Your child needs to take the medicine called carmustine (say: kar-MUS-teen). This information sheet explains what carmustine does, how to give it, and what side effects or problems your child may have when they take this medicine.
What is carmustine?
Carmustine is a medicine that is used to kill cancer cells. It may also be used to prepare the body for bone marrow or stem cell transplant.
You may hear carmustine called BCNU or by its brand name, BiCNU. Carmustine comes in an injection (needle) form.
Before giving carmustine to your child
Tell your doctor if your child has ever reacted badly to carmustine or to any other medication.
Talk with your doctor or pharmacist if your child has any of the following conditions. Precautions may need to be taken with this medicine if your child has:
- infection or recent exposure to infection (for example, chickenpox)
- history of lung problems
- kidney or liver problems
How do you give your child get carmustine?
Carmustine is a clear, colorless to light yellow liquid that the nurse will inject into the vein slowly, usually over one or two hours. Carmustine is given in the hospital clinic or on the nursing unit.
If carmustine leaks out of the vein through which it is being given, it can cause severe damage. Tell the nurse right away if you notice redness, pain, or swelling at the place of injection.
What are the possible side effects of carmustine?
Your child may have some of these side effects while they take carmustine. Check with your child's doctor if your child continues to have any of these side effects, and they do not go away, or they bother your child:
- nausea (upset stomach) and vomiting (throwing up)
- change in skin colour along the vein where carmustine was given
- facial flushing (face may get red and feel warm)
- diarrhea (loose, watery stools)
- skin rash or itching
Call your child's doctor during office hours if your child has any of these side effects:
- swelling of lower legs or feet
- dry cough or shortness of breath
- yellow coloured skin or eyes
- sores on lips, tongue, mouth, or throat
- unusual tiredness or weakness
Most of the following side effects are not common, but they may be a sign of a serious problem. Call your child's doctor right away or take your child to the Emergency Department if your child has any of these side effects:
- chest pain and shortness of breath or trouble breathing
- signs of infection, such as a fever or chills, cough, or sore throat
- pain in the lower back or side
- black tarry stools
- blood in the urine
- unusual bleeding or bruising
- pain, burning, or stinging when the medicine was given
- severe dizziness or loss of balance
What safety measures should you take when your child is using carmustine?
Keep all appointments at the clinic or doctor's office so that the doctor can check your child's reaction to carmustine. The doctor may need to change the dose so that your child is getting the right amount.
Your child will get medicine to prevent an upset stomach and throwing up.
Smoking may increase the risk of side effects that affect the lungs, such as cough and shortness of breath.
Carmustine may lower the number of white blood cells in the blood temporarily, which increases your child's chances of getting an infection. Your child can take the following precautions to prevent infections, especially when the blood count is low:
- Avoid people with infections, such as a cold or the "flu".
- Avoid places that are very crowded with large groups of people.
- Be careful when brushing or flossing your child's teeth. Your doctor, nurse, or dentist may suggest different ways to clean your child's mouth and teeth.
- You and your child shouldn't touch your child's eyes or inside their nose without washing your or your child's hands first.
- Your child should not receive permanent tattoo or any kind of body piercing.
- Your child's nurse and doctor will review with you what to do when your child has a fever.
Carmustine can lower the number of platelets in the blood, which increases your child's risk of bleeding. You can take the following precautions:
- Be careful not to cut your child when using a razor, scissors, or clippers to cut their nails or hair.
- Your child should be careful when shaving or waxing.
- Your child should avoid contact sports where bruising or injury could occur.
- Your child should not receive a permanent tattoo or any kind of body piercing.
- Before your child has surgery, including dental surgery, inform the doctor or dentist that your child is taking carmustine.
Your child should not receive any immunizations (vaccines) without your child's doctor's approval. Your child or anyone else in your household should not get oral polio vaccine while your child is being treated for cancer. Tell your child's doctor if anyone in your household has recently received oral polio vaccine. Your child should avoid contact with anyone who has recently received this vaccine. Other live vaccines that your child should not get include measles, mumps and rubella (MMR), and chicken pox vaccine.
There is a chance that carmustine may cause birth defects if it is taken at the time of conception or if it is taken during pregnancy. If your child is sexually active, it is recommended that they use some kind of birth control while receiving carmustine. Tell your doctor right away if you think your child may be pregnant.
After receiving carmustine, your child may not be able to have children or have more difficulty having children. Your child's doctor will discuss this in more detail with you and your child.
After your child stops receiving carmustine, it may still cause side effects. These delayed effects may include certain types of cancer. Check with your doctor right away if any of the following signs occur even after carmustine treatment has stopped:
- yellow eyes or skin
- black tarry stools
- blood in urine or stools
- lower back or side pain
- stomach pain
- cough or a hoarse voice
- unusual bleeding, bruising
- severe diarrhea
Your child may lose their hair. It will grow back once treatment with carmustine stops. Its colour and texture may change. Use a gentle shampoo and a soft brush on your child's hair.
Check with your child's doctor or pharmacist before giving your child any other medicines (prescription, non-prescription, herbal, or natural products).
What other important information should you know about carmustine?
- Keep a list of all medications your child is on and show the list to the doctor or pharmacist.
- Do not share your child's medicine with others and do not give anyone else's medicine to your child.
- Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.
Keep carmustine out of your child’s sight and reach and locked up in a safe place. If your child takes too much carmustine, call your local Poison Information Centre at one of these numbers. These calls are free.
- Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
- Call 1-800-463-5060 if you live in Quebec.