{"id":"carmustine","rwe":[],"_fda":{"id":"14b0f256-a380-424d-a9d4-fafb6ec0e246","set_id":"06a0322b-eb28-44e2-9925-88bebd8fa91b","openfda":{"upc":["0368475500013","0368475503014"],"rxcui":["309012"],"spl_id":["14b0f256-a380-424d-a9d4-fafb6ec0e246"],"brand_name":["Carmustine"],"spl_set_id":["06a0322b-eb28-44e2-9925-88bebd8fa91b"],"package_ndc":["68475-503-01","68475-502-01","68475-500-01"],"product_ndc":["68475-503"],"generic_name":["CARMUSTINE"],"product_type":["HUMAN PRESCRIPTION DRUG"],"manufacturer_name":["Navinta LLC"],"application_number":["ANDA210179"],"is_original_packager":[true]},"version":"11","pregnancy":["8.1 Pregnancy Risk Summary Carmustine for injection, USP can cause fetal harm when administered to a pregnant woman based on the mechanism of action [ see Clinical Pharmacology (12.1) ] and findings in animals [see Data] . Limited available data with carmustine for injection, USP use in pregnant women are insufficient to inform a drug-associated risk of major birth defects and miscarriage. Carmustine was embryotoxic in rats and rabbits and teratogenic in rats (thoracoabdominal closure, neural tube, and eye defects and malformations of the skeletal system of the fetus) when given in doses lower than the maximum cumulative human dose based on body surface area. Consider the benefits and risks of carmustine for injection, USP for the mother and possible risks to the fetus when prescribing carmustine for injection, USP to a pregnant woman. Adverse outcomes in pregnancy occur regardless of the health of the mother or the use of medications. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. Data Animal Data Intraperitoneal (IP) administration of carmustine to pregnant rats 14 days prior to mating and during the period of organogenesis at cumulative doses ≥ 26 mg/kg (158 mg/ m 2 ), approximately 0.1 times the maximum cumulative human dose of 1400 mg/m 2 , resulted in pre-implantation loss, increased resorptions (including completely resorbed litters), and reduced the number of live births in the presence of maternal toxicity. Carmustine administered IP to pregnant rats during the period of organogenesis at cumulative doses ≥ 4 mg/kg (24 mg/m 2 ), approximately 0.02 times the maximum cumulative human dose based on a mg/m 2 basis, resulted in reduced fetal weight and various malformations, which included thoracoabdominal closure defects, neural tube defects, and eye defects, including microphthalmia/anophthalmia, and skeletal anomalies in the skull, sternebra, vertebrae and ribs, and reduced skeletal ossification) in the presence of maternal toxicity. Embryo-fetal death was observed at cumulative doses ≥ 8 mg/kg (48 mg/m 2 ), approximately 0.03 times the maximum cumulative human dose on a mg/ m 2 basis. Intravenous (IV) administration of carmustine to rats at a cumulative dose of 50 mg/kg (300 mg/ m 2 ), approximately 0.2 times the maximum cumulative human dose on a mg/m 2 basis, during the last quarter of pregnancy resulted in the death of offspring within 4 months. Carmustine administered IV to rabbits during the period of organogenesis resulted in spontaneous abortions in mothers and growth defects in the fetus, mainly at cumulative doses ≥ 13 mg/kg (156 mg/ m 2 ), approximately 0.1 times the maximum cumulative human dose on a mg/ m 2 basis."],"overdosage":["10 OVERDOSAGE The main result of overdose is myeloablation. No proven antidotes have been established for carmustine for injection, USP overdosage."],"references":["15 REFERENCES \"OSHA Hazardous Drugs.\" OSHA . http://www.osha.gov/SLTC/hazardousdrugs/index.html"],"description":["11 DESCRIPTION The active ingredient in carmustine for injection, USP is a nitrosourea with the chemical name 1,3-bis(2-chloroethyl)-1-nitrosourea and a molecular weight of 214.06. The drug product is supplied as sterile lyophilized pale yellow flakes or a congealed mass, and it is highly soluble in alcohol and lipids, and poorly soluble in water. Carmustine for injection, USP is administered by intravenous infusion after reconstitution, as recommended. The structural formula of carmustine is: Carmustine for injection, USP is available in 100-mg single-dose vials of lyophilized material. Sterile diluent for constitution of carmustine for injection, USP is co-packaged with the active drug product for use in constitution of the lyophile. The diluent is supplied in a vial containing 3 mL of Dehydrated Alcohol Injection, USP. Image"],"how_supplied":["16 HOW SUPPLIED/STORAGE AND HANDLING 16.1 How Supplied Carmustine for injection, USP. Each package includes a vial containing 100 mg carmustine and a vial containing 3 mL sterile diluent. NDC 68475-503-01 16.2 Storage and Handling Store product and diluent in a refrigerator (2°-8°C, 36°-46°F). Stability Store the unopened vial of the dry drug in a refrigerator (2°-8°C, 36°-46°F). Store the diluent vials in a refrigerator (2°-8°C, 36°-46°F). The recommended storage of unopened carmustine for injection, USP vials provides a stable product for up to 3 years. Compatibility/ Incompatibility with Containers The intravenous solution is unstable in polyvinyl chloride container. DO NOT USE PVC Containers . Administer carmustine for injection, USP solution from the glass bottles or polypropylene container only. Ensure the polypropylene containers used are PVC free and DEHP free. Important Note Carmustine for injection, USP has a low melting point (30.5°-32.0°C or 86.9°-89.6°F). Exposure of the drug to this temperature or above will cause the drug to liquefy and appear as an oil film on the vials. This is a sign of decomposition and vials should be discarded. If there is a question of adequate refrigeration upon receipt of this product, immediately inspect the vial in each individual carton. Hold the vial to a bright light for inspection. The carmustine for injection, USP will appear as a very small amount of dry flakes or dry congealed mass. If this is evident, the carmustine for injection, USP is suitable for use and should be refrigerated immediately.","16.1 How Supplied Carmustine for injection, USP. Each package includes a vial containing 100 mg carmustine and a vial containing 3 mL sterile diluent. NDC 68475-503-01"],"boxed_warning":["WARNING: MYELOSUPPRESSION and PULMONARY TOXICITY Myelosuppression Carmustine for injection, USP causes suppression of marrow function (including thrombocytopenia and leukopenia), which may contribute to bleeding and overwhelming infections. [ see Warnings and Precautions (5.1) and Adverse Reactions (6) ]. Monitor blood counts weekly for at least 6 weeks after each dose. Adjust dosage based on nadir blood counts from the prior dose [ see Dosage and Administration (2.1) ]. Do not administer a repeat course of carmustine for injection, USP until blood counts recover. Pulmonary Toxicity Carmustine for injection, USP causes dose-related pulmonary toxicity. Patients receiving greater than 1400 mg/m 2 cumulative dose are at significantly higher risk than those receiving less. Delayed pulmonary toxicity can occur years after treatment, and can result in death, particularly in patients treated in childhood [see Adverse Reactions (6) and Use in Specific Populations (8.4) ] . WARNING: MYELOSUPPRESSION and PULMONARY TOXICITY See full prescribing information for complete boxed warning Suppression