bleomycin

Absorption: IV administration results in complete bioavailability. Well absorbed from IM and SUBQ sites. Absorption follows intrapleural and intraperitoneal administration.

Distribution: Widely distributed; concentrates in skin, lungs, peritoneum, kidneys, and lymphatics.

Metabolism/Excretion: 60–70% excreted unchanged by the kidneys.

Half-life: 2 hr (↑ in renal impairment).

Time/Action Profile ⬆ ⬇

(tumor response)

ROUTE	ONSET	PEAK	DURATION
IV, IM, SUBQ	2–3 wk	unknown	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity
OB: Pregnancy
Lactation: Lactation.

Use Cautiously in:

Renal impairment (dose ↓ required if CCr <35 mL/min)
Pulmonary disease
Women of reproductive potential
Geri: ↑risk of pulmonary toxicity and renal impairment in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension, peripheral vasoconstriction.

Derm: hyperpigmentation, mucocutaneous toxicity, alopecia, erythema, rash, urticaria, vesiculation.

GI: ↓weight, anorexia, nausea, stomatitis, vomiting.

Hemat: anemia, leukopenia, thrombocytopenia.

Local: pain at tumor site, phlebitis at IV site.

Neuro: aggressive behavior, disorientation, weakness.

Resp: pneumonitis, PULMONARY FIBROSIS.
Misc: chills, fever, ANAPHYLACTOID REACTIONS.

Interactions ⬆ ⬇

Drug-Drug:

Hematologic toxicity ↑ with concurrent use of radiation therapy and other antineoplastics.
Concurrent use with cisplatin↓ elimination of bleomycin and may ↑ toxicity.
↑risk of pulmonary toxicity with other antineoplastics or thoracic radiation therapy.
General anesthesia↑ the risk of pulmonary toxicity.
↑risk of Raynaud’s phenomenon when used with vinblastine.

Route/Dosage ⬆ ⬇

Patients with lymphoma should receive initial test doses of 2 units or less for the first 2 doses

IV, IM, SC (Adults and Children): 0.25–0.5 unit/kg (10–20 units/m²) weekly or twice weekly initially. If favorable response, lower maintenance doses given (1 unit/day or 5 units/wk IM or IV). May also be given as continuous IV infusion at 0.25 unit/kg or 15 units/m²/day for 4–5 days.
Intrapleural (Adults): 15–20 units instilled for 4 hr, then removed.

Availability ⬆ ⬇

(Generic available)

Powder for injection: 15 units/vial; 30 units/vial;

Assessment ⬆ ⬇

Monitor vital signs before and frequently during therapy.
Assess for fever and chills. May occur 3–6 hr after administration and last 4–12 hr.
Monitor for anaphylactic (fever, chills, hypotension, wheezing) and idiosyncratic (confusion, hypotension, fever, chills, wheezing) reactions. Keep resuscitation equipment and medications on hand. Patients with lymphoma are at particular risk for idiosyncratic reactions that may occur immediately or several hr after therapy, usually after the 1st or 2nd dose.
Assess respiratory status for dyspnea and rales/crackles. Monitor chest x-ray before and periodically during therapy. Pulmonary toxicity occurs primarily in geriatric patients (age 70 or older) who have received 400 or more units or at lower doses in patients who received other antineoplastics or thoracic radiation. May occur 4–10 wk after therapy. Discontinue and do not resume bleomycin if pulmonary toxicity occurs.
Assess nausea, vomiting, and appetite. Weigh weekly. Modify diet as tolerated. Antiemetics may be given before administration.

Lab Test Considerations:

Monitor CBC before and periodically during therapy. May cause thrombocytopenia and leukopenia (nadir occurs in 12 days and usually returns to pretreatment levels by day 17).
- Monitor baseline and periodic renal and hepatic function.

