Carmustine is a chemotherapy drug that is given as a treatment for some types of cancer. It is most commonly used to treat lymphomas, myeloma and brain tumours. This information describes carmustine, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer, which give more information and advice.

Wafers containing carmustine - known as Gliadel® wafers - may be used to treat certain types of brain tumour.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

Carmustine is a colourless fluid after being dissolved from powder.

Carmustine is given as a drip (infusion):

• through a fine tube inserted into the vein (cannula)
• through a central line, which is inserted under the skin through a vein near the collarbone, or into a PICC line which is inserted into a vein in the crook of the arm.

The infusion can take a couple of hours, or longer.

Chemotherapy is usually given as a course of several sessions (or cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer for which you are being treated. Your nurse or doctor will discuss your treatment plan with you.

Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given carmustine, and may be different if you are having more than one chemotherapy drug.

We have outlined the most common side effects and some of the less common ones, so you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you do notice any effects which you think may be due to the drug but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Feeling sick (nausea) and being sick (vomiting) If you do feel sick this may begin a couple of hours after the treatment is given and last for 2–3 hours. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting. If the sickness is not controlled, or continues, tell your doctor; they can prescribe other anti-sickness drugs which may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Lowered resistance to infection Carmustine can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 14–28 days after chemotherapy. Your blood cells will then increase steadily, and will usually return to normal levels over the next 1–2 weeks.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Carmustine can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with carmustine you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if you develop these symptoms.

Your liver may be temporarily affected Carmustine may cause changes in the way that your liver works, although your liver will return to normal when the treatment is finished. This is unlikely to cause you any harm, but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to check that your liver is working properly.

Changes to the lungs Carmustine may cause some changes to lung tissue. Tell your doctor if you smoke and if you notice any coughing or breathlessness. You may have a chest x-ray done to check your lungs before you are given any carmustine.

Diarrhoea This can usually be easily controlled with medicine but let your doctor know if it is severe or if it continues. It is important to drink plenty of fluids if you do have diarrhoea.

Loss of appetite A dietitian or specialist nurse at your hospital can give advice about how to boost your appetite, cope with eating difficulties and maintain your weight.

Sometimes people may have hot flushes and itchy eyes during the time that the drug is being given.

Carmustine is diluted with (alcohol) ethanol so you should tell your doctor if you cannot tolerate alcohol.

Injection site Carmustine can cause pain at the place where the injection is given, or along the vein. If you feel pain tell the nurse or doctor.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking carmustine, as the developing foetus may be harmed. It is necessary to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

This section is based on our Carmustine factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Medicines.org.uk website - www.medicines.org.uk (November 2007).
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott, Williams and Wilkins, 2001.

For further references, please see general bibliography.