bleomycin

Neuro: aggressive behavior, disorientation, weakness.

Resp: PULMONARY FIBROSIS, pneumonitis.

CV: hypotension, peripheral vasoconstriction.

GI: anorexia, nausea, stomatitis, vomiting.

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

Hemat: anemia, leukopenia, thrombocytopenia.

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

Metab: weight loss.

Misc: ANAPHYLACTOID REACTIONS, chills, fever.

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 ⬆ ⬇

Lymphoma patients 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.

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.
- Lymphoma patients 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.
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
- codeine
- cyclophosphamide
- cyclosporine
- cytarabine
- dacarbazine
- dactinomycin
- daptomycin
- daunorubicin
- dexamethasone
- dexmedetomidine
- dexrazoxane
- digoxin
- diltiazem
- diphenhydramine
- dobutamine
- docetaxel
- dopamine
- doxacurium
- doxorubicin
- doxorubicin liposome
- droperidol
- enalaprilat
- epinephrine
- epirubicin
- ertapenem
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fenoldopam
- filgrastim
- fludarabine
- fluorouracil
- fosphenytoin
- furosemide
- gemcitabine
- glycopyrrolate
- granisetron
- haloperidol
- heparin
- hetastarch
- hydralazine
- hydrocortisone
- idarubicin
- ifosfamide
- insulin
- isoproterenol
- ketorolac
- labetalol
- leucovorin calcium
- levofloxacin
- lidocaine
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- mesna
- metaraminol
- methotrexate
- methyldopate
- methylprednisolone
- metoclopramide
- metoprolol
- milrinone
- mitomycin
- mitoxantrone
- naloxone
- nicardipine
- nitroglycerin
- norepinephrine
- octreotide
- ondansetron
- oxaliplatin
- paclitaxel
- palonosetron
- pancuronium
- pantoprazole
- pemetrexed
- phentolamine
- phenylephrine
- piperacillin/tazobactam
- potassium chloride
- potassium phosphates
- procainamide
- quinupristin/dalfopristin
- rituximab
- sargramostim
- sodium acetate
- thiotepa
- tirofiban
- trastuzumab
- vinblastine
- vincristine
- vinorelbine
- voriconazole
Y-Site Incompatibility:
- amphotericin B liposome
- 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.

US Brand Names ⬆ ⬇

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: antitumor antibiotics

Availability ⬆ ⬇

(Generic available)

Injection: 15 units/vial; 30 units/vial;

Time/Action Profile ⬆ ⬇

(tumor response)

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

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. Lymphoma patients are at particular risk for idiosyncratic reactions that may occur immediately or several hrs 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.

Pot. Nursing Diagnoses ⬆ ⬇

Risk for injury (Side Effects).
Disturbed body image (Side Effects).

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.
Advise patient of the need for contraception during therapy.
Instruct patient not to receive any vaccinations without advice of health care professional.
Emphasize need for periodic lab tests to monitor for side effects.

Evaluation/Desired Outcomes ⬆ ⬇

Decrease in tumor size without evidence of hypersensitivity or pulmonary toxicity.

Code ⬆

NDC Code^*

0143- West-Ward Pharmaceuticals Corp
0143-9240- Bleomycin 0143-9240-01- 1 VIAL in 1 BOX, UNIT-DOSE (0143-9240-01) > 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL

0143- West-Ward Pharmaceuticals Corp
0143-9241- Bleomycin 0143-9241-01- 1 VIAL in 1 BOX, UNIT-DOSE (0143-9241-01) > 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL

0409- Hospira, Inc.
0409-0323- Bleomycin 0409-0323-20- 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-0323-20) > 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL, SINGLE-DOSE

0409- Hospira, Inc.
0409-0332- Bleomycin 0409-0332-20- 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-0332-20) > 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL, SINGLE-DOSE

0703- Teva Parenteral Medicines, Inc.
0703-3154- Bleomycin 0703-3154-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (0703-3154-01) > 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL, SINGLE-DOSE

0703- Teva Parenteral Medicines, Inc.
0703-3155- Bleomycin 0703-3155-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (0703-3155-01) > 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL, SINGLE-DOSE

16714- NorthStar Rx LLC
16714-886- Bleomycin 16714-886-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (16714-886-01) > 15 POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE

16714- NorthStar Rx LLC
16714-908- Bleomycin 16714-908-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (16714-908-01) > 30 POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE

61703- Hospira, Inc.
61703-323- Bleomycin 61703-323-22- 1 VIAL, SINGLE-DOSE in 1 CARTON (61703-323-22) > 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL, SINGLE-DOSE

61703- Hospira, Inc.
61703-332- Bleomycin 61703-332-18- 1 VIAL, SINGLE-DOSE in 1 CARTON (61703-332-18) > 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL, SINGLE-DOSE

63323- Fresenius Kabi USA, LLC
63323-136- Bleomycin 63323-136-10- 1 VIAL in 1 CARTON (63323-136-10) > 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL

63323- Fresenius Kabi USA, LLC
63323-137- Bleomycin 63323-137-20- 1 VIAL in 1 CARTON (63323-137-20) > 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL

69097- Cipla USA Inc.
69097-364- Bleomycin 69097-364-36- 1 VIAL in 1 CARTON (69097-364-36) > 1 INJECTION in 1 VIAL

70121- Amneal Biosciences
70121-1567- Bleomycin 70121-1567-1- 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 CARTON (70121-1567-1)

71288- Meitheal Pharmaceuticals Inc.
71288-106- Bleomycin 71288-106-10- 1 VIAL, SINGLE-DOSE in 1 CARTON (71288-106-10) > 15 POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE

71288- Meitheal Pharmaceuticals Inc.
71288-107- Bleomycin 71288-107-20- 1 VIAL, SINGLE-DOSE in 1 CARTON (71288-107-20) > 30 POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE

section name header

Pronunciation ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