of marrow function, notably thrombocytopenia and leukopenia, is the most common and severe of the toxic effects of carmustine for injection, USP. Monitor blood counts. (5, 6). Pulmonary toxicity from carmustine for injection, USP appears to be dose related. Patients receiving greater than 1400 mg/m 2 cumulative dose are at significantly higher risk than those receiving less (5, 6)."],"geriatric_use":["8.5 Geriatric Use Clinical studies of carmustine for injection, USP did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dose range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. Carmustine for injection, USP and its metabolites are known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and renal function should be monitored."],"pediatric_use":["8.4 Pediatric Use Safety and effectiveness in children have not been established. Delayed onset pulmonary fibrosis occurring up to 17 years after treatment has been reported in a long-term study of patients who received carmustine for injection, USP in childhood and early adolescence (1-16 years). Eight out of the 17 patients (47%) who survived childhood brain tumors, including all the 5 patients initially treated at less than 5 years of age, died of pulmonary fibrosis. [see Adverse Reactions (6.1) ]."],"effective_time":"20251118","pharmacodynamics":["12.2 Pharmacodynamics The exposure-response relationship for efficacy or safety is unknown."],"pharmacokinetics":["12.3 Pharmacokinetics Distribution Carmustine crosses the blood-brain barrier. Levels of radioactivity in the CSF are greater than or equal to 50% of those measured concurrently in plasma. Elimination Following a short intravenous infusion, the reported elimination half-life ranges from 15 minutes to 75 minutes. Metabolism Carmustine may be inactivated through denitrosation reactions catalyzed by both cytosolic and microsomal enzymes, including NADPH and glutathione-S-transferase. Excretion Approximately 60% to 70% of a total dose is excreted in the urine within 96 hours. Approximately 10% is eliminated as respiratory CO 2 ."],"adverse_reactions":["6 ADVERSE REACTIONS The following serious adverse reactions are described elsewhere in the labeling: Myelosuppression [see Warnings and Precautions (5.1) ] Pulmonary toxicity [see Warnings and Precautions (5.2) ] Administration Reactions [see Warnings and Precautions (5.3) ] Carcinogenicity [see Warnings and Precautions (5.4) ] Ocular Toxicity [see Warnings and Precautions (5.5) ] The following adverse reactions associated with the use of carmustine for injection, USP were identified in clinical studies or postmarketing reports. Because some of these reactions were reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Cardiac Disorders Tachycardia and chest pain. Eye Disorders Conjunctival edema, conjunctival hemorrhage, blurred vision and loss of depth perception Gastrointestinal Toxicity Nausea, vomiting, anorexia, and diarrhea Hepatotoxicity Increased transaminase, increased alkaline phosphatase, increased bilirubin levels Infections and Infestations Opportunistic infection (including with fatal outcome). Neoplasms Benign, Malignant and Unspecified (including cysts and polyps) Acute leukemia, bone marrow dysplasias. Nephrotoxicity Progressive azotemia, decrease in kidney size, renal failure Nervous System Disorders Headaches, encephalopathy, and seizures Pulmonary Toxicity Pneumonitis, interstitial lung disease Reproductive System and Breast Disorders Gynecomastia Skin and Subcutaneous Tissue Disorders Burning sensation, hyperpigmentation, swelling, pain, erythema, skin necrosis, alopecia, allergic reaction Vascular Disorders Veno-occlusive disease. Most common adverse reactions (>1%) are nausea, vomiting, renal toxicity, pneumonitis, pulmonary toxicity, myelosuppression ( 6 ) To report SUSPECTED ADVERSE REACTIONS, contact Navinta LLC, Ewing NJ 08618 at +1-609-883-1135 or FDA at +1-800-FDA-1088 or www.fda.gov/medwatch."],"contraindications":["4 CONTRAINDICATIONS Carmustine for injection, USP is contraindicated in patients with previous hypersensitivity to carmustine for injection, USP or its components. Hypersensitivity"],"drug_interactions":["7 DRUG INTERACTIONS Cimetidine: Increased myelosuppression with concomitant use. (7.1) Phenobarbital: Induces carmustine metabolism, reducing exposure. May lead to reduced efficacy. (7.1) Phenytoin: Carmustine for injection, USP may reduce the efficacy of phenytoin. (7.2) 7.1 Effects of other drugs on carmustine for injection, USP Cimetidine: Greater myelosuppression (e.g., leukopenia and neutropenia) has been reported when oral cimetidine has been coadministered with carmustine. Consider alternative drugs to cimetidine. Phenobarbital: Phenobarbital induces the metabolism of carmustine and may compromise antitumor activity of carmustine for injection, USP. Consider alternative drugs to phenobarbital. 7.2 Effects of carmustine for injection, USP on other drugs Phenytoin: Carmustine for injection, USP when coadministered with phenytoin may reduce phenytoin serum concentrations. Consider alternative drugs to phenytoin."],"mechanism_of_action":["12.1 Mechanism of Action The mechanism of action of carmustine is not fully understood. While carmustine alkylates DNA and RNA, it is not cross-resistant with other alkylators. As with other nitrosoureas, it may also inhibit several key enzymatic processes by carbamoylation of amino acids in proteins. The metabolites may contribute to antitumor activity and toxicities of carmustine."],"storage_and_handling":["16.2 Storage and Handling Store product and diluent in a refrigerator (2°-8°C, 36°-46°F). Stability Store the unopened vial of the dry drug in a refrigerator (2°-8°C, 36°-46°F). Store the diluent vials in a refrigerator (2°-8°C, 36°-46°F). The recommended storage of unopened carmustine for injection, USP vials provides a stable product for up to 3 years. Compatibility/ Incompatibility with Containers The intravenous solution is unstable in polyvinyl chloride container. DO NOT USE PVC Containers . Administer carmustine for injection, USP solution from the glass bottles or polypropylene container only. Ensure the polypropylene containers used are PVC free and DEHP free. Important Note Carmustine for injection, USP has a low melting point (30.5°-32.0°C or 86.9°-89.6°F). Exposure of the drug to this temperature or above will cause the drug to liquefy and appear as an oil film on the vials. This is a sign of decomposition and vials should be discarded. If there is a question of adequate refrigeration upon receipt of this product, immediately inspect the vial in each individual carton. Hold the vial to a bright light for inspection. The carmustine for injection, USP will appear as a very small amount of dry flakes or dry congealed mass. If this is evident, the carmustine for injection, USP is suitable for use and should be refrigerated immediately."],"clinical_pharmacology":["12 CLINICAL PHARMACOLOGY 12.1 Mechanism of Action The mechanism of action of carmustine is not fully understood. While carmustine alkylates DNA and RNA, it is not cross-resistant with other alkylators. As with other nitrosoureas, it may also inhibit several key enzymatic processes by carbamoylation of amino acids in proteins. The metabolites may contribute to antitumor activity and toxicities of carmustine. 