Carmustine (carmustine)
Multiple manufacturers; original brand: BiCNU by Bristol Myers Squibb · Nitrosourea Alkylating Agent
What is Carmustine? Carmustine (brand: BiCNU) is a nitrosourea alkylating agent that crosses the blood-brain barrier, making it valuable for brain tumors. Used in glioblastoma (GBM), brain metastases, lymphomas, and multiple myeloma. Also available as a wafer implant (Gliadel) for local GBM treatment.
About Carmustine
| Brand Name | Carmustine |
| Generic / INN | carmustine |
| Drug Class | Nitrosourea Alkylating Agent |
| Manufacturer | Multiple manufacturers; original brand: BiCNU by Bristol Myers Squibb |
| Administration | Intravenous (IV) infusion or Intracranial wafer implant (Gliadel) |
| FDA Approval | 1977 |
FDA-Approved Uses
- Brain tumors — glioblastoma, brainstem glioma, medulloblastoma, astrocytoma, ependymoma
- Multiple myeloma — combination with prednisone after primary therapy failure
- Hodgkin lymphoma — salvage with other agents
- Non-Hodgkin lymphoma — salvage
- Gliadel wafer — adjuvant to surgery in newly diagnosed high-grade glioma or recurrent GBM
How Does Carmustine Work?
Carmustine alkylates and crosslinks DNA strands, inhibiting DNA synthesis and transcription. Its lipophilicity and low molecular weight allow it to cross the blood-brain barrier — a critical property for CNS tumor treatment. It is cell cycle non-specific.
Dosage & Administration
IV: 150–200 mg/m² every 6 weeks as a single dose, or 75–100 mg/m² days 1–2 every 6 weeks. Delayed myelosuppression — nadir occurs at 4–6 weeks. Gliadel wafer: 8 wafers implanted in resection cavity.
Dosing is individualized by the treating oncologist. Do not adjust without medical guidance. This page is educational only.
Warnings & Side Effects
- Severe delayed myelosuppression (nadir 4–6 weeks) — can be fatal
- Cumulative pulmonary toxicity — can occur years later
- Hepatotoxicity
- Secondary malignancies
- Extravasation injury (vesicant)
- Embryo-fetal toxicity
Common Side Effects
- Delayed myelosuppression
- Nausea/vomiting
- Alopecia
- Elevated LFTs
- Pulmonary toxicity
- Burning at injection site
- Facial flushing
Storage & Handling
Refrigerate at 2°C to 8°C (36°F to 46°F). Do not freeze. Protect from light. Gliadel wafers: frozen at -20°C.
💰 Medication Cost & Insurance Coverage
Approximate Wholesale Acquisition Cost (WAC / List Price)
~$500–$2,000/cycle
generic BiCNU
Insurance & Prior Authorization
Carmustine requires prior authorization from all major insurance plans. BiologicHealthPlus handles the full PA process — clinical documentation, peer-to-peer reviews, and appeals — at no cost to patients or providers.
Prior Authorization Guide Patient Assistance Insurance & Savings
Frequently Asked Questions — Carmustine
Carmustine is used for brain tumors (glioblastoma, astrocytoma), multiple myeloma, and lymphomas. Its ability to cross the blood-brain barrier makes it valuable for CNS malignancies.
Carmustine causes delayed myelosuppression with nadir at 4–6 weeks after administration — much later than most chemotherapy drugs. Blood counts must be monitored for 6 weeks after each dose.
Gliadel is a biodegradable wafer containing carmustine implanted directly into the tumor resection cavity during surgery. It provides local sustained-release chemotherapy to residual tumor cells.
Yes — generic carmustine for IV use is available from multiple manufacturers.
Related Medications & Conditions
Related Medications
Temozolomide (Temodar) · Bevacizumab (Avastin) · Lomustine (CCNU) · Procarbazine · Gliadel wafer
Related Conditions
Glioblastoma (GBM) · Brain tumors · Multiple myeloma · Hodgkin lymphoma