bleomycin

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.

Availability ⬆ ⬇

(Generic available)

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

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.

Action ⬆ ⬇

Inhibits DNA and RNA synthesis.

Therapeutic Effects:

Death of rapidly replicating cells, particularly malignant ones.

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: antitumor antibiotics

Pharmacokinetics ⬆ ⬇

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

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.
Rep: 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.

Pronunciation ⬆ ⬇

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

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Indications ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