Karmustin
When ATH:
L01AD01
Characteristic
Nitrosoureas. Freeze-dried bulk or cereal pale yellow. Readily soluble in alcohol and lipids, slightly soluble in water. It has a low temperature Melting (at temperatures above 30 ° C melts and turns into oil film).
Pharmacological action
Antitumor, cytostatic, alkylating, immunosuppressive.
Application
Brain tumors: glioblastoma, brainstem glioma, medulloblastoma, astrocytoma, ependymoma, brain metastases; mnozhestvennaya myeloma, limfogranulematoz, nehodzhkinskaya lymphoma, Acute leukemia myeloblastnыy and lymfoblastnыy (nespetsificheskaya therapy), melanoma, liver cancer, malignant neoplasms of the gastrointestinal tract.
Contraindications
Hypersensitivity, severe liver and kidney, severe myelosuppression, pregnancy, lactation.
Restrictions apply
The ratio risk-polza needed at the chicken pox, herpes zoster, etc.. systemic infections, abnormal liver function, kidney, light (incl. history), suppression of bone marrow function, prior cytotoxic or radiation therapy, smoking, in elderly and childhood.
Pregnancy and breast-feeding
Contraindicated in pregnancy.
Category actions result in FDA - D. (There is evidence of the risk of adverse effects of drugs on the human fetus, obtained in research or practice, However, the potential benefits, associated with drugs in pregnant, may justify its use, in spite of the possible risk, if the drug is needed in life-threatening situations or severe disease, when safer agents should not be used or are ineffective.)
At the time of treatment should stop breastfeeding.
Side effects
From the digestive tract: anorexia, stomatitis, nausea, vomiting, diarrhea, abnormal liver function, giperʙiliruʙinemija.
From the nervous system and sensory organs: asthenia, dizziness, blurred vision, neyroretinit, swelling of the conjunctiva.
Cardio-vascular system and blood (hematopoiesis, hemostasis): mielodeprescia (leukopenia, thrombocytopenia), anemia, Acute leukemia, phlebitis, bleeding and hemorrhage, incl. gastrointestinal.
From the respiratory system: cough; infiltration of the lung tissue, pneumonitis and pulmonary fibrosis (develops in terms of 9 days before 43 months after treatment).
With the genitourinary system: painful and difficult urination, hematuria, impairment of renal function, swelling, renal failure, amenorrhea, azoospermia.
For the skin: rash, itch, alopecia, burning sensation and hyperpigmentation in contact with skin.
Other: swallowing disorder, difficulty of movement, pain syndrome (backache, by), flushing and redness of skin, the development of infections, hyperthermia; transaminase elevation, alkaline phosphatase, BUN; pain, redness, burning sensation at the injection site, discoloration of the skin along the vein.
Cooperation
Weakens the effectiveness of immunization inactivated vaccines; using vaccines, containing live viruses, enhances viral replication and side effects of vaccination. Increases (mutually) scarp- and nephrotoxicity of other drugs. Other means of myelotoxicity and radiotherapy increase bone marrow depression (potentiate the neutropenia and thrombocytopenia). Compatible with other anticancer drugs.
Overdose
Symptoms: nausea, vomiting, severe bone marrow depression, bleeding, manifestations hepato- and nephrotoxicity.
Treatment: hospitalization, monitoring vital functions; simptomaticheskaya therapy; if necessary - transfusion of blood components, the appointment of broad-spectrum antibiotics.
Dosing and Administration
B /, drop (for at least 1-2 hours). Monotherapy — momentarily from 150 to 200 mg / m2 (or for 75-100 mg/m2 during 2 d, or 40 mg / m2 during 5 days) intervals 6 Sun. Doses for subsequent injections selected according to the hematologic response to previous treatment. If after the previous injection the smallest platelet count was 100 109/l and leukocytes more than 3 109/l introduced 100% previous dose, with a platelet count of 25 109/l — 75·109/l, leukocytes 2 109/l — 3·109/- 70%; with platelet count less than 25 109/l and leukocytes less than 2 109/- 50% previous dose. B / A for tumors of the liver - 200 mg / m2 for 20-60 min. Locally, adult as plate (polifeprosan 20 + karmustin, 7,7 mg): after resection of brain tumors in the cavity to applitsiruyut 8 plates.
Precautions
Use only under medical supervision, with experience chemotherapy. Prior to initiating therapy, during it and for 6 weeks after treatment (at short intervals) you must determine the level of hemoglobin, or hematocrit, bilirubin, BUN, Uric acid, creatinine, IS aktivnosti, GOLD, LDH, the number of leukocytes (overall, differential), Platelet, pulmonary function tests (forced vital capacity, diffusion capacity, and others.).
Perhaps the development of cumulative gematotoksichnosti, so the introduction should be no more 1 times a 6 Sun (period, needed to restore bone marrow function). A second course is possible only if the number of platelets exceeds 100 109/l and leukocytes 4 109/l. Development expressed myelodepression require discontinuation of treatment to relieve symptoms gematotoksichnosti. Nausea and vomiting occur within 2 h after the introduction and ongoing 4-6 h (should be the appointment of antiemetics). Through 2 hours after the rapid on/in infusion observed tides blood to a person, continuing to 4 no. If the following symptoms: chills, fever, cough or hoarseness, pain in the lower back or side, painful or difficult urination, bleeding or hemorrhage, black stools, blood in the urine or feces should immediately consult a doctor.
In patients with thrombocytopenia recommended extreme caution when performing invasive procedures; Regular inspection of places on / in the, skin and mucous membranes (for signs of bleeding); limit frequency troublesome and the rejection of the / m injection; control of blood in the urine, vomit, Kale. Such patients must be carefully shave, manicure, brush your teeth, dentists use threads and toothpicks, to conduct dental procedures; should be the prevention of constipation, avoid falls and other injuries, as well as the intake of alcohol and aspirin, increase the risk of gastrointestinal bleeding.
Should defer vaccination schedule (available through 3-12 months ) sick and living with him family members, which also need to abandon immunization oral polio vaccine. It is recommended to avoid contact with infectious patients, or use non-event for the prevention of infection (face mask, etc.). It should refrain from the use in pediatric practice, because the safety and efficacy of its use in children is not identified. During treatment requires adequate contraceptive measures. In case of accidental contact with the mucous membranes carmustine thoroughly washed with water, And the skin with soap and water.
Cautions
The solution for the on / in the cook, adding in a bottle 3 ml of sterile alcohol reagents for injection, then the contents of bottle dissolved in 27 ml of sterile water for injection (A clear, slightly yellowish solution, 1 ml which contains 3,3 mg karmustina 10% ethanol, pH 5,6-6,0). The resulting solution was diluted 0,9% solution of sodium chloride or 5% solution dekstrozy to concentrations not higher than 0,5 mg / ml. Cooked solutions stable at room temperature for 8 no, in the refrigerator within 24 no; store in a dark place.
