Dangerous Drug: Busulfan(byoo sul’ fan)
Busulfex, Myleran
PREGNANCY CATEGORY D
Drug Classes
Alkylating drug
Antineoplastic
Therapeutic Actions
Cytotoxic: Interacts with normal function of DNA, causing cell death; cell cycle nonspecific.
Indications
Tablets: Palliative treatment of chronic myelogenous leukemia; less effective in patients without the Philadelphia chromosome (Ph1); ineffective in the blastic stage
Injection: In combination with cyclophosphamide as conditioning regimen prior to allogenic hematopoietic progenitor cell transplant for CML
Oral: Other myeloproliferative disorders, including severe thrombocytosis and polycythemia vera, myelofibrosis; bone marrow transplantation
Contraindications and Cautions
Contraindicated with allergy to busulfan, history of resistance to busulfan, chronic lymphocytic leukemia, acute leukemia, blastic phase of chronic myelogenous leukemia, hematopoietic depression, pregnancy, lactation.
Use cautiously with bone marrow suppression, history of seizure disorders, hepatic impairment.
Available Forms
Tablets—2 mg; injection—6 mg/mL
Dosages
Adults
Oral
Remission induction: 4–8 mg or 60 mcg/kg (WBC count more likely to drop with doses above 4 mg/day) total dose PO daily. Continue until WBC has dropped to 15,000/mm3; WBC may continue to fall for 1 mo after drug is discontinued. Normal WBC count is usually achieved in approximately 12–20 wk in most cases.
Maintenance therapy: Resume treatment with induction dosage when WBC count reaches 50,000/mm3. If remission is shorter than 3 mo, maintenance therapy of 1–3 mg PO daily is advised to keep hematologic status under control.
Parenteral
Conditioning regimen: 0.8 mg/kg of ideal body weight or actual body weight, whichever is lower, as a 2-hr infusion every 6 hr for 4 consecutive days (16 doses) via central venous catheter.
Pediatric patients
Oral
Children may be dosed at 60–120 mcg/kg/day or 1.8–4.6 mg/m2/day (body surface) for remission induction.
Patients with hepatic impairment
Monitor patient closely; dosage adjustment may be needed.
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