Carmustine (BiCNU)

How does it work?

BiCNU injection contains the active ingredient carmustine, which is a type of chemotherapy medicine to treat cancer called an alkylating agent.

Cancers form when some cells within the body multiply uncontrollably and abnormally. These cells spread, destroying nearby tissues. Carmustine works by stopping the cancer cells from multiplying. It does this by binding to and damaging the DNA in the cancer cells. This stops the cells from growing and multiplying.

Carmustine is used in the treatment of a wide range of cancers including lymphomas, brain tumours and bone marrow cancer.

Unfortunately, carmustine can also affect normal, healthy cells, particularly those that multiply quickly, such as blood cells and hair cells. The most important side effect is on the bone marrow where blood cells are made. Carmustine can decrease the production of healthy blood cells, leaving people susceptible to infection. Regular blood tests are therefore needed to monitor the levels of blood cells.

In most chemotherapy regimens, doses are administered in courses at various intervals to allow normal cells to recover from the adverse effects of the anticancer medicines between doses. However, during this period, cancer cells will also recover and start to replicate again. Successful treatment depends on the administration of the next course of therapy before the cancer has regrown to its previous size, with the aimed net effect to decrease the amount of cancer with each successive course of chemotherapy.

What is it used for?

  • A form of cancer of the bone marrow (multiple myeloma).
  • Cancer of the lymph nodes (lymphomas).
  • Brain tumours.

How is this treatment given?

  • Carmustine can be given via a drip into a vein (intravenous infusion) over one or two hours.
  • If carmustine leaks into the tissues around the vein, it can cause damage to the tissue there. For this reason, it is important to tell the doctor or nurse administering the medicine if you feel any burning or stinging around the vein or if you notice any fluid leaking out of the injection site.
  • Treatment with carmustine is given in several cycles of treatment. The number of cycles you have will depend on the type of cancer you are being treated for, how well it responds and how well your body copes with the treatment.
  • Carmustine can also be given as an implant in the brain to treat brain tumours. There is more information about this treatment in our factsheet on Gliadel implants.


  • Chemotherapy medicines can decrease the number of blood cells in your blood. A low white blood cell count can increase your susceptibility to infections; a low red blood cell count causes anaemia and a low platelet count can cause problems with blood clotting. For this reason, you will need regular blood tests to monitor your blood cells during treatment with this medicine. Tell your doctor immediately if you experience any of the following symptoms during your treatment, as they may indicate problems with your blood cells: unexplained bruising or bleeding, purple spots, sore mouth or throat, mouth ulcers, high temperature (fever) or other signs of infection, or suddenly feeling tired, breathless, or generally unwell.
  • Your kidney and liver function should also be regularly monitored during your treatment.
  • This medicine can sometimes cause changes to the lungs. You may need to have tests to monitor your lung function both during treatment and after your treatment is finished. This is to make sure that your lungs have not been affected. Tell your doctor if you smoke, and if you get any shortness of breath, rapid breathing or cough while having treatment with this medicine.
  • This medicine may be harmful to a developing baby. Women who could get pregnant should use effective contraception to prevent pregnancy, and men should use effective contraception to prevent fathering a child, both during treatment and for at least a few months after treatment is finished.
  • Your ability to become get or father a child may be affected by taking this medicine. It is important to discuss fertility with your doctor before starting treatment.

Use with caution in

  • People with decreased kidney or liver function.
  • People with a history of lung disease.
  • Children (there may be a higher risk of delayed side effects on the lungs if this medicine is given to children).
  • Hereditary blood disorders called porphyrias.

Not to be used in

  • People with a very low number of white blood cells or platelets in their blood (for example as a result of previous radiotherapy or chemotherapy treatments).
  • Breastfeeding.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

  • This medicine may be harmful to a developing baby. It should not be used during pregnancy unless considered essential by your doctor for treating life-threatening disease.
  • Women who could get pregnant should use effective contraception to prevent pregnancy, and men should use effective contraception to avoid fathering a child, both during treatment, and for at least a few months after treatment is finished. Ask your doctor for further advice.
  • It is not known if this medicine passes into breast milk, however if it does, it is likely to be harmful to a nursing baby. Mothers who need treatment with this medicine should not breastfeed. Seek further medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

  • Decrease in the number of healthy white blood cells, red blood cells or platelets in the blood (leucopenia, anaemia and thrombocytopenia) -– see warning section above.
  • Feeling or being sick. You will be given medicines to help with this.
  • Feeling tired or weak.
  • Fever or chills.
  • Diarrhoea.
  • Loss of appetite.
  • Disturbance in liver function.
  • Decreased kidney function or kidney failure.
  • Increased heart rate (tachycardia).
  • Chest pain.
  • Headache.
  • Low blood pressure.
  • Local pain and swelling at the site of injection.
  • Scarring and stiffening of the lungs causing breathlessness (pulmonary fibrosis).
  • Long-term treatment with carmustine may increase the risk of developing cancers such as leukaemia (cancer of the white blood cells) after many years. After your treatment you will have regular blood tests which will detect any possible leukaemic changes early, if they do occur. Your doctor or nurse can discuss the risks of this with you.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before treatment with this medicine is started. Similarly, check with your doctor or pharmacist before taking any new medicines during treatment with this one, to make sure that the combination is safe.

Vaccines may be less effective in people receiving chemotherapy. This is because chemotherapy medicines reduce the activity of the immune system and can prevent the body forming adequate antibodies. Live vaccines should be postponed until at least six months after finishing chemotherapy because they may cause infection. Live vaccines include the following: oral polio; rubella; measles, mumps and rubella (MMR); BCG; chickenpox; yellow fever and oral typhoid vaccines.

There may be an increased risk of side effects on the blood cells if this medicine is used in combination with cimetidine, or with other medicines that can also affect blood cell counts, for example other chemotherapy medicines, or the antipsychotic clozapine.

Other medicines containing the same active ingredient

  • Gliadel implant.