Indications
Bleomycin is an anticancer antibiotic used, usually with other chemotherapy medicines, to treat Hodgkin and some non-Hodgkin lymphomas, testicular (germ cell) cancer, and squamous cell cancers of the head and neck, skin, cervix and other sites. It is also used to control fluid build-up around the lungs caused by cancer (malignant pleural effusion).
How It Works
Bleomycin binds to DNA in cancer cells and, together with iron and oxygen, causes breaks in the DNA strands. This stops the cells from dividing and leads to their death. It has little effect on the bone marrow compared with many other chemotherapy medicines.
Dosage and Administration
Bleomycin is given only in hospital by a doctor or nurse experienced in chemotherapy, by injection into a vein, muscle or under the skin, or into the chest cavity. The dose and schedule are set by the cancer specialist based on the cancer type, body size, kidney function and the total lifetime dose received. A small test dose may be given first in lymphoma patients.
Interactions
- Cisplatin and other kidney-harming medicines can reduce bleomycin clearance and increase toxicity.
- High-concentration oxygen during or after treatment (for example during surgery) increases the risk of lung damage: tell every anaesthetist you have received bleomycin.
- Radiation to the chest and other chemotherapy such as Brentuximab may add to lung toxicity.
- It may reduce levels of Phenytoin and Digoxin.
Contraindications
- Allergy to bleomycin.
- Serious lung disease or reduced lung function, as judged by the doctor.
- Ataxia telangiectasia, and breastfeeding.
Side Effects
Common effects include fever and chills on the day of treatment, darkening, thickening or peeling of the skin, nail changes, hair loss, mouth sores, nausea, loss of appetite and weight loss. The most important serious risk is lung inflammation and scarring (pneumonitis and fibrosis), which is more likely with higher total doses, older age, kidney disease and smoking.
Get urgent medical help for new or worsening cough, shortness of breath or chest pain, high fever with confusion or low blood pressure soon after a dose, wheezing or facial swelling, or reduced urine output.
Pregnancy and Lactation
Bleomycin can harm an unborn baby. Women and men should use effective contraception during treatment and for a period afterwards as advised by the doctor. Do not breastfeed during treatment.
Precautions and Warnings
- Lung function tests and chest examinations are done before and during treatment.
- Stop smoking; avoid unnecessary high-flow oxygen.
- Kidney function is checked, as doses are reduced if it is poor.
- Chemotherapy-handling precautions apply for staff and caregivers.
Overdose
Overdose increases the risk of severe lung damage, fever and skin toxicity. Treatment is supportive in hospital.
Therapeutic Class
Antineoplastic, cytotoxic antibiotic.
Storage
Store unopened vials in a refrigerator at 2 to 8°C. Do not freeze. Hospital use: prepare and store as directed on the pack.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.