Why is this medication prescribed?

Carmustine implant (brand name: Gliadel) is prescribed for the treatment of glioblastoma multiforme, a type of brain cancer. It is typically prescribed as part of treatment following surgical removal of the tumor. The implants are placed directly into the brain where the tumor was removed.

How should this medicine be used?

Here’s how it is used:

• Administration: Neurosurgeons implant the Carmustine wafers directly into the brain during surgery. These wafers slowly release Carmustine, which is a chemotherapy drug, directly to the tumor site over a period of time.
• Dosage: The number of implants used depends on the size of the tumor cavity. The usual dose is between 8 and 10 implants.
• Duration: The implants are left in place and gradually dissolve over 2 to 3 weeks, delivering the chemotherapy directly to the surrounding tissues.
• Monitoring: Patients are monitored closely after surgery to manage potential side effects and to assess the effectiveness of the treatment.

It’s important for patients to follow their healthcare provider’s instructions carefully regarding the use of Carmustine implant and to attend follow-up appointments to monitor their progress and manage any side effects.

Other uses for this medicine

While Carmustine implant is primarily used for glioblastoma multiforme, there have been some investigations into its potential use in other types of brain tumors or cancers. However, its effectiveness and safety profiles for these conditions have not been well-established, and it is not widely used outside of glioblastoma treatment.

What special precautions should I follow?

Special Precautions:

• Surgical Considerations: Carmustine implantation requires a surgical procedure. Special precautions related to surgical techniques and sterile conditions must be followed to minimize the risk of infection or other complications.
• Monitoring: Patients who receive Carmustine implants require close monitoring after surgery. This includes regular neurological assessments to monitor for any signs of complications, such as increased intracranial pressure or neurological deficits.
• Side Effects: Like all chemotherapy drugs, Carmustine can cause side effects. When administered via implants, the drug is localized to the tumor site, which helps reduce systemic side effects. However, local side effects such as brain swelling, seizures, or infection can still occur and require prompt medical attention.
• Contraindications: Carmustine implant should not be used in patients who are allergic to Carmustine or any components of the implant.
• Pregnancy and Breastfeeding: Carmustine can harm the fetus if used during pregnancy. It is important to discuss the risks and benefits with your healthcare provider if you are pregnant or planning to become pregnant while undergoing treatment. It is not known whether Carmustine passes into breast milk, so breastfeeding is usually not recommended during treatment.
• Drug Interactions: Inform your healthcare provider about all other medications you are taking, including over-the-counter drugs and supplements, as they may interact with Carmustine.
• Liver and Kidney Function: Carmustine is metabolized in the liver and excreted through the kidneys. Patients with impaired liver or kidney function may require dosage adjustments or close monitoring during treatment.
• Long-term Effects: The long-term effects of Carmustine implants on brain function and overall health are not fully understood. Long-term follow-up with a neurologist or oncologist is recommended to monitor for any late effects of treatment.

Always follow your healthcare provider’s instructions carefully regarding Carmustine implant treatment and attend all recommended follow-up appointments to ensure optimal management and monitoring of your condition.

What special dietary instructions should I follow?

There are no specific dietary restrictions associated with Carmustine implant treatment. However, maintaining a balanced diet and staying well-hydrated are generally recommended to support overall health during cancer treatment. Your healthcare provider may provide personalized dietary advice based on your individual needs and any concurrent medical conditions.

What should I do if I forget a dose?

Since Carmustine implants are placed surgically and gradually release the medication over time, there is no concern about forgetting a dose in the traditional sense. However, if you have concerns or questions about your treatment schedule or if you miss a follow-up appointment, contact your healthcare provider immediately. Consistent follow-up and adherence to the treatment plan are crucial for the success of Carmustine implant therapy.

What side effects can this medication cause?

Carmustine implant (Gliadel) can cause several side effects, both locally at the implant site and systemically. Here are some common side effects associated with Carmustine implant:

Localized Side Effects (at the implant site):

• Brain Edema: Swelling of the brain tissue around the implant site can occur, leading to symptoms such as headache, nausea, vomiting, and changes in neurological function.
• Seizures: There is a risk of developing seizures, especially shortly after implantation.
• Infection: Any surgical procedure carries a risk of infection. Signs of infection include fever, redness, swelling, or drainage at the surgical site.
• Wound Healing Issues: Delayed wound healing or wound complications may occur.

