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Carmustine Injection and Cimetidine Injection

Determining the interaction of Carmustine Injection and Cimetidine Injection and the possibility of their joint administration.

Check result:
Carmustine Injection <> Cimetidine Injection
Relevance: 08.11.2023 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Talk to your doctor before using carmustine together with cimetidine. Combining these medications may increase the suppressive effects of carmustine on your bone marrow function, resulting in low numbers of different types of blood cells (*). This can make you more likely to develop anemia, bleeding problems, or infections. Contact your doctor if you experience potential signs and symptoms of these conditions such as paleness, fatigue, dizziness, fainting, unusual bleeding or bruising, fever, chills, sore throat, body aches, or other flu-like symptoms. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor. *It is not known whether this interaction can occur if you are receiving carmustine in the form of a surgical implant (brand name Gliadel), since the effects from an implant are more localized. The interaction has only been studied in patients receiving the injectable formulation of carmustine (brand name BiCNU).

Professional:

MONITOR CLOSELY: Coadministration with cimetidine may potentiate the myelosuppressive effects of systemic carmustine. The exact mechanism of interaction is unknown, but may involve additive myelosuppression or inhibition by cimetidine of the hepatic clearance of carmustine. In one study, marked neutropenia occurred in nine patients with glioblastomas who were administered carmustine, methylprednisolone, and cranial irradiation in combination with cimetidine (1200 mg/day for 1 to 4 weeks). The nadir in neutrophil cell counts in this group averaged 650 +/- 220/microL, compared to 2,160 +/- 240/microL in a group of 31 similarly treated patients who did not receive cimetidine. The neutropenia observed in the cimetidine-treated patients extended through day 42 of the treatment cycle, whereas patients who did not receive cimetidine did not experience significant neutropenia. In another study, leukopenia and thrombocytopenia occurred in 6 of 8 patients treated with carmustine, corticosteroids and cimetidine, compared to 6 out of 40 similarly treated patients who did not receive cimetidine. The interaction has not been studied with carmustine implants.

MANAGEMENT: Caution is advised if systemic carmustine is used in combination with cimetidine. Patients should be closely monitored for the development of delayed myelosuppression that may occur 4 to 6 weeks after carmustine administration. Blood counts are recommended weekly for at least 6 weeks after a dose. Alternatively, other H2-receptor antagonists such as ranitidine and famotidine may be considered in patients who require treatment with carmustine, since they have not been reported to cause the interaction and generally have minimal effects on hepatic metabolism.

References
  • Selker RG, Moore P, LoDolce D "Bone-marrow depression with cimetidine plus carmustine." N Engl J Med 299 (1978): 834
  • Feagin OT "Alternative mechanisms for severe neutropenia." Arch Intern Med 142 (1982): 1971
  • "Product Information. Gliadel Wafer (carmustine)." Rhone-Poulenc Rorer, Collegeville, PA.
  • Volkin RL, Shadduck RK, Winkelstein A, Zeigler ZR, Selker RG "Potentiation of carmustine-cranial irradiation-induced myelosuppression by cimetidine." Arch Intern Med 142 (1982): 243-5
  • "Product Information. BiCNU (carmustine)." Bristol-Myers Squibb, Princeton, NJ.
Carmustine Injection

Generic Name: carmustine

Brand name: BiCNU, Gliadel

Synonyms: Carmustine

Cimetidine Injection

Generic Name: cimetidine

Brand name: Tagamet HB, Tagamet

Synonyms: Cimetidine

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

Interaction with food and lifestyle