Implementation ⬆ ⬇

High Alert:Fatalities have occurred with chemotherapeutic agents. Before administering, clarify all ambiguous orders; double-check single, daily, and course-of-therapy dose limits; have second practitioner independently double-check original order and dose calculations.
Prepare solution in a biologic cabinet. Wear gloves, gown, and mask while handling medication. Discard equipment in specially designated containers.
- Patients with lymphoma should receive a 1- or 2-unit test dose 2–4 hr before initiation of therapy. Monitor closely for anaphylactic reaction. May not detect reactors.
- Premedication with acetaminophen, corticosteroids, and diphenhydramine may reduce drug fever and risk of anaphylaxis.
- Reconstituted solution is stable for 24 hr at room temperature and for 14 days if refrigerated.
IM, SC: Reconstitute vial with 1–5 mL of sterile water for injection, 0.9% NaCl, or bacteriostatic water for injection. Do not reconstitute with diluents containing benzyl alcohol when used for neonates.

IV Administration:

Intermittent Infusion: Prepare IV doses by diluting 15-unit vial with at least 5 mL of 0.9% NaCl. Further dilute dose in 50 to 1000 mL of D5W or 0.9% NaCl.
Rate: Administer slowly over 10 min.
Y-Site Compatibility:
- allopurinol
- amifostine
- aminocaproic acid
- aminophylline
- amiodarone
- anidulafungin
- atracurium
- aztreonam
- bivalirudin
- bumetanide
- busulfan
- calcium chloride
- calcium gluconate
- carboplatin
- carmustine
- caspofungin
- cefepime
- chlorpromazine
- cimetidine
- cisatracurium
- cisplatin
- cyclophosphamide
- cyclosporine
- cytarabine
- dacarbazine
- dactinomycin
- daptomycin
- daunorubicin hydrochloride
- dexamethasone
- dexmedetomidine
- dexrazoxane
- digoxin
- diltiazem
- diphenhydramine
- dobutamine
- docetaxel
- dopamine
- doxorubicin hydrochloride
- doxorubicin liposomal
- droperidol
- enalaprilat
- epinephrine
- epirubicin
- ertapenem
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- filgrastim
- fludarabine
- fluorouracil
- fosphenytoin
- furosemide
- gemcitabine
- glycopyrrolate
- granisetron
- haloperidol
- heparin
- hetastarch
- hydralazine
- hydrocortisone
- idarubicin
- ifosfamide
- insulin, regular
- isoproterenol
- ketorolac
- labetalol
- leucovorin calcium
- levofloxacin
- lidocaine
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- mesna
- methotrexate
- methylprednisolone
- metoclopramide
- metoprolol
- milrinone
- mitomycin
- mitoxantrone
- naloxone
- nicardipine
- nitroglycerin
- norepinephrine
- octreotide
- ondansetron
- oxaliplatin
- paclitaxel
- palonosetron
- pantoprazole
- pemetrexed
- phentolamine
- phenylephrine
- piperacillin/tazobactam
- potassium chloride
- potassium phosphate
- procainamide
- rituximab
- sargramostim
- sodium acetate
- thiotepa
- tirofiban
- trastuzumab
- vinblastine
- vincristine
- vinorelbine
- voriconazole
Y-Site Incompatibility:
- amphotericin B liposomal
- dantrolene
- phenytoin
- tigecycline
Intrapleural: Dissolve 60 units in 50–100 mL of 0.9% NaCl.
- May be administered through thoracotomy tube. Position patient as directed.

Patient/Family Teaching ⬆ ⬇

Instruct patient to notify health care professional if fever, chills, wheezing, faintness, diaphoresis, shortness of breath, prolonged nausea and vomiting, or mouth sores occur.
Encourage patient not to smoke because this may worsen pulmonary toxicity.
Explain to the patient that skin toxicity may manifest itself as skin sensitivity, hyperpigmentation (especially at skin folds and points of skin irritation), and skin rashes and thickening.
Instruct patient to inspect oral mucosa for erythema and ulceration. If ulceration occurs, advise patient to use sponge brush and rinse mouth with water after eating and drinking. Opioid analgesics may be required if pain interferes with eating.
Discuss with patient the possibility of hair loss. Explore coping strategies.
Instruct patient not to receive any vaccinations without advice of health care professional.
May cause fetal harm. Advise patient of the need for contraception during therapy. Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Emphasize need for periodic lab tests to monitor for side effects.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