Carmustine (BCNU, Gliadel)

Carmustine is a chemotherapy drug used to treat Hodgkin’s lymphoma, non Hodgkin’s lymphoma, malignant melanoma, and brain tumours. Carmustine works by sticking to one of the cancer cell's DNA strands. The cell can't then divide into 2 new cells.

Carmustine is a liquid. You have it 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 drug directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

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 for carmustine depends on which type of cancer you have. There is detailed information about planning chemotherapy in this section.

Carmustine also comes in a gel wafer called a Gliadel wafer. 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). 

We've listed below the side effects associated with carmustine. You can use the links to find out more about each side effect. Where there is no link please see our cancer drugs side effect section, or use the search box at the top of the page.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• 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, sore throat, pain passing urine or feel cold and shivery
• 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, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your treatment centre if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• 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 get pregnant or father a child after treatment with this drug. It is important to talk to your doctor about your fertility before starting treatment.
• This drug may have a harmful effect on a developing baby – do talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant

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 if you have this side effect. This 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
• Headaches
• Diarrhoea – you should 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 immediately

Fewer than 1 in 100 people have these.

• Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your liver is working
• There is a small risk that you may get a second cancer some years after carmustine treatment

The side effects above 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)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. 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.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.