- Severe anaphylactic reactions presenting with hypotension, mental confusion, fever, chills, and wheezing may occur after first or second dose in lymphoma patients. Carefully monitor patients after the first few doses
- Lyphoma patients should be treated with 2 units or less for the first two doses. If no acute reaction occurs, then the regular dosage schedule may be followed
- Bleomycin may cause severe pulmonary toxicity manifesting as pneumonitis and pulmonary fibrosis. Obtain chest x-rays q1-2 wks during therapy to monitor for onset of pulmonary toxicity. If changes are noted, discontinue therapy until it can be determined if they are drug related. Determine diffusion capacity for carbon monoxide (DLco) before starting therapy and then monthly during treatment. Discontinue therapy if DLco falls below 30% to 35% of pretreatment value
- Document total cumulative dose. Due to the risk of pulmonary toxicity, ensure that dosing beyond 400 units is only attempted after careful evaluation of the patient and clinical situation
- If patient is undergoing surgical intervention, FIO2 should be maintained, if possible, at concentrations
25%. Fluid replacement should consist of colloids rather than crystalloids to reduce the risk of lung damage - Bleomycin can cause fetal harm when administered to a pregnant woman. If the patient becomes pregnant during therapy, apprise her of the potential hazard to the fetus
- Skin toxicity, a relatively late manifestation, is related to the cumulative dose. It usually develops in the second and third week of treatment after administration of 150 to 200 units of the drug
- Death has been rarely reported in association with bleomycin pleurodesis in very seriously ill patients
- Local irritation or phlebitis may occur in case of extravasation
- Exceed cumulative lifetime dosage of 400 units with great caution
Cautions: Use cautiously in
- Renal impairment
- Pulmonary impairment
- Chronic debilitating illness
- Women of childbearing potential
- Use of oxygen during surgery
