Busulfan Injection: Uses, Dosage, Side Effects, Precautions and Alternates

Quick overview

Busulfan Injection contains busulfan, a potent cancer chemotherapy drug belonging to the alkylating agent class. It is given before a bone marrow or blood stem cell transplant to destroy the original bone marrow so that new transplanted cells can take over. It is given as an infusion by a qualified healthcare professional and is used in adults, new-born infants, children, and adolescents preparing for transplant.

What is Busulfan Injection

This medicine contains busulfan, a potent cancer chemotherapy drug. It is given before a bone marrow or blood stem cell transplant to destroy the original bone marrow so the new transplanted cells can take over.

Busulfan Injection uses

• Used as part of a conditioning treatment before bone marrow or blood stem cell transplantation
• Used in combination with other chemotherapy drugs such as cyclophosphamide, melphalan, or fludarabine
• Used in adults, new-born infants, children, and adolescents prior to transplant for conditions such as leukemia, lymphoma, multiple myeloma, and myelodysplastic syndrome

Benefits of Busulfan Injection

• Destroys the original bone marrow so new transplanted bone marrow or stem cells can engraft
• Used as part of an established conditioning regimen prior to hematopoietic progenitor cell transplantation
• Used as part of conditioning before stem-cell transplantation
• Helps destroy abnormal or malignant bone-marrow cells
• Suppresses existing bone marrow before transplantation

How Busulfan Injection works

Busulfan is a strong chemotherapy drug that attaches to and damages DNA in cells, which destroys rapidly dividing cells such as those in the bone marrow before a transplant.

Busulfan Injection dosage

This medicine is given by a qualified healthcare professional as an infusion into a central vein, never as a rapid injection. It must be diluted before use and given by infusion pump over the prescribed time. It is given on a fixed schedule over several days leading up to the transplant. Before each dose, you will be given medicine to help prevent seizures and medicine to prevent vomiting. Before and after each infusion, the catheter line is flushed with a saline or dextrose solution. Caution is advised if paracetamol is used in the 72 hours before or during treatment with this medicine.

Available forms and strengths

• Concentrate/solution for infusion (injection), supplied in single-dose glass vials

Side effects of Busulfan Injection

Common

• Vomiting, stomach pain, diarrhoea, constipation, heart burn
• Rash, itching
• Headache, pain or inflammation at injection site, chest pain
• Sleeplessness, anxiety, dizziness and depression
• Loss of appetite, changes in blood minerals and blood sugar
• Increase or decrease in heart rate or blood pressure, widening of blood vessels, blood clots
• Shortness of breath, runny nose, sore throat, cough, hiccup, nosebleeds, abnormal breath sounds
• Nausea, hair loss
• Back, muscle and joint pain
• Changes in urination and kidney tests
• Weakness, swelling (oedema), inflammation of the mucosa
• Elevated liver enzymes, weight gain
• Enlarged liver, jaundice
• Infections, fever, chills
• Inflammation of the mouth lining
• Decrease in red and white blood cells and platelets

Serious

• Severe confusion, nervousness, hallucination, agitation, abnormal brain function, brain bleeding and seizure
• Liver toxicity including blocking of a liver vein, and graft versus host disease
• Serious lung complications
• Serious infection
• Severe decrease in blood cell counts, blood clots, extra or slowed heartbeats, fluid leakage from blood vessels
• Decrease in blood oxygen
• Bleeding in the stomach or gut
• Low white blood cells with high fever, metabolic disturbances, unusual bleeding or bruising under the skin, severe infections, sepsis, and changes in tooth hardness

Warnings and precautions

• This medicine causes a severe, expected drop in blood cell counts in all patients, so you will be closely monitored and may need blood transfusions or infection-prevention treatment.
• This medicine may cause a serious liver condition called veno-occlusive disease, which blocks blood flow in the liver.
• This medicine may cause or contribute to a second cancer developing later in life.
• This medicine can cause temporary or permanent infertility in both men and women, and may bring on early menopause or prevent puberty in young girls.
• This medicine can cause seizures, especially in people with a history of seizures, so preventive anti-seizure medicine is given beforehand.
• Men being treated with this medicine should not father a child during treatment and for 6 months afterward because of possible genetic harm to a baby.
• Some medicines can change how this drug works or increase its side effects, including certain antifungal and antibiotic drugs, a strong pain medicine, and paracetamol used shortly before or during treatment.
• This medicine must not be used during pregnancy because it can harm an unborn baby. Women should avoid becoming pregnant during and for 6 months after treatment.
• Women must not breastfeed while being treated with this medicine.
• Tell your doctor if you have kidney problems, as caution is needed, though the drug is not significantly removed by the kidneys.
• Caution is needed in people with liver problems, since busulfan is processed mainly by the liver and can cause liver damage, especially in those with severe liver impairment.
• Tell your doctor if you drink alcohol while being treated with this medicine.
• This medicine may cause dizziness, so be careful before driving or using machines until you know how it affects you.

Storage

• BUSULFAN ARX will be stored at 2°C - 8°C in a refrigerator (do not freeze) in the Pharmacy.
• Any unused medicine must be disposed of appropriately by the medical staff.
• Do not use this medicine after the expiry date.

When to see a doctor

• Call your doctor right away or go straight to the Emergency Department if you notice serious side effects such as severe confusion, hallucinations, seizures, signs of liver problems, lung complications, infection, or unusual bleeding.
• If you experience any side effects after being given this medicine, contact your doctor or go to the nearest hospital emergency department right away, even if you feel fine.
• Report any fever immediately to your healthcare professional, as this can be a sign of serious infection from low blood cell counts.

Alternatives

• Melphalan
• Cyclophosphamide
• Treosulfan