12.2 Pharmacodynamics The exposure-response relationship for efficacy or safety is unknown. 12.3 Pharmacokinetics Distribution Carmustine crosses the blood-brain barrier. Levels of radioactivity in the CSF are greater than or equal to 50% of those measured concurrently in plasma. Elimination Following a short intravenous infusion, the reported elimination half-life ranges from 15 minutes to 75 minutes. Metabolism Carmustine may be inactivated through denitrosation reactions catalyzed by both cytosolic and microsomal enzymes, including NADPH and glutathione-S-transferase. Excretion Approximately 60% to 70% of a total dose is excreted in the urine within 96 hours. Approximately 10% is eliminated as respiratory CO 2 ."],"indications_and_usage":["1 INDICATIONS AND USAGE Carmustine for injection, USP is indicated as palliative therapy as a single agent or in established combination therapy in the following: Brain tumors glioblastoma, brainstem glioma, medulloblastoma, astrocytoma, ependymoma, and metastatic brain tumors. Multiple myeloma in combination with prednisone. Relapsed or refractory Hodgkin's lymphoma in combination with other approved drugs. Relapsed or refractory Non-Hodgkin's lymphomas in combination with other approved drugs. Carmustine for injection, USP is a nitrosourea indicated as palliative therapy as a single agent or in established combination therapy with other approved chemotherapeutic agents in the following: Brain tumors glioblastoma, brainstem glioma, medulloblastoma, astrocytoma, ependymoma, and metastatic brain tumors (1) Multiple myeloma-in combination with prednisone (1) Relapsed or refractory Hodgkin's lymphoma in combination with other approved drugs (1) Relapsed or refractory Non-Hodgkin's lymphomas in combination with other approved drugs (1)"],"warnings_and_cautions":["5 WARNINGS AND PRECAUTIONS Administration Reactions: Extravasation may occur; monitor infusion site closely during administration (5.3) Carcinogenicity: Potentially carcinogenic to humans. Monitor patient periodically for such signs and apprise the patient of the symptoms for which they need to seek medical help. (5.4) Ocular Toxicity: Has occurred when administered via unapproved intraarterial intracarotid route. (5.5) Embryo-Fetal toxicity: Can cause fetal harm. Advise females of reproductive potential of the potential risk to a fetus and to avoid pregnancy. (5.6) 5.1 Myelosuppression Bone marrow toxicity is a dose-limiting, common and severe toxic effect of carmustine for injection, USP occurring 4-6 weeks after drug administration (thrombocytopenia occurs at about 4 weeks post-administration persisting for 1 to 2 weeks; leukopenia occurs at 5 to 6 weeks after a dose of carmustine for injection, USP persisting for 1 to 2 weeks; thrombocytopenia is generally more severe than leukopenia; anemia is less frequent and less severe compared to thrombocytopenia and/or leukopenia) Complete blood count should therefore be monitored weekly for at least six weeks after a dose. Repeat doses of carmustine for injection, USP should not be given more frequently than every six weeks. The bone marrow toxicity of carmustine for injection, USP is cumulative and therefore the dosage adjustment must be considered on the basis of nadir blood counts from prior dose [see Adverse Reactions (6) ]. Greater myelotoxicity (e.g., leukopenia and neutropenia) has been reported when carmustine was combined with cimetidine [see Drug Interactions (7) ]. 5.2 Pulmonary Toxicity Cases of fatal pulmonary toxicity with carmustine for injection, USP have been reported. Pulmonary toxicity characterized by pulmonary infiltrates and/or fibrosis has been reported to occur from 9 days to 43 months after treatment with carmustine for injection, USP and related nitrosoureas. Pulmonary toxicity from carmustine for injection, USP is dose-related. Patients receiving greater than 1400 mg/m 2 cumulative dose are at significantly higher risk than those receiving less. However, there have been reports of pulmonary fibrosis in patients receiving lower total doses. Interstitial fibrosis (with lower doses) occurred rarely. Additionally, delayed onset pulmonary fibrosis occurring up to 17 years after treatment has been reported in patients who received carmustine for injection, USP (in cumulative doses ranging from 770 to 1800 mg/m 2 combined with cranial radiotherapy for intracranial tumors) in childhood and early adolescence. Other risk factors include past history of lung disease and duration of treatment. Baseline pulmonary function studies should be conducted along with frequent pulmonary function tests during treatment. Patients with a baseline below 70% of the predicted forced vital capacity (FVC) or carbon monoxide diffusing capacity (DLCO) are particularly at risk. 5.3 Administration Reactions Injection site reactions may occur during the administration of carmustine for injection, USP. Rapid intravenous infusion of carmustine for injection, USP may produce intensive flushing of the skin and suffusion of the conjunctiva within 2 hours, lasting about 4 hours. It is also associated with burning at the site of injection although true thrombosis is rare. Given the possibility of extravasation, close monitoring of the infusion site for possible infiltration during drug administration is recommended. A specific treatment for extravasation reactions is unknown at this time. 5.4 Carcinogenicity Long-term use of nitrosoureas, such as carmustine for injection, USP, has been reported to be associated with the development of secondary malignancies. Carmustine was carcinogenic when administered to laboratory animals [see Nonclinical Toxicity (13.1) ] . Nitrosourea therapy, such as carmustine for injection, USP, has carcinogenic potential in humans. Patients treated with carmustine for injection, USP should be monitored long-term for development of second malignancies. 5.5 Ocular Toxicity Carmustine for injection, USP has been administered through an intraarterial intracarotid route; this procedure is investigational and has been associated with ocular toxicity. Safety and effectiveness of the intraarterial route have not been established. 5.6 Embryo-Fetal Toxicity Carmustine was embryotoxic in rats and rabbits and teratogenic in rats when given in doses lower than the maximum cumulative human dose based on body surface area. There are no adequate and well-controlled studies in pregnant women. Advise pregnant women of the potential risk to the fetus [ see Use in Specific Populations ( 8.1 , 8.3 ) ]. Advise females of reproductive potential to use highly effective contraception during and after treatment with carmustine for injection, USP for at least 6 months after therapy. Advise males of reproductive potential to use effective contraception during and after treatment with carmustine for injection, USP for at least 3 months after therapy [see Use in Specific Populations ( 8.1 , 8.3 )]."],"nonclinical_toxicology":["13 NONCLINICAL TOXICOLOGY 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility Carmustine is carcinogenic in rats and mice, producing a marked increase in tumor incidence in doses approximating those employed clinically. Nitrosourea therapy does have carcinogenic potential in humans [see Adverse Reactions (6.1) ] . Carmustine was mutagenic and clastogenic in multiple in vitro and in vivo genetic toxicology studies. Male rats treated with carmustine at cumulative doses ≥ 36 mg/kg (216 mg/m 2 ), approximately 0.15 times the maximum cumulative human dose on a mg/m 2 basis, showed decreases in reproductive potential when mated with untreated female rats (e.g., decreased implantations, increased resorption rate, and a decrease in viable fetuses)."],"information_for_patients":["17 PATIENT COUNSELING INFORMATION Myelosuppression [ see Warnings and Precautions (5.1) ]. A serious and frequent toxicity of carmustine for injection, USP is delayed myelosuppression and usually occurs 4 to 6 weeks after drug administration. Hence, patients should be advised to get blood counts monitored weekly for at least 6 weeks. The bone marrow toxicity of carmustine for injection, USP is cumulative. Pulmonary Toxicity [ see Warnings and Precautions (5.2) ]. Advise patients to contact a health care professional immediately for any of the following: shortness of breath, particularly during exercise, dry, hacking cough, fast, shallow breathing, gradual unintended weight loss, tiredness, aching joints and muscles, clubbing (widening and rounding) of the tips of the fingers or toes. Seizures [ see Adverse Reactions (6) ] Inform the patient that they may suffer from fits and advise them to get medical attention immediately in such cases. Pregnancy [ see Warnings and Precautions (5.6) and Use in Specific Populations ( 8.1 and 8.3 )] Advise pregnant women and females of reproductive potential that carmustine for injection, USP exposure during pregnancy can result in fetal harm. Advise female patients to contact their healthcare provider with a known or suspected pregnancy. Advise women of reproductive potential to avoid becoming pregnant. Advise females of reproductive potential to use effective contraception during treatment. Lactation [ see Use in Specific Populations ( 8.2 )] Advise the female patient to discontinue nursing while taking carmustine for injection, USP."],"dosage_and_administration":["2 DOSAGE AND ADMINISTRATION Recommended Dosage: As a single agent, 150 to 200 mg/m 2 carmustine for injection, USP intravenously every 6 weeks as a single dose or divided into daily injections such as 75 to 100 mg/m 2 on 2 successive days. Adjust dose for combination therapy or in patients with reduced bone marrow reserve (2.1) Administer reconstituted solution only as a slow intravenous infusion over at least 2 hours. (2.2) 2.1 Dosage The recommended dose of carmustine for injection, USP as a single agent in previously untreated patients is 150 to 200 mg/m 2 intravenously every 6 weeks. Administer as a single dose or divided into daily injections such as 75 to 100 mg/m 2 on two successive days. Lower the dose when carmustine for injection, USP is used with other myelosuppressive drugs or in patients in whom bone marrow reserve is depleted. Administer carmustine for injection, USP for the duration according to the established regimen. Premedicate each dose with anti-emetics. Adjust doses subsequent to the initial dose according to the hematologic response of the patient to the preceding dose. The following schedule is suggested as a guide to dosage adjustment: Nadir After Prior Dose Percentage of Prior Dose to be Given Leukocytes/mm 3 Platelets/mm 3 >4000 >100,000 100% 3000-3999 75,000-99,999 100% 2000-2999 25,000-74,999 70% <2000 <25,000 50% The hematologic toxicity can be delayed and cumulative. Monitor blood counts weekly. Do not administer a repeat course of carmustine for injection, USP until circulating blood elements have returned to acceptable levels (platelets above 100 Gi/L, leukocytes above 4 Gi/L and absolute neutrophil count above 1 Gi/L). The usual interval between courses is 6 weeks. Evaluate renal function prior to administration and periodically during treatment. For patients with compromised renal function, monitor for toxicity more frequently. Discontinue carmustine for injection, USP if the creatinine clearance is less than 10 mL/min. Do not administer carmustine for injection, USP to patients with compromised renal function. Monitor transaminases and bilirubin periodically during treatment. [see Adverse Reactions (6) ]. 2.2 Preparation and Administration of Intravenous Solution Dissolve carmustine for injection, USP with 3 mL of the supplied sterile diluent (Dehydrated Alcohol Injection, USP). Aseptically add 27 mL Sterile Water for Injection, USP. Each mL of resulting solution contains 3.3 mg of carmustine for injection, USP in 10% ethanol. Such solutions should be protected from light. The reconstituted solution is a clear, colorless to yellowish solution. Once reconstituted, the solution must be further diluted with Sodium Chloride Injection, USP or 5% Dextrose Injection, USP. Examine reconstituted vials for crystal formation prior to use. If crystals are observed, they may be re-dissolved by warming the vial to room temperature with agitation. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. After reconstitution as recommended, carmustine for injection, USP is stable for 24 hours under refrigeration (2°-8°C, 36°-46°F) in glass container. Examine reconstituted vials for crystal formation prior to use. If crystals are observed, they may be redissolved by warming the vial to room temperature with agitation. Vials reconstituted as directed and further diluted with 500 mL Sodium Chloride Injection, USP or 5% Dextrose Injection, USP, in glass or polypropylene containers to a concentration of 0.2 mg/mL, should be stored at room temperature, protected from light and utilized within 8 hours. These solutions are also stable 24 hours under refrigeration (2°-8°C, 36°-46°F) and an additional 6 hours at room temperature protected from light. Administer reconstituted solution by slow intravenous infusion over at least two hours. Administration of carmustine for injection, USP over a period of less than two hours can lead to pain and burning at the site of injection. Monitor the injected area during the administration. The rate of administration of the intravenous infusion should not be more than 1.66 mg/m 2 /min See Section 16.2 for important instructions on the storage and handling of the injection. Carmustine for injection, USP is a cytotoxic drug. Follow applicable special handling and disposal procedures. 