Carmustine (BCNU, Gliadel)
This page tells you about the chemotherapy drug carmustine and its possible side effects. There is information about
- What carmustine is
- How carmustine works
- How you have carmustine
- Tests during treatment
- About side effects
- Common side effects
- Side effects of carmustine wafers in the brain
Carmustine is a chemotherapy drug used to treat Hodgkin lymphoma, non Hodgkin lymphoma, myeloma, malignant melanoma, and brain tumours.
Carmustine is used as a liquid given into a vein or it can be used as chemotherapy wafers for brain tumours.
Carmustine into a vein
You have carmustine into your bloodstream (intravenously). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.
You can read our information about having chemotherapy into a vein.
The treatment takes 1 to 2 hours, or sometimes longer. You usually have carmustine as a course of several cycles of treatment. The treatment plan depends on which type of cancer you have. Your doctor or nurse can give you information about this.
Carmustine also comes in gel wafers called Gliadel wafers. They can treat a type of brain tumour called a glioma. The wafers are used for glioma that has just been diagnosed (primary glioma) and for glioma that has come back after it was first treated (recurrent glioma).
You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
We've listed the side effects associated with carmustine into a vein. You can use the links to find out more about each side effect. Where there is no link, please go to our information about cancer drug side effects or use the search box at the top of the page.
You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on
- How many times you've had the drug before
- Your general health
- The amount of the drug you have (the dose)
The side effects may be different if you are having carmustine with other medicines.
Tell your doctor or nurse straight away if any of the side effects get severe.
More than 10 in every 100 people have one or more of the side effects listed below.
- An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
- Bruising more easily due to a drop in platelets – you may have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae)
- Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
- Feeling and being sick – this usually starts within 2 hours of having the drug and can last for up to 6 hours. You should have anti sickness medicines before the chemotherapy and will have them to take regularly at home. Tell your doctor or nurse if your anti sickness medicines are not working
- Loss of appetite
- Women may stop having periods (amenorrhoea) but this may only be temporary
- Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
If you have carmustine wafers implanted in your brain, you might also have these side effects
- Swelling of the brain (oedema)
- Convulsions (fits)
- Problems with wound healing
- Infection of the brain tissue
Between 1 and 10 in every 100 people have one or more of these.
- Lung problems – you may have a cough or breathlessness due to inflammation of the lungs. Tell your doctor or nurse if you have this effect. It can happen in up to 1 in 3 people treated but usually only affects people who have had high doses of BCNU
- Skin flushing, especially of the face – this can last for about 4 hours
- Diarrhoea – drink plenty of fluids. If diarrhoea becomes severe or continues you could get dehydrated, so tell your doctor or nurse
- Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse straight away
- Kidney changes that are mild and unlikely to cause symptoms – they will usually go back to normal when treatment finishes
- An increased risk of leukaemia or blood disorders some years after treatment
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
Pregnancy and contraception
This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Don't breastfeed during this treatment because the drug may come through in the breast milk.
You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
This page doesn't list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at yellowcard.mhra.gov.uk.
Question about cancer? Contact our information nurse team