Busulfan (Busilvex®, Myleran®)
Busulfan (pronounced bu-sul-fan), or Busulphan as it used to be known, is a type of chemotherapy drug. It is most often used to treat a type of leukaemia known as chronic myeloid leukaemia (CML), but may sometimes be used to treat other types of cancer. This information describes busulfan, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about CML, which give more advice.
If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.
- What busulfan looks like
- How it is given
- Possible side effects
- Less common side effects
- Additional information
- Things to remember about busulfan tablets
What busulfan looks like
Busulfan is available as 2mg white tablets, and as a colourless liquid after being dissolved from a white powder.
How it is given
Busulfan is given either:
- as tablets swallowed whole
- by injection into a vein (intravenously) when used as a high-dose treatment.
Possible side effects
Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described here will not affect everyone who is given busulfan, and may be different if you are having more than one chemotherapy drug.
We have outlined the most common and less common side effects, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you do notice any effects which you think may be due to the drug but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.
Lowered resistance to infection Busulfan can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can occur between 10–30 days after treatment has been given. Your blood cells will then increase steadily, and will usually return to normal levels over several weeks.
Contact your doctor or the hospital straightaway if:
- Your temperature goes above 38ºC (100.5ºF)
- You suddenly feel unwell (even with a normal temperature).
You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.
Bruising or bleeding Busulfan can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.
Anaemia (low number of red blood cells) While having treatment with busulfan you may become anaemic. This may make you feel tired and breathless. You may need to have a transfusion of blood if the number of red blood cells becomes too low.
Skin changes Your skin may darken due to excess production of pigment in some areas.
Tiredness and feeling of weak You may feel very tired. It is important to allow yourself plenty of time to rest.
Less common side effects
Raised levels of uric acid in the blood A drug called allopurinol may be given to stop this happening. Allopurinol is taken as tablets. It may also help to drink plenty of fluids. While you are taking busulfan your uric acid levels may be checked regularly by blood tests.
Changes to the lungs Busulfan may cause some changes to the lungs. Tell your doctor if you smoke and if you notice any coughing or breathlessness. You may have a chest x-ray done to check your lungs before you are given any busulfan.
Irritation of the bladder It is important to drink plenty of fluids to prevent the irritation. To protect the bladder you may sometimes be given fluids through a drip before high-dose intravenous treatment. If you notice any blood in your urine tell your doctor or nurse.
Skin changes Busulfan can cause a rash, which may be itchy. Your doctor can prescribe medicine to help with this.
Hair loss Hair loss does not usually occur if you take busulfan as tablets. It can occur if busulfan is taken as a high-dose intravenous treatment. The hair loss is temporary and your hair will return to normal once the treatment ends.
Your liver may be temporarily affected Busulfan may cause changes in the way that your liver works, but your liver will return to normal when the treatment is finished. This is unlikely to cause any symptoms or harm you but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to check how well your liver is working.
Feeling sick (nausea) and vomiting This is an rare side effect unless you are having high doses of intravenous busulfan. If sickness does occur it may begin a few hours after the treatment is given and last for up to five days. Your doctor can now prescribe very effective anti-sickness (anti‑emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness persists, tell your doctor, who can prescribe other anti-sickness drugs which may be more effective.
Sore mouth and ulcers Your mouth may become sore or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as special mouthwashes and medicines, which prevent or clear any mouth infection, can be prescribed.
Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.
Diarrhoea This can usually be controlled with anti-diarrhoea medicine but let your doctor know if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.
Loss of appetite A dietitian or specialist nurse at your hospital can give advice and tips on boosting appetite, coping with eating difficulties and maintaining weight.
Dizziness, blurred vision or confusion These are very rare and occur only with high-dose treatment. If you notice any of these effects tell your doctor immediately.
Second cancer With long-term use of this drug over many years, there is a very small risk of developing a second cancer. Your doctor or nurse will discuss this risk with you.
Cataracts Rarely these can occur some years after busulfan treatment. Let your doctor know if you notice any change in your eyesight.
Swelling and tenderness of the breasts This may be experienced by both men and women.
Fever and chills These may occur soon after the drug is given, but they do not usually last long. Your doctor may prescribe medicines to reduce this effect.
Fits or seizures When high doses of busulfan are given there is a small risk of seizures. Your doctor can discuss this with you and you may need to take medication to help prevent them.
Additional information
Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.
Contraception It is not advisable to become pregnant or father a child while taking busulfan, as the developing foetus may be harmed. It is necessary to use effective contraception while taking this drug, and for at least a few months afterwards.
Things to remember about busulfan tablets
- It is important to take your tablets at the right times. You must take them as directed by your doctor.
- Keep the tablets in the original packaging and store them at room temperature, away from heat and direct sunlight
- Keep the tablets in a safe place where children cannot reach them, as busulfan could harm them.
- If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
- If you are sick just after taking the tablets let your doctor know as you may need to take another dose. Do not take another tablet without first telling your doctor.
- If you forget to take a tablet do not take a double dose. Inform your doctor and keep to your regular dose schedule.