1 The lyophilized dosage formulation contains no preservatives and is not intended for use as a multiple dose via. Accidental contact of reconstituted carmustine for injection, USP with the skin has caused transient hyperpigmentation of the affected areas. Wear impervious gloves to minimize the risk of dermal exposure impervious gloves when handling vials containing carmustine for injection. Immediately wash the skin or mucosa thoroughly with soap and water if carmustine for injection, USP lyophilized material or solution contacts the skin or mucosa 1 ."],"spl_product_data_elements":["Carmustine carmustine Dehydrated Alcohol Alcohol ALCOHOL carmustine carmustine CARMUSTINE CARMUSTINE"],"dosage_forms_and_strengths":["3 DOSAGE FORMS AND STRENGTHS For injection: 100 mg of carmustine as a lyophilized powder in a single-dose vial for reconstitution and a vial containing 3 mL sterile diluent (Dehydrated Alcohol Injection, USP). For injection: 100 mg of carmustine lyophilized powder in a single-dose vial for reconstitution and a vial containing 3mL sterile diluent (Dehydrated Alcohol Injection, USP)"],"use_in_specific_populations":["8 USE IN SPECIFIC POPULATIONS Lactation: Advise lactating females not to breastfeed (8.2) 8.1 Pregnancy Risk Summary Carmustine for injection, USP can cause fetal harm when administered to a pregnant woman based on the mechanism of action [ see Clinical Pharmacology (12.1) ] and findings in animals [see Data] . Limited available data with carmustine for injection, USP use in pregnant women are insufficient to inform a drug-associated risk of major birth defects and miscarriage. Carmustine was embryotoxic in rats and rabbits and teratogenic in rats (thoracoabdominal closure, neural tube, and eye defects and malformations of the skeletal system of the fetus) when given in doses lower than the maximum cumulative human dose based on body surface area. Consider the benefits and risks of carmustine for injection, USP for the mother and possible risks to the fetus when prescribing carmustine for injection, USP to a pregnant woman. Adverse outcomes in pregnancy occur regardless of the health of the mother or the use of medications. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. Data Animal Data Intraperitoneal (IP) administration of carmustine to pregnant rats 14 days prior to mating and during the period of organogenesis at cumulative doses ≥ 26 mg/kg (158 mg/ m 2 ), approximately 0.1 times the maximum cumulative human dose of 1400 mg/m 2 , resulted in pre-implantation loss, increased resorptions (including completely resorbed litters), and reduced the number of live births in the presence of maternal toxicity. Carmustine administered IP to pregnant rats during the period of organogenesis at cumulative doses ≥ 4 mg/kg (24 mg/m 2 ), approximately 0.02 times the maximum cumulative human dose based on a mg/m 2 basis, resulted in reduced fetal weight and various malformations, which included thoracoabdominal closure defects, neural tube defects, and eye defects, including microphthalmia/anophthalmia, and skeletal anomalies in the skull, sternebra, vertebrae and ribs, and reduced skeletal ossification) in the presence of maternal toxicity. Embryo-fetal death was observed at cumulative doses ≥ 8 mg/kg (48 mg/m 2 ), approximately 0.03 times the maximum cumulative human dose on a mg/ m 2 basis. Intravenous (IV) administration of carmustine to rats at a cumulative dose of 50 mg/kg (300 mg/ m 2 ), approximately 0.2 times the maximum cumulative human dose on a mg/m 2 basis, during the last quarter of pregnancy resulted in the death of offspring within 4 months. Carmustine administered IV to rabbits during the period of organogenesis resulted in spontaneous abortions in mothers and growth defects in the fetus, mainly at cumulative doses ≥ 13 mg/kg (156 mg/ m 2 ), approximately 0.1 times the maximum cumulative human dose on a mg/ m 2 basis. 8.2 Lactation Risk Summary There is no information regarding the presence of carmustine in human milk, the effects on the breastfed infant, or the effects on milk production. Because many drugs are excreted in human milk and because of the potential for serious adverse events (e.g., carcinogenicity and myelosuppression) in nursing infants, nursing should be discontinued while taking carmustine for injection, USP. 8.3 Females and Males of Reproductive Potential Contraception Advise female patients to avoid pregnancy during treatment with carmustine for injection, USP because of the risk of fetal harm [ see Use in Specific Populations (8.1) ]. Advise female patients of reproductive potential to use highly effective contraception during and for up to six months after completion of treatment. Advise males with female sexual partners of reproductive potential to use effective contraception during carmustine for injection, USP treatment and for at least three months after the final dose of carmustine for injection, USP [ see Nonclinical Toxicology (13.1) ]. Infertility Based on nonclinical findings, male fertility may be compromised by treatment with carmustine for injection, USP [see Nonclinical Toxicology (13.1) ]. 8.4 Pediatric Use Safety and effectiveness in children have not been established. Delayed onset pulmonary fibrosis occurring up to 17 years after treatment has been reported in a long-term study of patients who received carmustine for injection, USP in childhood and early adolescence (1-16 years). Eight out of the 17 patients (47%) who survived childhood brain tumors, including all the 5 patients initially treated at less than 5 years of age, died of pulmonary fibrosis. [see Adverse Reactions (6.1) ]. 8.5 Geriatric Use Clinical studies of carmustine for injection, USP did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dose range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. Carmustine for injection, USP and its metabolites are known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and renal function should be monitored."],"dosage_and_administration_table":["<table ID=\"ID569\" width=\"100%\"><col width=\"33%\"/><col width=\"33%\"/><col width=\"33%\"/><tbody><tr><td colspan=\"2\" valign=\"top\" styleCode=\"Lrule Toprule Botrule Rrule Botrule\" align=\"center\"> Nadir After Prior Dose  </td><td valign=\"top\" styleCode=\" Toprule Botrule Rrule\" align=\"center\"> Percentage of Prior Dose to be Given </td></tr><tr><td valign=\"top\" styleCode=\"Lrule Botrule Rrule\" align=\"center\"> Leukocytes/mm<sup>3 </sup> </td><td valign=\"top\" styleCode=\" Botrule Rrule\" align=\"center\"> Platelets/mm<sup>3 </sup> </td><td valign=\"top\" styleCode=\" Botrule Rrule\"/></tr><tr><td valign=\"top\" styleCode=\"Lrule Botrule Rrule\" align=\"center\"> &gt;4000  </td><td valign=\"top\" styleCode=\" Botrule Rrule\" align=\"center\"> &gt;100,000  </td><td valign=\"top\" styleCode=\" Botrule Rrule\" align=\"center\"> 100% </td></tr><tr><td valign=\"top\" styleCode=\"Lrule Botrule Rrule\" align=\"center\"> 3000-3999  </td><td valign=\"top\" styleCode=\" Botrule Rrule\" align=\"center\"> 75,000-99,999  </td><td valign=\"top\" styleCode=\" Botrule Rrule\" align=\"center\"> 100% </td></tr><tr><td valign=\"top\" styleCode=\"Lrule Botrule Rrule\" align=\"center\"> 2000-2999  </td><td valign=\"top\" styleCode=\" Botrule Rrule\" align=\"center\"> 25,000-74,999  </td><td valign=\"top\" styleCode=\" Botrule Rrule\" align=\"center\"> 70% </td></tr><tr><td valign=\"top\" styleCode=\"Lrule Botrule Rrule\" align=\"center\"> &lt;2000  </td><td valign=\"top\" styleCode=\" Botrule Rrule\" align=\"center\"> &lt;25,000  </td><td valign=\"top\" styleCode=\" Botrule Rrule\" align=\"center\"> 50% </td></tr></tbody></table>"],"package_label_principal_display_panel":["PACKAGE LABEL.PRINCIPAL DISPLAY PANEL Manufactured for: Navinta LLC Ewing, NJ 08618 Manufactured By: Piramal Pharma Solutions, Inc. 1575 McGrathiana Parkway, Lexington, Kentucky (KY) 40511, United States (USA) Revised 09/2020 30141118 R2 PACKAGE LABEL.PRINCIPAL DISPLAY PANEL - diluent label NDC 68475-502-01 Dehydrated Alcohol Injection, USP 3 mL Sterile Diluent for carmustine for injection, USP PACKAGE LABEL.PRINCIPAL DISPLAY PANEL - vial label NDC 68475-500-01 Rx Only Carmustine for injection, USP 