• Treatment of:
  • Lymphomas,
  • Squamous cell carcinoma,
  • Testicular embryonal cell carcinoma,
  • Choriocarcinoma,
  • Teratocarcinoma.
• Intrapleural administration to prevent the reaccumulation of malignant effusions.

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.

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.

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.

(Generic available)

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

• 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.

• Inhibits DNA and RNA synthesis.

• Death of rapidly replicating cells, particularly malignant ones.

Therapeutic Classification: antineoplastics

Pharmacologic Classification: antitumor antibiotics

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).

(tumor response)

• 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.

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