Gliadel is a wafer that contains the chemotherapy drug carmustine. Your brain surgeon (neurosurgeon) puts the wafer in during surgery to remove the brain tumour. It is a treatment for a brain tumour called glioblastoma multiforme (glioma) in adults.
How it works
Gliadel wafers are small discs about the size of a 5p coin. The wafers release the chemotherapy drug carmustine as they dissolve. The carmustine in the wafer works by sticking to one of the cancer cell's DNA strands. The cell can't then divide into 2 new cells. This stops the cells growing and they die.
How you have Gliadel
Your brain surgeon puts the wafers in during brain surgery to remove some or all of the tumour. They put up to 8 wafers in the space where the tumour was. Over the next few days, the wafers slowly release the chemotherapy drug carmustine into this area.
You might have blood tests before starting treatment and during your treatment. They check your general health and might check your levels of blood cells and other substances in the blood.
We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.
How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.
When to contact your team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
Surgery and Gliadel can cause side effects and because you have them at the same time it can be difficult to know which is causing any of the side effects you have.
Common side effects
These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:
Slow wound healing
Gliadel can cause wounds to heal more slowly than usual. So it might take longer for the wound from your operation to heal. Your doctor or nurse will check the wound regularly to make sure it is healing well. If the wound is sore, swollen and red or leaking contact your health advice line straight away. And tell your doctor or nurse.
Swelling of the brain
This can happen after surgery and is temporary. Contact your healthcare team if you have any of the following:
- difficulty walking
- weakness in your arms or legs
- changes to how you speak
Difficulty with language
You might find you have a problem with how you speak, how you understand speech and your ability to read and write. Let your doctor or nurse know if you do.
Confusion, anxiety and depression
You might have some mood changes while having this drug. Let your doctor or nurse know if you feel anxious or depressed.
More rarely you might have hallucinations, loss of memory, personality changes or changes to the way you think.
Feeling weak and loss of movement
Gliadel can make you feel weak.
You might have weakness or loss of movement on one side of your body. This could affect the way you walk.
More rarely you can loss control of body movements or have uncontrolled shaking or trembling (tremors). This can increase your risk of accidental injury.
Your veins might become inflamed which can affect how well your blood circulates.
More rarely you might have inflammation of the lining of the brain (meningitis).
Feeling or being sick
Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.
Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.
You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before.
Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.
Worsening of your condition
Your condition could become worse.
Tell your doctor or nurse if you keep getting headaches. They can give you painkillers to help.
Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
You might have a bladder infection. You might find it difficult to pass urine, want to go with some urgency or are going more often. There may be pain or burning when you go. You may see blood in your urine, or your urine might smell bad or look cloudy.
More rarely you might have white patches in the mouth or a sore, red mouth this could be a yeast infection.
Contact your healthcare advice line or tell your doctor or nurse if you have symptoms of an infection or think you might have an infection.
This treatment can cause pain in your muscles, bones or where the tumour site is. Let your doctor or nurse know if you have it so that they can give you painkillers.
Tell your doctor if you have any fits, twitching or jerking of your limbs.
More rarely you might have fits causing loss of concsiousness and stiffness (grand mal seizure).
Occasional side effects
These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:
- blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
- an allergic reaction
- raised levels of sugar in the blood - this can cause diabetes, tell your doctor if you feel thirsty all time, peeing more than usual, losing weight or feel tired
- swelling of your arms and legs
- increased blood pressure in your head caused by an abnormal build up of fluid
- loss of ability to move your face (paralysis)
- nerve changes including pain, decrease in the sense of touch, tingling or prickling (pins and needles)
- difficulty sleeping or getting to sleep
- a drop in blood cells causing tiredness, looking pale, breathlessness and an increased risk of bleeding
- an increased number of white blood cells
- eye problems including pain, blurred, double or abnormal vision and swelling of the lining of the eyelids
- loss of bladder control (urinary incontinence)
- a low amount of sodium and potassium in your blood
Rare side effects
These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:
- bleeding in the brain
- narrowing or blocking of the blood vessels in the brain
Coping with side effects
We have more information about side effects and tips on how to cope with them.
What else do I need to know?
Other medicines, food and drink
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
Loss of fertility
It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Contraception and pregnancy
It is unknown whether treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment.
Talk to your doctor or nurse about effective contraception you can use during treatment. Ask how long you should use it before starting treatment and after treatment has finished.
It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).
- have other vaccines, but they might not give you as much protection as usual
- have the flu vaccine (as an injection)
Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
More about this treatment
For further information about this treatment go to the electronic Medicines Compendium (eMC) website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.