What is this medication?
Antineoplastic Agent, Alkylating Agent
Busulfan, Myleran/Busulfex is indicated for management of chronic myeloid leukemia.
“Alert: US Warning
Busulfan is a potent drug that should only be used for chronic myelogenous leukemia (CML) and under the direct supervision of an experienced physician. Busulfan can cause severe bone marrow suppression.”
How does this medication work?
Busulfan, Myleran/Busulfex is an alkylating agent which reacts with the N-7 position of guanosine and interferes with DNA replication and transcription of RNA. Busulfan has a more marked effect on myeloid cells than on lymphoid cells and is also very toxic to hematopoietic stem cells. Busulfan, Myleran/Busulfex exhibits little immunosuppressive activity. It interferes with the normal function of DNA by alkylation and cross-linking the strands of DNA.
How should I take this medication?
Usual (Oral): 1 mg/kg every 6 hours for a total of 8 to 16 total doses depending on conditioning regimen.
Note: Premedicate with prophylactic anticonvulsant therapy (eg, phenytoin, levetiracetam, benzodiazepines, or valproic acid) beginning 12 hours prior to high-dose busulfan treatment and continuing for 24 hours after the last busulfan dose. Antiemetics may be recommended to prevent nausea and vomiting; depending on dose and/or administration route, busulfan is associated with a moderate or high emetic potential in adults. Antiemetics are recommended when used for transplantation.
How to Take:
Oral (HSCT only): To facilitate ingestion of high oral doses, may place multiple tablets into an empty gelatin capsule.
What should I watch for while using this medication?
Before using Busulfan, Myleran/Busulfex make sure your physician is aware of any allergies, medications you currently take, pre-existing medical conditions and activities you perform. Severe and prolonged bone marrow suppression commonly occurs; reduce dose or discontinue busulfan for unusual suppression; may require bone marrow biopsy. Antiemetics may be recommended to prevent nausea and vomiting, due to the moderate to high emetic potential of busulfan. Chronic busulfan use can cause bronchopulmonary dysplasia and pulmonary fibrosis. Seizures have been reported with IV busulfan and with high-dose oral busulfan. When used as a conditioning regimen for transplant, initiate prophylactic anticonvulsant therapy (eg, phenytoin, levetiracetam, benzodiazepines, or valproic acid) prior to treatment. Use with caution in patients predisposed to seizures, with a history of seizures, head trauma, or with other medications associated with inducing seizures. The solvent in IV busulfan, dimethylacetamide (DMA) may be associated with hepatotoxicity, hallucinations, somnolence, lethargy, and confusion.
What if I miss a dose?
If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.
How should I store this medication?
Keep out of the reach of children at all times. Store at room temperature, 59 to 86° F (15 to 30° C). Protect from light. Keep the container tightly closed. Properly dispose of any unused medication after the expiration date.
What are the possible side effects of using this medication?
Edema, tachycardia, hypertension, thrombosis, chest pain, vasodilation, hepatic sinusoidal obstruction syndrome, insomnia, anxiety, headache, chills, pain, dizziness, depression, skin rash, pruritus, hypomagnesemia, hyperglycemia, hypokalemia, hypocalcemia, vomiting, nausea, mucositis, stomatitis, anorexia, diarrhea, abdominal pain, dyspepsia, constipation, xerostomia, rectal disease, gastrointestinal fullness, neutropenia, bone marrow depression, thrombocytopenia, lymphocytopenia, anemia, hyperbilirubinemia, increased serum ALT, hypersensitivity reaction, graft versus host disease, inflammation at injection site, weakness, back pain, increased serum creatinine, rhinitis, pulmonary disease, cough, dyspnea, epistaxis, pneumonia, fever
Note this is not a complete list of side effects, only the most common.
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