Busulfan

What is busulfan?

Busulfan is a medicine that is used to kill cancer cells. It stops cancer cells and bone marrow cells from making new cells. It is also used to prepare your child for bone marrow or stem cell transplant.

You may hear busulfan called by its brand name, Myleran or Busulfex. Busulfan comes in injection and tablet form.

Before giving busulfan to your child?

Tell your doctor if your child has ever reacted badly to busulfan or any other drug product.

Talk with your doctor or pharmacist if your child has any of the following conditions. Precautions may need to be taken with this medicine if your child has:

• infection or recent exposure to infection (for example, chickenpox)
• history of seizures or head injury
• thalassemia (a type of blood disorder)

How should you give your child busulfan?

Follow these instructions when giving your child busulfan:

• The injection form of busulfan is normally given. It is a clear liquid that a nurse will give into a vein (intravenously, IV).
• The amount of busulfan your child gets will depend on how much of the medicine is in the blood after the first dose.
• If your child is taking busulfan by mouth, your doctor, nurse, or pharmacist will review the way to give this.

What are the possible side effects of busulfan?

Your child may have some of these side effects while they take busulfan. Check with your child's doctor if your child continues to have any of these side effects and they do not go away or they bother your child:

• diarrhea (watery bowel movements)
• nausea (upset stomach) and vomiting (throwing up)
• loss of appetite
• weight loss (sudden)
• muscle pain
• feeling tired or weak
• headache
• skin rash
• darkening of the skin, especially elbows, knees, and skin folds

Most of the following side effects are not common, but they may be a sign of a serious problem. Call your child's doctor right away or take your child to the Emergency Department if your child has any of these side effects:

• seizures
• black, tarry stools
• blood in urine or stools
• lower back or side pain
• pain or trouble urinating
• very dark coloured urine
• cough or hoarseness
• fever or chills
• pinpoint red spots on skin
• unusual bleeding or bruising
• chest pain
• fast or uneven heartbeat
• shortness of breath or difficulty breathing
• weight gain, swelling, or puffiness
• stomach pain
• sores in the mouth or pain with swallowing
• yellowing of the skin or eyes

What safety measures should you take when your child is using busulfan?

Acetaminophen (Tylenol) may change the way the body handles busulfan. As a result, your child should try to avoid use of acetaminophen (Tylenol) just before and during the time that busulfan is being given.

Grapefruit or grapefruit juice may affect how the body handles busulfan. Your child should avoid having grapefruit, grapefruit juice, or fruit punches with grapefruit juice at any time while they are being treated with busulfan.

Busulfan can lower the number of white blood cells in the blood temporarily, which increases your child's chances of getting an infection. Your child can take the following precautions to prevent infections, especially when the blood count is low:

• Avoid people with infections, such as a cold or the flu.
• Avoid places that are very crowded with large groups of people.
• Be careful when brushing or flossing your child's teeth. Your doctor, nurse, or dentist may suggest different ways to clean your child's mouth and teeth.
• You and our child shouldn't touch your child's eyes or inside their nose without washing your or your child's hands first.
• Your child's nurse and doctor will review with you what to do in case of fever.

Your child should not receive any immunizations (vaccines) without your child's doctor's approval. Your child or anyone else in your household should not get oral polio vaccine for a period after your child has been treated with busulfan. Tell your child's doctor if anyone in your household has recently received oral polio vaccine. Your child should avoid contact with anyone who has recently received this vaccine. Other live vaccines that your child should not get include measles, mumps and rubella (MMR), and chicken pox vaccine.

Busulfan can lower the number of platelets in the blood, which increases your child's risk of bleeding. You can take the following precautions:

• Be careful not to cut your child when using a razor, fingernail scissors, or toenail clippers.
• Your child should be careful when shaving or waxing.
• Your child should avoid contact sports where bruising or injury could occur.
• Before your child has surgery, including dental surgery, inform the doctor or dentist that your child is taking busulfan.

Check with your child's doctor or pharmacist before giving your child any other medicines (prescription or non-prescription or herbal products).

What other important information should you know about busulfan?

• Busulfan may cause an upset stomach and throwing up. Your child will get medicine to prevent these problems.
• Your child will get a medicine to prevent seizures while they are taking busulfan.
• Your child may lose their hair. It will grow back once treatment with busulfan stops. Its colour and texture may change. Use a gentle shampoo and a soft brush.
• Your child's skin may darken while receiving busulfan, especially on elbows and knees and in skin creases. If this happens, it will slowly fade once treatment with busulfan stops.
• There is a chance that busulfan may cause birth defects if it is taken at the time of conception or if it is taken during pregnancy. If your child is sexually active, it is recommended that they use some kind of birth control while receiving busulfan. Tell the doctor right away if your child may be pregnant.
• After receiving busulfan, your child may not be able to have children or have more difficulty having children. Your child's doctor will discuss this in more detail with you and or your child.
• Keep a list of medications your child is on and show the list to the doctor or pharmacist.
• Do not share your child's medicine with others and do not give anyone else's medicine to your child.
• Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.
  

Keep busulfan out of your child’s sight and reach and locked up in a safe place. If your child takes too much busulfan, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.