Bleomycin
Synonym :
BLM
Mechanism :
Bleomycin is an anti-neoplastic agent. The exact mechanism of action is unknown, available evidence indicates that the main mode of action is the inhibition of DNA synthesis with some evidence of lesser inhibition of RNA and protein synthesis.
Indication :
- Hodgkin lymphoma
- Malignant effusions
- Glioma
- Germ cell tumours
Contraindications :
Contraindicated in patients who have demonstrated a hypersensitivity or an idiosyncratic reaction to it and in reduced pulmonary function.
Dosing :
Not recommended in children. Always consult the recent protocol for detailed dosage and schedule.
Squamous cell carcinoma:
0.25 to 0.50 units/kg (10 to 20 units/m²) IV/IM/SC weekly or twice weekly.
Non-Hodgkin’s Lymphoma:
Test dose 1 to 2 units of bleomycin for the first two doses, it is necessary to wait for at least an hour before administering the remainder of the dose 0.25 to 0.50 units/kg (10 to 20 units/m²) IV/IM/SC weekly or twice weekly.
Germ cell tumors:
15 units/m²/dose once weekly IV/IM/SC for 3 weeks per regimen.
Hodgkin’s Lymphoma:
10 units/m²/dose on days 1 and 15 of the cycle. IV continuous infusion: 15-20 units/m²/day over 24 hours for 3-5 days.
Adverse Effect :
Pneumonitis occasionally progressing to pulmonary fibrosis, acute febrile reaction, idiosyncratic Reactions (hypotension, mental confusion, chills, and wheezing), erythema, rash, striae, vesiculation, hyperpigmentation, hyperkeratosis, alopecia, pruritus, stomatitis.
Interaction :
Concurrent use with phenytoin decreases the phenytoin levels, Cisplatin decreases the clearance of bleomycin, Bleomycin may decrease digoxin absorption, concurrent use with amphotericin B products may increase nephrotoxicity and risk for hypotension and bronchospasm.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | 75% of normal dose (100% for malignant effusions) |
| <10 | 50% of normal dose (100% for malignant effusions) |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in GFR<10 mL/min |
| HD | Not dialysed. Dose as in GFR<10 mL/min |
| HDF/High flux | Unknown dialysability. Dose as in GFR<10 mL/min |
| CAV/VVHD | Unknown dialysability. Dose as in GFR=10–20 mL/min |
Hepatic Dose :
No dosage adjustments are recommended.