100 mg per vial For intravenous infusion after reconstitution REFRIGERATE IMMEDIATELY Single Dose Vial – Discard Unused Portion PACKAGE LABEL.PRINCIPAL DISPLAY PANEL - carton NDC 68475- 503 -01 Rx only Carmustine for injection, USP 100 mg per vial Each carton contains: 1 vial carmustine for injection, USP 100 mg, 1 vial Sterile Diluent for carmustine for injection, USP 3 mL For intravenous infusion after reconstitution REFRIGETRATE IMMEDIATELY Single Dose Vial- Discard Unused Portion medication guide Diluent image image"],"carcinogenesis_and_mutagenesis_and_impairment_of_fertility":["13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility Carmustine is carcinogenic in rats and mice, producing a marked increase in tumor incidence in doses approximating those employed clinically. Nitrosourea therapy does have carcinogenic potential in humans [see Adverse Reactions (6.1) ] . Carmustine was mutagenic and clastogenic in multiple in vitro and in vivo genetic toxicology studies. Male rats treated with carmustine at cumulative doses ≥ 36 mg/kg (216 mg/m 2 ), approximately 0.15 times the maximum cumulative human dose on a mg/m 2 basis, showed decreases in reproductive potential when mated with untreated female rats (e.g., decreased implantations, increased resorption rate, and a decrease in viable fetuses)."]},"tags":[{"label":"Alkylating Drug","category":"class"},{"label":"Small Molecule","category":"modality"},{"label":"Glutathione reductase, mitochondrial","category":"target"},{"label":"GSR","category":"gene"},{"label":"L01AD01","category":"atc"},{"label":"Intracavitary","category":"route"},{"label":"Wafer","category":"form"},{"label":"Off-Patent","category":"patent"},{"label":"Generic Available","category":"availability"},{"label":"Established","category":"status"},{"label":"Diffuse non-Hodgkin's lymphoma, large cell","category":"indication"},{"label":"Glioblastoma multiforme of brain","category":"indication"},{"label":"Glioma, malignant","category":"indication"},{"label":"Hodgkin's disease","category":"indication"},{"label":"Malignant neoplasm of brain","category":"indication"},{"label":"Multiple myeloma","category":"indication"},{"label":"Avet Lifesciences","category":"company"},{"label":"Approved 1970s","category":"decade"},{"label":"Alkylating Agents","category":"pharmacology"},{"label":"Antineoplastic Agents","category":"pharmacology"},{"label":"Antineoplastic Agents, Alkylating","category":"pharmacology"},{"label":"Noxae","category":"pharmacology"}],"phase":"marketed","safety":{"boxedWarnings":["WARNING: MYELOSUPPRESSION and PULMONARY TOXICITY Myelosuppression Carmustine for injection, USP causes suppression of marrow function (including thrombocytopenia and leukopenia), which may contribute to bleeding and overwhelming infections. [ see Warnings and Precautions (5.1) and Adverse Reactions (6) ]. Monitor blood counts weekly for at least 6 weeks after each dose. Adjust dosage based on nadir blood counts from the prior dose [ see Dosage and Administration (2.1) ]. Do not administer a repeat course of carmustine for injection, USP until blood counts recover. Pulmonary Toxicity Carmustine for injection, USP causes dose-related pulmonary toxicity. Patients receiving greater than 1400 mg/m 2 cumulative dose are at significantly higher risk than those receiving less. Delayed pulmonary toxicity can occur years after treatment, and can result in death, particularly in patients treated in childhood [see Adverse Reactions (6) and Use in Specific Populations (8.4) ] . WARNING: MYELOSUPPRESSION and PULMONARY TOXICITY See full prescribing information for complete boxed warning Suppression of marrow function, notably thrombocytopenia and leukopenia, is the most common and severe of the toxic effects of carmustine for injection, USP. Monitor blood counts. (5, 6). Pulmonary toxicity from carmustine for injection, USP appears to be dose related. Patients receiving greater than 1400 mg/m 2 cumulative dose are at significantly higher risk than those receiving less (5, 6)."],"safetySignals":[{"date":"","signal":"OFF LABEL USE","source":"FDA FAERS","actionTaken":"494 reports"},{"date":"","signal":"FEBRILE NEUTROPENIA","source":"FDA FAERS","actionTaken":"358 reports"},{"date":"","signal":"MYELODYSPLASTIC SYNDROME","source":"FDA FAERS","actionTaken":"290 reports"},{"date":"","signal":"DISEASE PROGRESSION","source":"FDA FAERS","actionTaken":"278 reports"},{"date":"","signal":"THROMBOCYTOPENIA","source":"FDA FAERS","actionTaken":"242 reports"},{"date":"","signal":"PYREXIA","source":"FDA FAERS","actionTaken":"236 reports"},{"date":"","signal":"NEUTROPENIA","source":"FDA FAERS","actionTaken":"204 reports"},{"date":"","signal":"MUCOSAL INFLAMMATION","source":"FDA FAERS","actionTaken":"200 reports"},{"date":"","signal":"PNEUMONIA","source":"FDA FAERS","actionTaken":"194 reports"},{"date":"","signal":"DRUG INEFFECTIVE","source":"FDA FAERS","actionTaken":"183 reports"}],"drugInteractions":[{"url":"/drug/cimetidine","drug":"cimetidine","action":"Avoid combination","effect":"May interact with Cimetidine","source":"DrugCentral","drugSlug":"cimetidine"}],"commonSideEffects":[{"effect":"Cerebral edema","drugRate":"","severity":"serious","_validated":false,"_confidence":0.3},{"effect":"Wound healing abnormalities","drugRate":"","severity":"serious","_validated":false,"_confidence":0.3},{"effect":"Nausea","drugRate":"","severity":"common","_validated":false,"_confidence":0.3},{"effect":"Vomiting","drugRate":"","severity":"common","_validated":false,"_confidence":0.3},{"effect":"Constipation","drugRate":"","severity":"common","_validated":false,"_confidence":0.3},{"effect":"Asthenia","drugRate":"","severity":"common","_validated":false,"_confidence":0.3},{"effect":"Fever","drugRate":"","severity":"common","_validated":false,"_confidence":0.3},{"effect":"Urinary tract infections","drugRate":"","severity":"common","_validated":false,"_confidence":0.3},{"effect":"Chest pain","drugRate":"5%","severity":"mild","_validated":true},{"effect":"Back pain","drugRate":"","severity":"mild","_validated":false,"_confidence":0.3},{"effect":"Depression","drugRate":"","severity":"common","_validated":false,"_confidence":0.3},{"effect":"Intracranial hypertension","drugRate":"","severity":"mild","_validated":false,"_confidence":0.3},{"effect":"Cerebral hemorrhage","drugRate":"","severity":"mild","_validated":false,"_confidence":0.3},{"effect":"Brain abscess","drugRate":"","severity":"mild","_validated":false,"_confidence":0.3},{"effect":"Brain cyst","drugRate":"","severity":"mild","_validated":false,"_confidence":0.3},{"effect":"Meningitis","drugRate":"","severity":"mild","_validated":false,"_confidence":0.3},{"effect":"Abdominal pain","drugRate":"8%","severity":"mild","_validated":true},{"effect":"Severe adverse reactions","drugRate":"","severity":"serious","_validated":false,"_confidence":0.3},{"effect":"Cerebral hematoma/edema","drugRate":"","severity":"mild","_validated":false,"_confidence":0.3},{"effect":"Pulmonary embolism","drugRate":"","severity":"mild","_validated":false,"_confidence":0.3},{"effect":"Acute coronary event","drugRate":"","severity":"mild","_validated":false,"_confidence":0.3},{"effect":"Sepsis","drugRate":"","severity":"mild","_validated":false,"_confidence":0.3},{"effect":"Malignant