bleomycin, Blenoxane

 Indications

Treatment of: Lymphomas, Squamous cell carcinoma,

Testicular embryonal cell carcinoma, Choriocarcinoma,

Teratocarcinoma. Intrapleural administration to

prevent the reaccumulation of malignant effusions.

Action

Inhibits DNA and RNA synthesis. Therapeutic Effects:

Death of rapidly replicating cells, particularly

malignant ones.

Pharmacokinetics

Absorption: Well absorbed from IM and subcut

sites. Absorption follows intrapleural and intraperitoneal

administration.

Distribution: Widely distributed, concentrates in

skin, lungs, peritoneum, kidneys, and lymphatics.

Metabolism and Excretion: 60–70% excreted

unchanged by the kidneys.

Half-life: 2 hr (qin renal impairment).

TIME/ACTION PROFILE (tumor response)

ROUTE ONSET PEAK DURATION

IV, IM, Subcut 2–3 wk unknown unknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity; OB, Lactation:

Potential for fetal, infant harm.

Use Cautiously in: Renal impairment (doseprequired

if CCr 35 mL/min); Pulmonary impairment;

Nonmalignant chronic debilitating illness; Patients with

childbearing potential; Geri:qrisk of pulmonary toxicity

and reduction in renal function. 

Adverse Reactions/Side Effects

CNS: 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 toxicityqwith concurrent

use of radiation therapy and other antineoplastics.

Concurrent use with cisplatinpelimination of bleomycin

and mayqtoxicity.qrisk of pulmonary toxicity with

other antineoplastics or thoracic radiation therapy.

General anesthesiaqthe risk of pulmonary toxicity.

qrisk 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, Subcut (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)

Injection: 15 units/vial, 30 units/vial.