[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Alkylating agents](https://durgical.com/en/pharmacology/classes/alkylating-agents/) › Carmustine # Carmustine ## Alkylating agents? Alkylating agents ## High alert? An error with this medicine can cause serious harm: double checks and protocols are used. A nitrosourea that crosses into the brain. Its myelosuppression is delayed and cumulative, and it can scar the lungs even years after treatment. Updated Nov 1, 2026 Also called: BCNU ## Quick facts **Group** [Alkylating agents](https://durgical.com/en/pharmacology/classes/alkylating-agents/) **Target** DNA (guanine), alkylated and cross-linked; proteins carbamoylated **Used for** Brain tumours · Multiple myeloma **Key effects** Nausea and vomiting · Flushing · Liver enzyme rises **Monitor** Pulmonary function tests before · Infusion site **ATC** L01AD01 No doses: the clinician sets them by the current guideline. On this page - The basics Mechanism of action - Indications - Adverse effects - Pharmacokinetics - Memory aid - Clinical What the labels mean - Safety Contraindications - Key interactions - What is monitored - Administration and safety - Pregnancy and breastfeeding - Nursing care - Study Test yourself - Connections Connections ## Mechanism of action Carmustine breaks down without enzymes into two reactive pieces. A chloroethyl group alkylates guanines and then forms cross-links between DNA strands; an isocyanate group carbamoylates proteins, which may inhibit DNA repair enzymes. Because it is very lipid-soluble it reaches the brain and cerebrospinal fluid, and it is not fully cross-resistant with other alkylators. - Carmustine breaks down spontaneously into reactive pieces - The chloroethyl part alkylates and cross-links DNA - The isocyanate part carbamoylates proteins - Lipid-soluble: it reaches brain tumours ## Indications - Brain tumours: glioblastoma, other gliomas, medulloblastoma and brain metastases. [Glioblastoma →](https://durgical.com/en/conditions/glioblastoma/) - Multiple myeloma, with prednisone. [Multiple myeloma →](https://durgical.com/en/conditions/multiple-myeloma/) - Relapsed or refractory Hodgkin lymphoma. [Hodgkin lymphoma →](https://durgical.com/en/conditions/hodgkin-lymphoma/) - Relapsed or refractory non-Hodgkin lymphomas. [Non-Hodgkin lymphoma →](https://durgical.com/en/conditions/non-hodgkin-lymphoma/) ## Adverse effects ### Common - Nausea and vomiting - Pain and burning at the infusion site - Flushing - Liver enzyme rises ### Serious (rare, important) - Delayed, cumulative myelosuppression (mainly thrombocytopenia and leukopenia), with bleeding and infection - Pulmonary infiltrates and fibrosis, dose-related and sometimes appearing years later (especially after childhood treatment) - Extravasation injury - Second cancers ## Contraindications - Previous hypersensitivity to carmustine or its components ## Key interactions **Cimetidine** More myelosuppression (leukopenia, neutropenia). **Phenobarbital** Speeds up carmustine breakdown and may weaken it. **Phenytoin** Carmustine can lower phenytoin levels (seizure risk in brain tumour patients). ## What is monitored - Blood counts weekly for several weeks after each dose (delayed nadir) - Pulmonary function tests before and during treatment - Liver and kidney function - Infusion site ## Administration and safety - Hazardous drug; the solution irritates veins and skin. The site is watched closely for extravasation. - A new course is not given until blood counts have recovered. - Not given into the carotid artery: that route has caused eye toxicity. ## Pregnancy and breastfeeding Can cause fetal harm; pregnancy is avoided during treatment. ## Nursing care - Check counts before each course and teach that the low point comes weeks later, not days. - Ask about cough and breathlessness at every visit, and long after treatment. - Bleeding precautions while platelets are low. - Teaching: avoid pregnancy; report fever, bruising or breathing problems. ## Pharmacokinetics **Absorption** Intravenous infusion (an implantable wafer is also used after brain surgery). **Distribution** Crosses the blood–brain barrier; cerebrospinal fluid levels are high compared with plasma. **Metabolism** Rapid chemical and liver breakdown; phenobarbital speeds it up. **Elimination** Metabolites mainly in the urine. ## Memory aid «Nitrosoureas Never forget the brain or the lungs»: they cross into the brain, and their marrow and lung toxicity come LATE. ## Test yourself Think of the answer, then tap the question to see it. ## Why can carmustine treat brain tumours? It is highly lipid-soluble and crosses the blood–brain barrier. ## When does carmustine's myelosuppression usually appear? Late, weeks after the dose, and it builds up with repeated courses. ## Which late organ toxicity is typical of carmustine? Pulmonary fibrosis, which can appear years after treatment. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/carmustine/) [More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology) ## What the labels mean **High alert** An error with this medicine can cause serious harm: double checks and protocols are used. ## Connections ## Related drugs 2 - [Lomustine](https://durgical.com/en/pharmacology/lomustine/) - [Temozolomide](https://durgical.com/en/pharmacology/temozolomide/) ## Related conditions 4 - [Glioblastoma](https://durgical.com/en/conditions/glioblastoma/) - [Multiple myeloma](https://durgical.com/en/conditions/multiple-myeloma/) - [Hodgkin lymphoma](https://durgical.com/en/conditions/hodgkin-lymphoma/) - [Non-Hodgkin lymphoma](https://durgical.com/en/conditions/non-hodgkin-lymphoma/) [← Back to the class: Alkylating agents](https://durgical.com/en/pharmacology/classes/alkylating-agents/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [DailyMed - CARMUSTINE- carmustine kit](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=06a0322b-eb28-44e2-9925-88bebd8fa91b) (DailyMed (U.S. National Library of Medicine), 2026); [Carmustine: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a682060.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=L01AD01) (WHO Collaborating Centre for Drug Statistics Methodology, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/carmustine/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/carmustine/