disease","drugRate":"","severity":"mild","_validated":false,"_confidence":0.3}],"contraindications":["Abscess of brain","Acute leukemia, disease","Anemia","Bacterial infectious disease","Bone marrow depression","Breastfeeding (mother)","Cerebral edema","Disease of liver","Disorder of lung","Epilepsy","Fibrosis of lung","Infectious disease","Kidney disease","Leukopenia","Liver function tests abnormal","Meningitis","Mycosis","Obstructive hydrocephalus","Pregnancy, function","Protozoal Infection","Pulmonary Infiltrates","Retinal hemorrhage","Significant Bleeding","Thrombocytopenic disorder","Viral disease"],"specialPopulations":{"Lactation":"No data are available regarding the presence of carmustine, the active component of GLIADEL Wafer, or its metabolites in human milk or its effects on the breastfed child or on milk production. Because of the potential for serious adverse reactions in breastfed children from GLIADEL Wafers, advise women not to breastfeed following implantation with GLIADEL Wafers and for at least 7 days after implantation.","Pregnancy":"GLIADEL Wafer can cause fetal harm when administered to pregnant woman. There are no available data on GLIADEL use in pregnant women. There have been no animal reproductive studies with GLIADEL Wafer; however, carmustine, the active component of GLIADEL Wafer, is embryotoxic and teratogenic in rats at exposures less than the exposure at the recommended human dose based on body surface area (BSA) and embryotoxic in rabbits at exposures similar to exposures at the recommended human dose based on BSA. Advise pregnant women of the potential risk to fetus.","Geriatric use":"Clinical trials of GLIADEL Wafer did not include sufficient numbers of patients aged 65 years and over to determine whether they respond differently from younger patients.","Paediatric use":"The safety and effectiveness of GLIADEL Wafer in pediatric patients have not been established."}},"trials":[],"aliases":[],"company":"Avet Lifesciences","patents":[],"pricing":[],"_sources":{"trials":{"url":"https://clinicaltrials.gov/search?intr=CARMUSTINE","method":"api_direct","source":"ClinicalTrials.gov","rawText":"","confidence":1,"sourceType":"ctgov","retrievedAt":"2026-04-20T00:36:14.328714+00:00"},"regulatory.ca":{"url":"","method":"api_direct","source":"Health Canada DPD","rawText":"","confidence":1,"sourceType":"health_canada_dpd","retrievedAt":"2026-04-20T00:36:20.546369+00:00"},"regulatory.us":{"url":"","method":"api_direct","source":"FDA Drugs@FDA","rawText":"","confidence":1,"sourceType":"fda_drugsfda","retrievedAt":"2026-04-20T00:36:12.961241+00:00"},"publicationCount":{"url":"https://pubmed.ncbi.nlm.nih.gov/?term=CARMUSTINE","method":"api_direct","source":"PubMed/NCBI","rawText":"","confidence":1,"sourceType":"pubmed","retrievedAt":"2026-04-20T00:36:21.485718+00:00"},"safety.boxedWarnings":{"url":"","method":"deterministic","source":"FDA Label (boxed_warning)","rawText":"WARNING: MYELOSUPPRESSION and PULMONARY TOXICITY Myelosuppression Carmustine for injection, USP causes suppression of marrow function (including thrombocytopenia and leukopenia), which may contribute to bleeding and overwhelming infections. [ see Warnings and Precautions (5.1) and Adverse Reactions (6) ]. Monitor blood counts weekly for at least 6 weeks after each dose. Adjust dosage based on nadir blood counts from the prior dose [ see Dosage and Administration (2.1) ]. Do not administer a repe","confidence":1,"sourceType":"fda_label","retrievedAt":"2026-04-20T00:36:06.468813+00:00"},"safety.safetySignals":{"url":"https://api.fda.gov/drug/event.json","method":"api_direct","source":"FDA FAERS","rawText":"","confidence":1,"sourceType":"fda_faers","retrievedAt":"2026-04-20T00:36:22.989352+00:00"},"mechanism.target_chembl":{"url":"","method":"api_direct","source":"ChEMBL mechanism: RNA inhibitor","rawText":"","confidence":1,"sourceType":"chembl","retrievedAt":"2026-04-20T00:36:22.060717+00:00"},"crossReferences.chemblId":{"url":"https://www.ebi.ac.uk/chembl/compound_report_card/CHEMBL513/","method":"api_direct","source":"ChEMBL (EMBL-EBI)","rawText":"","confidence":1,"sourceType":"chembl","retrievedAt":"2026-04-20T00:36:21.960611+00:00"},"regulatory.fda_application":{"url":"","method":"deterministic","source":"FDA Label","rawText":"ANDA210179","confidence":1,"sourceType":"fda_label","retrievedAt":"2026-04-20T00:36:06.468853+00:00"}},"allNames":"gliadel","offLabel":[],"synonyms":["carmustine","becenun","carmubris","carmustin","nitrumon"],"timeline":[{"date":"1977-01-01","type":"neutral","source":"FDA Orange Book","milestone":"Rights transferred from EMCURE PHARMS LTD to Avet Lifesciences"},{"date":"1977-03-07","type":"positive","source":"DrugCentral","milestone":"FDA approval (Emcure Pharms Ltd)"},{"date":"1996-09-23","type":"positive","source":"FDA Orange Book","milestone":"Gliadel approved — 7.7MG"},{"date":"2019-04-02","type":"neutral","source":"FDA Orange Book","milestone":"Generic entry — 3 manufacturers approved"},{"date":"2022-05-16","type":"positive","source":"FDA Orange Book","milestone":"New formulation approved (Accord Hlthcare)"}],"aiSummary":"Gliadel (Carmustine) is a small molecule alkylating drug originally developed by EMCURE PHARMS LTD and currently owned by Avet Lifesciences. It targets glutathione reductase in the mitochondria and has been FDA-approved since 1977 for various cancer indications, including glioblastoma multiforme, non-Hodgkin's lymphoma, and multiple myeloma. Gliadel is available as a generic medication due to its off-patent status, with multiple manufacturers. Key safety considerations include its short half-life of 0.37 hours and limited bioavailability of 12%. It is used to treat various types of cancer, including brain tumors and blood cancers.","brandName":"Gliadel","ecosystem":[{"indication":"Diffuse non-Hodgkin's lymphoma, large cell","otherDrugs":[{"name":"bleomycin","slug":"bleomycin","company":"Bristol Myers Squibb"},{"name":"dexamethasone","slug":"dexamethasone","company":""},{"name":"doxorubicin","slug":"doxorubicin","company":""},{"name":"prednisone","slug":"prednisone","company":""}],"globalPrevalence":123507000},{"indication":"Glioblastoma multiforme of brain","otherDrugs":[{"name":"temozolomide","slug":"temozolomide","company":"Merck Sharp Dohme"}],"globalPrevalence":80000},{"indication":"Glioma, malignant","otherDrugs":[{"name":"temozolomide","slug":"temozolomide","company":"Merck Sharp Dohme"}],"globalPrevalence":null},{"indication":"Hodgkin's disease","otherDrugs":[{"name":"betamethasone","slug":"betamethasone","company":""},{"name":"betamethasone acetate","slug":"betamethasone-acetate","company":""},{"name":"bleomycin","slug":"bleomycin","company":"Bristol Myers Squibb"},{"name":"brentuximab vedotin","slug":"brentuximab-vedotin","company":"Seattle Genetics"}],"globalPrevalence":null},{"indication":"Malignant neoplasm of brain","otherDrugs":[],"globalPrevalence":null},{"indication":"Multiple myeloma","otherDrugs":[{"name":"belantamab mafodotin","slug":"belantamab-mafodotin","company":"Glaxosmithkline"},{"name":"bortezomib","slug":"bortezomib","company":"Millennium Pharms"},{"name":"carfilzomib","slug":"carfilzomib","company":"Onyx Pharms"},{"name":"cyclophosphamide","slug":"cyclophosphamide","company":"Baxter Hlthcare"}],"globalPrevalence":176000},{"indication":"Non-Hodgkin's