Carmustine

CLINICAL USE

Alkylating agent:

Myeloma, lymphoma and brain tumours

DOSE IN NORMAL RENAL FUNCTION

150–200 mg/m2 as a single dose or 75–100 mg/m2 on 2 consecutive days every 6 weeks Implants: 7.7mg, maximum 8 implants

PHARMACOKINETICS

Molecular weight :214.1

%Protein binding :77

%Excreted unchanged in urine : 60–70

Volume of distribution (L/kg) :3.25

half-life – normal/ESRD (hrs) :22 minutes/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in normal renal function

HD :Not dialysed. Dose as in normal renal function

HDF/high flux :Unknown dialysability. Dose as in normal renal function

CAV/VVHD :Not dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsNone known

ADMINISTRATION

Reconstition

3 mL of the supplied diluent (absolute ethanol) then add 27 mL of sterile water for injection

This solution may be further diluted with sodium chloride 0.9% or glucose 5% for injection

Route

Rate of Administration

Administer by IV drip over a period of 1–2 hours

Comments

Therapy should not be repeated before 6 weeks

Can further dilute the reconstituted solution with 500 mL of sodium chloride 0.9% or glucose 5%

OTHER INFORMATION

Renal abnormalities, e.g. a decrease in kidney size: progressive azotaemia and renal failure have been reported in patients receiving large cumulative doses after prolonged therapy

Partially metabolised to active species by liver microsomal enzymes, which have a long T½. It is thought that the antineoplastic activity may be due to metabolites. Approximately 30% of a dose is excreted in the urine after 24 hours, and 60–70% of the total dose after 96 hours. About 10% is excreted as respiratory CO2. Terminal half-life of the metabolites are about 1 hour.

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