Systemic Side Effects (affecting the whole body):

• Bone Marrow Suppression: Carmustine can suppress bone marrow function, leading to decreased production of blood cells (white blood cells, red blood cells, and platelets). This can result in increased susceptibility to infections, fatigue, anemia, and easy bruising or bleeding.
• Nausea and Vomiting: These are common side effects of chemotherapy drugs, including Carmustine.
• Liver Toxicity: Elevated liver enzymes and liver function abnormalities may occur.
• Kidney Toxicity: Carmustine can also affect kidney function, causing renal impairment.
• Allergic Reactions: Although rare, allergic reactions to Carmustine can occur, presenting as rash, itching, swelling, or difficulty breathing.
• Neurological Effects: Besides localized effects, Carmustine can also cause neurological symptoms such as dizziness, confusion, or changes in mental status.

Long-term Effects:

• Cognitive Changes: Some patients may experience cognitive changes or memory impairment following treatment with Carmustine implants.
• Secondary Malignancies: There is a small risk of developing secondary cancers as a result of Carmustine treatment.

It’s important to note that not all patients will experience these side effects, and their severity can vary. Your healthcare provider will monitor you closely during and after treatment to manage any side effects that may arise. If you experience any new or worsening symptoms during treatment with Carmustine implant, notify your healthcare team promptly. They can provide appropriate interventions or adjustments to your treatment plan to ensure your safety and well-being.

What should I know about storage and disposal of this medication?

Storage and Disposal:

• Storage: Carmustine implants are usually stored by the healthcare provider or hospital pharmacy under controlled conditions. If you are given any leftover implants to take home (which is uncommon), store them according to the instructions provided by your healthcare provider.
• Disposal: Unused or expired Carmustine implants should be disposed of properly. Follow any specific disposal instructions provided by your healthcare provider or pharmacist. Typically, medications like Carmustine implants should not be flushed down the toilet or thrown into the trash. Instead, they may need to be returned to a pharmacy or healthcare facility for proper disposal.

In case of emergency/overdose

• Symptoms: Symptoms of an overdose or excessive exposure to Carmustine could include severe neurological symptoms (such as seizures, confusion, or coma), severe bone marrow suppression (leading to severe infections, bleeding, or anemia), and severe organ toxicity (such as liver or kidney dysfunction).
• Immediate Action: If you suspect an overdose or experience severe adverse effects, seek emergency medical attention immediately. Call emergency services (911 in the United States) or your local emergency number.
• Management: Treatment for Carmustine overdose may involve supportive care to manage symptoms and monitoring of vital signs and laboratory tests. There is no specific antidote for Carmustine overdose, so management will focus on symptomatic and supportive measures.

What other information should I know?

• Follow-up Care: Regular follow-up appointments with your healthcare provider are essential during and after treatment with Carmustine implants. These visits allow for monitoring of treatment effectiveness, management of side effects, and assessment of your overall health.
• Pregnancy and Contraception: Carmustine can cause harm to a developing fetus. If you are pregnant, planning to become pregnant, or breastfeeding, discuss the risks and precautions with your healthcare provider. Effective contraception is recommended during treatment and for some time after treatment ends.
• Other Medications and Supplements: Inform your healthcare provider about all medications (prescription and over-the-counter), herbal supplements, and vitamins you are taking. Some medications and supplements may interact with Carmustine, affecting its effectiveness or increasing the risk of side effects.
• Psychosocial Support: Dealing with a diagnosis of glioblastoma multiforme and undergoing treatment with Carmustine implants can be emotionally challenging. Seek support from family, friends, or counseling services as needed to cope with the emotional aspects of your treatment journey.
• Driving and Activities: Carmustine treatment may cause dizziness or other neurological effects that could impair your ability to drive or operate machinery. Exercise caution until you know how this medication affects you.
• Clinical Trials: Your healthcare provider may discuss participation in clinical trials evaluating new treatments or combinations of treatments for glioblastoma multiforme. Consideration of clinical trials may provide access to potentially innovative therapies.

Always follow your healthcare provider’s instructions and recommendations regarding Carmustine implant treatment and any additional information specific to your individual health needs.