lymphoma","otherDrugs":[{"name":"betamethasone","slug":"betamethasone","company":""},{"name":"betamethasone acetate","slug":"betamethasone-acetate","company":""},{"name":"bleomycin","slug":"bleomycin","company":"Bristol Myers Squibb"},{"name":"cortisone acetate","slug":"cortisone-acetate","company":""}],"globalPrevalence":123507000}],"mechanism":{"target":"Glutathione reductase, mitochondrial","novelty":"Follow-on","targets":[{"gene":"GSR","source":"DrugCentral","target":"Glutathione reductase, mitochondrial","protein":"Glutathione reductase, mitochondrial"}],"moaClass":"Alkylating Activity","modality":"Small Molecule","drugClass":"Alkylating Drug","explanation":"The activity of GLIADEL Wafer is due to release of cytotoxic concentrations of carmustine, DNA and RNA alkylating agent, into the tumor resection cavity. On exposure to the aqueous environment of the resection cavity, the anhydride bonds in the copolymer are hydrolyzed, releasing carmustine, carboxyphenoxypropane, and sebacic acid into the surrounding brain tissue.","oneSentence":"Gliadel works by attaching an alkyl group to the DNA of cancer cells, interfering with their ability to replicate and grow.","technicalDetail":"Gliadel (Carmustine) is a nitrosourea alkylating agent that exerts its cytotoxic effects by cross-linking DNA strands, thereby inhibiting DNA replication and transcription, and ultimately leading to cell death.","_target_confidence":0.5},"commercial":{"launchDate":"1977","_launchSource":"DrugCentral (FDA 1977-03-07, EMCURE PHARMS LTD)"},"references":[{"id":1,"url":"https://drugcentral.org/drugcard/512","fields":["approvals","synonyms","ATC","PK","indications","contraindications","DDIs","targets","patents","FAERS"],"source":"DrugCentral"},{"id":2,"url":"https://clinicaltrials.gov/search?intr=CARMUSTINE","fields":["trials"],"source":"ClinicalTrials.gov"},{"id":3,"url":"https://pubmed.ncbi.nlm.nih.gov/?term=CARMUSTINE","fields":["publications"],"source":"PubMed/NCBI"},{"id":4,"url":"https://www.fda.gov/drugs/drug-approvals-and-databases/orange-book-data-files","fields":["patents","exclusivity","genericManufacturers"],"source":"FDA Orange Book"}],"_enrichedAt":"2026-03-30T09:11:03.788367","_validation":{"fieldsValidated":0,"lastValidatedAt":"2026-04-20T00:36:28.218604+00:00","fieldsConflicting":22,"overallConfidence":0.8},"biosimilars":[],"competitors":[{"drugName":"lomustine","drugSlug":"lomustine","fdaApproval":"1976-08-04","genericCount":1,"patentStatus":"Off-patent — generic available","relationship":"same-class"},{"drugName":"streptozocin","drugSlug":"streptozocin","fdaApproval":"1982-05-07","patentStatus":"Unknown","relationship":"same-class"},{"drugName":"uracil mustard","drugSlug":"uracil-mustard","fdaApproval":"1962-09-13","patentStatus":"Unknown","relationship":"same-class"}],"genericName":"carmustine","indications":{"approved":[{"name":"Diffuse non-Hodgkin's lymphoma, large cell","source":"DrugCentral","snomedId":109969005,"regulator":"FDA","eligibility":null,"usPrevalence":null,"globalPrevalence":123507000,"prevalenceMethod":"curated","prevalenceSource":"J Insur Med, 2023 (PMID:37725503)"},{"name":"Glioblastoma multiforme of brain","source":"DrugCentral","snomedId":276828006,"regulator":"FDA","eligibility":"newly-diagnosed high-grade glioma as an adjunct to surgery and radiation, and recurrent glioblastoma as an adjunct to surgery","usPrevalence":null,"globalPrevalence":80000,"prevalenceMethod":"curated","prevalenceSource":"Orphanet ([EXPERT])"},{"name":"Glioma, malignant","source":"DrugCentral","snomedId":74532006,"regulator":"FDA"},{"name":"Hodgkin's disease","source":"DrugCentral","snomedId":118599009,"regulator":"FDA","eligibility":null},{"name":"Malignant neoplasm of brain","source":"DrugCentral","snomedId":428061005,"regulator":"FDA","eligibility":null},{"name":"Multiple myeloma","source":"DrugCentral","snomedId":109989006,"regulator":"FDA","eligibility":null,"usPrevalence":35000,"globalPrevalence":176000,"prevalenceMethod":"curated","prevalenceSource":"IARC GLOBOCAN, 2022"},{"name":"Non-Hodgkin's lymphoma","source":"DrugCentral","snomedId":118601006,"regulator":"FDA","eligibility":null,"usPrevalence":null,"globalPrevalence":123507000,"prevalenceMethod":"curated","prevalenceSource":"J Insur Med, 2023 (PMID:37725503)"}],"offLabel":[{"name":"Allogeneic bone marrow transplantation","source":"DrugCentral","drugName":"CARMUSTINE","evidenceCount":75,"evidenceLevel":"strong"},{"name":"Astrocytoma, anaplastic","source":"DrugCentral","drugName":"CARMUSTINE","evidenceCount":583,"evidenceLevel":"strong"},{"name":"Mycosis fungoides","source":"DrugCentral","drugName":"CARMUSTINE","evidenceCount":53,"evidenceLevel":"strong"}],"pipeline":[]},"currentOwner":"Avet Lifesciences","drugCategory":"established","labelChanges":[],"patentStatus":"Off-patent — no active Orange Book patents","relatedDrugs":[{"drugId":"lomustine","brandName":"lomustine","genericName":"lomustine","approvalYear":"1976","relationship":"same-class"},{"drugId":"streptozocin","brandName":"streptozocin","genericName":"streptozocin","approvalYear":"1982","relationship":"same-class"},{"drugId":"uracil-mustard","brandName":"uracil mustard","genericName":"uracil mustard","approvalYear":"1962","relationship":"same-class"}],"trialDetails":[{"nctId":"NCT02443077","phase":"PHASE3","title":"Ibrutinib Before and After Stem Cell Transplant in Treating Patients With Relapsed or Refractory Diffuse Large B-cell Lymphoma","status":"ACTIVE_NOT_RECRUITING","sponsor":"National Cancer Institute (NCI)","startDate":"2016-10-12","conditions":["Recurrent Diffuse Large B-Cell Lymphoma Activated B-Cell Type","Refractory Diffuse Large B-Cell Lymphoma Activated B-Cell Type"],"enrollment":94,"completionDate":"2026-12-23"},{"nctId":"NCT06915246","phase":"PHASE2","title":"A Study of Carmustine With and Without Ethanol in Subjects With Lymphoma","status":"RECRUITING","sponsor":"VIVUS LLC","startDate":"2025-03-12","conditions":["Lymphoma","Non-Hodgkin Lymphoma","Hodgkin Lymphoma"],"enrollment":49,"completionDate":"2027-04-30"},{"nctId":"NCT07101588","phase":"PHASE4","title":"Ruxolitinib-Decitabine Intensified Conditioning Regimen for AML: A Randomized Trial","status":"RECRUITING","sponsor":"Chinese PLA General Hospital","startDate":"2025-01-01","conditions":["Allogeneic Hematopoietic Stem Cell Transplantation (HSCT)"],"enrollment":200,"completionDate":"2028-12-30"},{"nctId":"NCT01011920","phase":"PHASE2","title":"Trial for Patients With Newly Diagnosed Primary Central Nervous System (CNS) Lymphoma","status":"COMPLETED","sponsor":"International Extranodal Lymphoma Study Group (IELSG)","startDate":"2009-11","conditions":["Central Nervous System Lymphoma"],"enrollment":227,"completionDate":"2024-12-19"},{"nctId":"NCT05540340","phase":"PHASE1","title":"A Study of Melphalan in People With Lymphoma Getting an Autologous Hematopoietic Cell Transplant","status":"ACTIVE_NOT_RECRUITING","sponsor":"Memorial Sloan Kettering Cancer Center","startDate":"2022-09-09","conditions":["Lymphoma","Lymphoma, B-Cell","Lymphoma, T-Cell","Lymphoma, Hodgkin","Lymphoma, Non-Hodgkin"],"enrollment":39,"completionDate":"2027-09"},{"nctId":"NCT07448480","phase":"","title":"Comprehensive Analysis of Chemotherapy and Targeted Therapy Outcomes in Recurrent Malignant 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