lCAUTIONSAvoid in Acute porphyrias p. 603 .high dose
(antiepileptic prophylaxis required).history of seizures
(antiepileptic prophylaxis required).ineffective once in
blast crisis phase.previous progenitor cell transplant
(increased risk of hepatic veno-occlusive disease).
previous radiation therapy (increased risk of hepatic veno-
occlusive disease).risk of second malignancy.three or
more cycles of chemotherapy (increased risk of hepatic
veno-occlusive disease)
lINTERACTIONS→Appendix 1 : alkylating agents
lSIDE-EFFECTS
GENERAL SIDE-EFFECTS
▶Common or very commonAlopecia.diarrhoea.hepatic
disorders.nausea.respiratory disorders.sinusoidal
obstruction syndrome.skin reactions.thrombocytopenia.
vomiting
▶UncommonSeizure
▶Rare or very rareCataract.eye disorders
SPECIFIC SIDE-EFFECTS
▶Common or very common
▶With intravenous useAnaemia.anxiety.appetite decreased.
arrhythmias.arthralgia.ascites.asthenia.asthma.
cardiomegaly.chest pain.chills.confusion.constipation.
cough.depression.dizziness.dyspnoea.dysuria.
electrolyte imbalance.embolism and thrombosis.fever.
gastrointestinal discomfort.gastrointestinal disorders.
haemorrhage.headache.hiccups.hyperglycaemia.
hypersensitivity.hypertension.hypoalbuminaemia.
hypotension.increased risk of infection.insomnia.
mucositis.myalgia.nervous system disorder.neutropenia
.oedema.pain.pancytopenia.pericardial effusion.
pericarditis.reactivation of infections.renal disorder.
renal impairment.stomatitis.vasodilation.weight
increased
▶With oral useAmenorrhoea (may be reversible).
azoospermia.bone marrow disorders.cardiac tamponade.
delayed puberty.hyperbilirubinaemia.infertility male.
leucopenia.leukaemia.menopausal symptoms.oral
disorders.ovarian and fallopian tube disorders.testicular
atrophy
▶Uncommon
▶With intravenous useCapillary leak syndrome.delirium.
encephalopathy.hallucination.hypoxia.intracranial
haemorrhage
▶Rare or very rare
▶With oral useDry mouth.erythema nodosum.
gynaecomastia.myasthenia gravis.radiation injury.
Sjögren’s syndrome
▶Frequency not known
▶With intravenous useHypogonadism.ovarian failure.
premature menopause.sepsis
SIDE-EFFECTS, FURTHER INFORMATION
Lung toxicityDiscontinue if lung toxicity develops.
Secondary malignancyUse of busulfan is associated with
an increased incidence of secondary malignancy.
Fluid retentionAlkylating drugs can causefluid retention
with oedema and dilutional hyponatraemia in younger
children; the risk of this complication is higher in thefirst
2 days and also when given with concomitant vinca
alkaloids.
lCONCEPTION AND CONTRACEPTIONManufacturers advise
effective contraception during and for 6 months after
treatment in men or women. See alsoPregnancy and
reproductive functionin Cytotoxic drugs p. 531.
lPREGNANCYAvoid (teratogenic inanimals). See also
Pregnancy and reproductive functionin Cytotoxic drugs
p. 531.
lBREAST FEEDINGDiscontinue breast-feeding.
lHEPATIC IMPAIRMENTManufacturer advises caution.MonitoringIn patients with hepatic impairment,
manufacturer advises regular liver function tests—consult
product literature.
lMONITORING REQUIREMENTS
▶Monitor cardiac and liver function.
▶Monitor full blood count regularly throughout treatment.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: capsule, oral suspension, oral solution
Tablet
▶Busulfan (Non-proprietary)
Busulfan 2 mgBusulfan 2 mg tablets| 25 tabletP£ 69. 02 DT =
£ 69. 02
Solution for infusion
▶Busilvex(Pierre Fabre Ltd)
Busulfan 6 mg per 1 mlBusilvex 60 mg/ 10 ml concentrate for
solution for infusion ampoules| 8 ampouleP£ 1 , 610. 00 (Hospital
only)Chlorambucil
lINDICATIONS AND DOSE
Hodgkin’s disease|Non-Hodgkin’s lymphoma
▶BY MOUTH
▶Child:(consult local protocol)
Relapsing steroid-sensitive nephrotic syndrome (initiated
in specialist centres)
▶BY MOUTH
▶Child 3 months–17 years: 200 micrograms/kg daily for
8 weekslUNLICENSED USENot licensed for use in nephrotic
syndrome.IMPORTANT SAFETY INFORMATION
RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES
See Cytotoxic drugs p. 531.lCAUTIONSChildren with nephrotic syndrome (increased
seizure risk).history of epilepsy (increased seizure risk)
lINTERACTIONS→Appendix 1 : alkylating agents
lSIDE-EFFECTS
▶Common or very commonAnaemia.bone marrow disorders
.diarrhoea.gastrointestinal disorder.leucopenia.nausea
.neoplasms.neutropenia.oral ulceration.seizures.
thrombocytopenia.vomiting
▶UncommonSkin reactions
▶Rare or very rareCystitis.fever.hepatic disorders.
movement disorders.muscle twitching.peripheral
neuropathy.respiratory disorders.severe cutaneous
adverse reactions (SCARs).tremor
▶Frequency not knownAmenorrhoea.azoospermia
SIDE-EFFECTS, FURTHER INFORMATION
Secondary malignancyUse of chlorambucil is associated
with an increased incidence of acute leukaemia,
particularly with prolonged use.
Skin reactionsManufacturer advises assessing continued
use if rash occurs—has been reported to progress to
Stevens-Johnson syndrome and toxic epidermal
necrolysis.
Fluid retentionAlkylating drugs can causefluid retention
with oedema and dilutional hyponatraemia in younger
children; the risk of this complication is higher in thefirst
2 days and also when given with concomitant vinca
alkaloids.
lCONCEPTION AND CONTRACEPTIONContraceptive advice
required, seePregnancy and reproductive functionin
Cytotoxic drugs p. 531.
lPREGNANCYAvoid. See alsoPregnancy and reproductive
functionin Cytotoxic drugs p. 531.534 Cytotoxic responsive malignancy BNFC 2018 – 2019
Immune system and malignant disease8