Busulfan is one of the chemotherapy drugs to alleviate the symptoms of blood cancer, especially chronic myelocytic leukemia ( chronic myelocytic leukemia ). This drug is available in the form of tablets and liquid infusion.

Busulfan works by attaching to one of the DNA strands of cancer cells, so that the cells cannot divide. That way, the growth and spread of cancer cells in the body can be inhibited.

Busulfan can also be used in the treatment of bone marrow disorders, such as polycythemia vera , and part of the preparation therapy for patients with chronic myelocytic leukemia who will undergo bone marrow transplantation.

Busulfan trademarks : Myleran, Busulfex

What Is Busulfan?

Group Cytotoxic chemotherapy
Category Prescription drugs
Benefits Prevents the growth and spread of cancer cells
Used by Adults and children
Busulfan for pregnant and lactating women Category D:  There is positive evidence of risk to the human fetus, but the magnitude of the benefit may outweigh the risk, for example to overcome a life-threatening situation.

Busulfan is not yet known to be absorbed into breast milk or not. If you are breastfeeding, do not use this medicine without first consulting your doctor.

Drug form Tablets and injections

Warnings Before Using Busulfan

  • Do not consume or use busulfan if you have a history of allergy to this drug or other cytotoxic chemotherapy drugs.
  • Tell your doctor if you have ever undergone radiation therapy or treatment with other chemotherapy drugs.
  • Tell your doctor if you have used busulfan before but your cancer has not improved.
  • Tell your doctor if you have a history of blood or bone marrow disorders, such as thrombocytopenia , neutropenia, anemia , thalassemia , or myeloproliferative disease .
  • Tell your doctor if you suffer from or have a history of immune system weakness, epilepsy , head injury , or lung and respiratory tract disorders.
  • Tell your doctor if you are pregnant, breastfeeding, or planning to become pregnant.
  • Tell your doctor if you are planning a pregnancy, because busulfan can affect the fertility of the reproductive organs, both male and female.
  • If you experience a drug allergic reaction or overdose after using busulfan, see a doctor immediately.

Dosage and Administration of Busulfan

The dose of busulfan will be given by the doctor according to the purpose of use. Here is the explanation:

Overcoming chronic myelocytic leukemia

Busulfan is given in tablet form with the following doses:

  • Adults: Initial dose 0.66 mg/kgBW per day, maximum 4 mg per day, for 3 weeks. The dose can be changed according to the doctor's recommendation.
  • Children: same as adult dose.

Preparation before bone marrow transplantation

Busulfan is given in tablet form with the following doses:

  • Adults: 1 mg/kgBW, every 6 hours, for 4 days, starting 7 days before transplantation.
  • Children: Maximum dose 37.5 mg/m2, every 6 hours, for 4 days, starting 7 days before transplantation.

In preparation for bone marrow transplantation , the administration of busulfan is combined with another chemotherapy drug, namely cyclophosphamide . Cyclophosphamide is given for 2 days, starting 24 hours after the duration of busulfan administration is over.

Busulfan can also be given in the form of an injection through an infusion fluid in patients who are preparing for a bone marrow transplant operation. The dose will be adjusted according to the patient's condition. Giving busulfan in the form of an injection can only be done by a doctor or by medical personnel under the supervision of a doctor.

Treatment of polycythemia vera

Busulfan is given in tablet form with the following doses:

  • Adults: 4–6 mg per day, for 4–6 weeks. During drug administration, the condition of the blood should always be monitored, especially the number of blood platelets ( thrombocytes ).
  • Children: the dose will be determined by the doctor based on the patient's condition.

How to Use Busulfan Correctly

Consume busulfan tablets according to the doctor's recommendations and the instructions for use on the medicine packaging. Patients are advised to take the medicine at the same time every day so that the effect is optimal.

Busulfan can be consumed before or after meals. Swallow the tablet with a glass of water.

Busulfan can make patients more susceptible to infection. Therefore, avoid direct contact with sufferers of easily contagious infectious diseases, such as flu and smallpox, while using busulfan.

While using busulfan, do not do vaccinations without a doctor's permission. Patients are also advised to avoid contact with people who have not recently been vaccinated with live attenuated vaccines , such as the MMR , typhoid, and varicella vaccines .

Carry out regular health tests during and after the use of busulfan. This is done to estimate the drug dose and monitor long-term side effects that may arise.

If you forget to take busulfan, take it immediately so you remember. However, if the distance to the next medication schedule is too close, proceed directly to the next dose and do not double the dose.

Interactions of Busulfan with Other Drugs

There are several drug interaction effects that can occur if busulfan is used with other drugs, including:

  • Increased risk of drug side effects, when used together with paracetamol, itraconazole , or metronidazole 
  • Decreased drug effectiveness, when used with phenytoin
  • Increased risk of seizures , when used with tramadol , phenothiazine, theophylline , or amitriptyline 
  • Increased risk of liver disorders, when used with thioguanine

Side Effects and Dangers of Busulfan

Some of the side effects that may arise due to the use of busulfan are:

  • The mouth, nose, and throat feel dry
  • Skin looks darker
  • Fever and chills
  • Nausea
  • Diarrhea
  • Decreased appetite
  • Muscle pain
  • Headache
  • Thrush
  • Difficulty sleeping (insomnia)

If the condition does not improve or even worsens, immediately check yourself with a doctor. You are also recommended to see a doctor immediately if you experience a serious drug allergic reaction or side effect, such as:

  • Feces are black
  • Difficulty breathing
  • Blurred vision
  • Chest pain
  • Convulsions
  • The whites of the eyes and skin appear yellow ( jaundice )
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