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Bleomycin information from DrugsUpdate  

See Available Brands of Bleomycin in India

P - Contraindicated in pregnancy
L - Contraindicated in lactation

Bleomycin is a glycopeptide antibiotic produced by the bacterium Streptomyces verticillus. Bleomycin refers to a family of structurally related compounds. When used as an anti-cancer agent, the chemotherapeutical forms are primarily bleomycin A2 and B2. Bleomycin A2 is shown in the image. The drug is used in the treatment of Hodgkin lymphoma (as a component of the ABVD regimen), squamous cell carcinomas, and testicular cancer, as well as in the treatment of pleurodesis and plantar warts.

Pharmacodynamics

Pharmacokinetics

Bleomycin causes breakage of single- and double- stranded DNA by binding to DNA and inhibiting DNA synthesis. To a lesser extent, it also inhibits RNA and protein synthesis. It causes very little bone marrow suppression.
Absorption: Poorly absorbed from the GI tract (oral).
Distribution: Crosses the placenta.
Metabolism: Enzymatic degradation in plasma, liver and other organs.
Excretion: Urine (as active drug). Elimination half-life: Initial: 0.5 hr (IV bolus), 1.3 hr (infusion); terminal: 4 hr (IV bolus), 9 hr (infusion).

Bleomycin Indications / Bleomycin Uses

Information Not Available

Bleomycin Adverse Reactions / Bleomycin Side Effects

Fever, thrombophloebitis (inj). Acute anaphlyactoid reactions, hyperpyrexia. Rash, erthyema, pruritus, vesiculate, hyperkeratosis, nail changes, alopecia, hyperpigmentation, striae, stomatitis. Pulmonary toxocity , interstitial pnemonitis, fibrosis, cardiorespiratory collapse in patients with lymphoma.

Precautions

Information Not Available

Special Precautions

Pulmonary infection, preexisting pulmonary function impairment, renal impairment. Patients who received radiotherapy, particularly to the thorax. Regular chest x-rays should be done. Elderly. Discontinue treatment if chest x rays show infiltrates or breathlesness occurs.

Other Drug Interactions

Lomustine increases severity of leukopenia. Elimination decreased by cisplatin. Decreases plasma levels of digoxin and phenytoin.
Potentially Fatal: Enhanced pulmonary toxicity in patients given with oxygen.

Other Interactions

Information Not Available

Dosage

Intramuscular
Lymphoma
Adult: 15,000 IU once or twice a wk, up to a total cumulative dose of 225,000 IU.
Elderly: Dose reduction is necessary.
Renal impairment: Dose reduction is necessary.
Parenteral
Squamous cell or testicular tumours
Adult: 15,000 IU 3 times a wk or 30,000 IU twice a wk IM/IV, repeated at usual intervals of 3-4 wk up to a total cumulative dose of 500,000 IU.
Elderly: Dose reduction is necessary.
Renal impairment: Dose reduction is necessary.
Injection

Malignant effusions
Adult: 60,000 IU in 100 ml of 0.9% sodium chloride instilled into the affected serous cavity, may be repeated up to a total cumulative dose of 500,000 IU.
Elderly: Dose reduction is necessary.
Renal impairment: Dose reduction is necessary.
Incompatibility: Incompatible with solutions of essential amino acids, riboflavin, dexamethasone or furosemide.

Food(before/after)

Information Not Available

List of Contraindications

Bleomycin and Pregnancy

Contraindicated in pregnancy
Category D: There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

Bleomycin and Lactation

Contraindicated in lactation.
It is not known whether the drug is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants, it is recommended that nursing be discontinued by women receiving Bleomycin therapy.

Bleomycin and Children

Safety and effectiveness of Bleomycin for Injection in pediatric patients have not been established.

Bleomycin and Geriatic

In clinical trials, pulmonary toxicity was more common in patients older than 70 years than in younger patients. Other reported clinical experience has not identified other differences in responses between elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out.
Bleomycin is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.

Bleomycin and Other Contraindications

Hypersensitivity. Severe pulmonary disease; pregnancy and lactation.

Storage

Injection: Refrigerate at 2-8°C.
Intramuscular: Refrigerate at 2-8°C.
Parenteral: Refrigerate at 2-8°C.

Lab interference

Injection: Refrigerate at 2-8°C.
Intramuscular: Refrigerate at 2-8°C.
Parenteral: Refrigerate at 2-8°C.

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