Bleomycin
BLENOXANE
Pronunciation: blee-oe-MYE-sin
What it isAntitumor glycopeptide generating free-radical DNA strand breaks; testicular cancer and Hodgkin lymphoma.
Why this oneMinimal marrow suppression lets it combine with cytotoxic partners that would otherwise compound myelosuppression.
What limits it⚑ Cumulative pulmonary fibrosis can be fatal; prior exposure matters to anesthesia planning because high inspired oxygen may worsen lung injury.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Squamous cell carcinoma, non-Hodgkin's lymphoma, testicular carcinoma | Adults | 0.25-0.5 units/kg (10-20 units/m2) IV/IM/SC weekly or twice weekly | Total cumulative dose >400 units only with great caution | |
| Hodgkin's disease | Adults | 0.25-0.5 units/kg (10-20 units/m2) IV/IM/SC weekly or twice weekly | After 50% response: maintenance 1 unit IV/IM QD or 5 units IV/IM weekly | Total cumulative dose >400 units only with great caution |
| Malignant pleural effusion | Adults | 60 units single-dose bolus intrapleural injection | Single dose |
Renal CrCl <50 mL/min: reduce dose — CrCl 40-50: 70% of dose; 30-40: 60%; 20-30: 55%; 10-20: 45%; 5-10: 40%
Hepatic Undefined
Pulmonary toxicity is dose-related with a striking increase over 400 units total dose; in combination chemotherapy it may occur at lower doses
Instructions
- Lymphoma patients: give 2 units or less for the first 2 doses (anaphylactoid-reaction risk); if no acute reaction, follow regular schedule
- Routes: IV, IM, or SC (intrapleural for malignant pleural effusion)
Available strengths
- inj 15, 30 units
Contraindications
- Prior hypersensitivity or idiosyncratic reaction to bleomycin
Cautions
- Pulmonary toxicity (~10%; ~1% fatal fibrosis): monitor chest X-ray q1-2 wk and consider DLco monthly (stop if DLco falls below 30-35% of pretreatment); discontinue if pulmonary changes until drug-relatedness determined
- Oxygen sensitivity: prior bleomycin increases lung-injury risk from intraoperative O2 — keep FIO2 near room air (~25%) during surgery/postop; favor colloid fluid replacement
- Idiosyncratic anaphylaxis-like reaction (~1% of lymphoma patients), immediate or delayed hours, usually after 1st or 2nd dose
- Toxicity increased in elderly and with cumulative dose >400 units
- Death reported with bleomycin pleurodesis in seriously ill patients
Adverse reactions
- Pneumonitis/pulmonary fibrosis (~10%; ~1% fatal)
- Skin/mucosal toxicity (~50%): erythema, rash, striae, vesiculation, hyperpigmentation, tenderness; hyperkeratosis, nail changes, alopecia, pruritus, stomatitis (cumulative, wk 2-3)
- Idiosyncratic reaction: hypotension, confusion, fever, chills, wheezing (~1% lymphoma)
- Fever, chills, vomiting; anorexia and weight loss (may persist)
- Vascular events (MI, CVA, HUS, cerebral arteritis) in combination therapy; Raynaud's phenomenon
- Local pain and hypotension with intrapleural use; pain at tumor site, phlebitis
Pregnancy Pregnancy Category D — can cause fetal harm (see label WARNINGS)
Lactation Undefined
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 15 units | inj | per unit | not offered | |
| 30 units | inj | per unit | not offered |
⚠ BOXED WARNINGS
- Pulmonary fibrosis
- Idiosyncratic reaction in lymphoma patients
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilityPotentially fatal pneumonitis and pulmonary fibrosis