Gliadel (carmustine wafers)

Gliadel is a wafer that contains the chemotherapy drug carmustine. Your brain surgeon (neurosurgeon) puts the wafer in during surgery to remove the brain tumour. It is a treatment for a brain tumour called glioblastoma multiforme (glioma) in adults.

How does Gliadel work?

Gliadel wafers are small discs about the size of a 5p coin. The wafers release the chemotherapy drug carmustine as they dissolve. The carmustine in the wafer works by sticking to one of the cancer cell's DNA strands. The cell can't then divide into 2 new cells. This stops the cells growing and they die.  

How do you have Gliadel?

Your brain surgeon puts the wafers in during brain surgery to remove some or all of the tumour. They put up to 8 wafers in the space where the tumour was. Over the next few days, the wafers slowly release the chemotherapy drug carmustine into this area.

Tests

You might have blood tests before starting treatment and during your treatment. They check your general health and might check your levels of blood cells and other substances in the blood.

What are the side effects of Gliadel?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Surgery and Gliadel can cause side effects and because you have them at the same time it can be difficult to know which is causing any of the side effects you have.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Slow wound healing

Gliadel can cause wounds to heal more slowly than usual. So it might take longer for the wound from your operation to heal. Your doctor or nurse will check the wound regularly to make sure it is healing well. If the wound is sore, swollen and red or leaking contact your health advice line straight away. And tell your doctor or nurse.

Swelling of the brain

This can happen after surgery and is temporary. Contact your healthcare team if you have any of the following:

• headaches
• difficulty walking 
• weakness in your arms or legs
• changes to how you speak
• confusion
• drowsiness

Difficulty with language

You might find you have a problem with how you speak, how you understand speech and your ability to read and write. Let your doctor or nurse know if you do. 

Confusion, anxiety and depression

You might have some mood changes while having this drug. Let your doctor or nurse know if you feel anxious or depressed.

Feeling weak and loss of movement 

Gliadel can make you feel weak.

You might have weakness or loss of movement on one side of your body. This could affect the way you walk. 

More rarely you can loss control of body movements or have uncontrolled shaking or trembling (tremors). This can increase your risk of accidental injury. 

Inflammation 

Your veins might become inflamed which can affect how well your blood circulates. You might develop a blood clot. 

More rarely you might have inflammation of the lining of the brain (meningitis). 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a laxative if needed.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Skin rash

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your healthcare team can tell you what products you can use on your skin to help.

Worsening of your condition

Your condition could become worse.

Headaches

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

You might have a bladder infection. You might find it difficult to pass urine, want to go with some urgency or are going more often. There may be pain or burning when you go. You may see blood in your urine, or your urine might smell bad or look cloudy.

More rarely you might have white patches in the mouth or a sore, red mouth this could be a yeast infection.

Contact your healthcare advice line or tell your doctor or nurse if you have symptoms of an infection or think you might have an infection. 

Pain

This treatment can cause pain in your muscles, bones or where the tumour site is. Let your doctor or nurse know if you have it so that they can give you painkillers.

Fits (seizures)

Tell your doctor if you have any fits, twitching or jerking of your limbs. 

More rarely you might have fits causing loss of consciousness and stiffness (grand mal seizure). Dial 999 or go straight to A and E if this happens. 

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
• an allergic reaction
• raised levels of sugar in the blood - this can cause diabetes, tell your doctor if you feel thirsty all time, peeing more than usual, losing weight or feel tired
• swelling of your arms and legs
• increased blood pressure in your head caused by an abnormal build up of fluid
• loss of ability to move your face (paralysis)
• nerve changes including pain, decrease in the sense of touch, tingling or prickling (pins and needles)
• dizziness
• difficulty sleeping or getting to sleep
• a drop in blood cells causing tiredness, looking pale, breathlessness and an increased risk of bleeding
• an increased number of white blood cells
• eye problems including pain, blurred, double or abnormal vision and swelling of the lining of the eyelids
• diarrhoea
• loss of bladder control (urinary incontinence)
• a low amount of sodium and potassium in your blood
• white patches in the mouth or a sore, red mouth (oral candida)
• hallucinations, loss of memory, personality changes or changes to the way you think
• tummy (abdominal pain)

Rare side effects

This side effects happens in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• bleeding in the brain
• narrowing or blocking of the blood vessels in the brain

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, food and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Contraception and pregnancy

It is unknown whether treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment. Let your team know straight away if you or your partner become pregnant while having treatment.

Talk to your doctor or nurse about effective contraception you can use during treatment. Ask how long you should use it before starting treatment and after treatment has finished.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisation

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.