leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Consider eliminating the use of a leflunomide loading dose in patients who are receiving other immunosuppressants in order to reduce the risk for serious adverse events such as hematologic toxicity. Also, patients receiving both leflunomide and another immunosuppressive medication should be monitored for bone marrow suppression at least monthly throughout the duration of concurrent therapy.

Natalizumab	Immunosuppressants such as carmustine may enhance the adverse/toxic effect of natalizumab. Specifically, the risk of concurrent infection may be increased. Patients receiving natalizumab should not use concurrent immunosuppressants.
Cimetidine	Increases myelosuppression caused by carmustine
Tacrolimus	Tacrolimus (Topical) may enhance the adverse/toxic effect of immunosuppressants such as carmustine. Avoid use of tacrolimus ointment in patients receiving immunosuppressants.
Trastuzumab	Trastuzumab may increase the risk of neutropenia and anemia. Monitor closely for signs and symptoms of adverse events.
Leflunomide	Immunosuppressants such as carmustine may enhance the adverse/toxic effect of leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Consider eliminating the use of a leflunomide loading dose in patients who are receiving other immunosuppressants in order to reduce the risk for serious adverse events such as hematologic toxicity. Also, patients receiving both leflunomide and another immunosuppressive medication should be monitored for bone marrow suppression at least monthly throughout the duration of concurrent therapy.
Fosphenytoin	The antineoplasic agent decreases the effect of hydantoin
Pimecrolimus	Pimecrolimus may enhance the adverse/toxic effect of immunosuppressants such as carmustine. Avoid use of pimecrolimus cream in patients receiving immunosuppressants.
Roflumilast	Roflumilast may enhance the immunosuppressive effect of immunosuppressants such as carmustine. The Canadian roflumilast product monograph recommends avoiding concurrent use of roflumilast with any immunosuppressant medications due to the antiinflammatory/immune altering effects of roflumilast and the lack of relevant clinical experience with such use. Of note, this recommendation to avoid concurrent use does not apply to either inhaled corticosteroids (which have much more limited systemic immune-suppressing actions) or short-term systemic corticosteroid use. U.S. prescribing information does not contain this warning; but it appears prudent to avoid this combination when possible.
Phenytoin	The antineoplasic agent decreases the effect of hydantoin
Digoxin	The antineoplasic agent decreases the effect of digoxin

Targets

Glutathione reductase, mitochondrial

Enzymes

Cytochrome P450 1A2