Bleomycin

Bleomycin is a prescription medication used to treat various types of cancer. It is also used to treat pleural effusions (a condition when fluid collects in the lungs) that are caused by cancerous tumors. Bleomycin belongs to a group of drugs called antibiotics that are only used in cancer chemotherapy. It slows or stops the growth of cancer cells in your body.

This medication is available in an injectable form to be given directly into a vein (IV), muscle (IM), under the skin, or into the pleural space by a healthcare professional.

Common side effects of this medication include skin reactions, hair loss, and sores on the mouth or tongue.

Bleomycin is a prescription medication used to treat:

• head and neck cancer (including cancer of the mouth, lip, cheek, tongue, palate, throat, tonsils, and sinuses) 
• cancer of the penis, testicles, cervix, and vulva (the outer part of the vagina)
• Hodgkin's lymphoma (Hodgkin's disease) 
• non-Hodgkin's lymphoma (cancer that begins in the cells of the immune system)
• pleural effusions (a condition when fluid collects in the lungs) that are caused by cancerous tumors

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Bleomycin may be found in some form under the following brand names:

• Blenoxane

Common side effects of bleomycin include the following:

• redness, blistering, tenderness, or thickening of the skin
• darkened skin color
• rash
• hair loss
• sores on the mouth or tongue
• vomiting
• loss of appetite
• weight loss

This is not a complete list of this medication’s side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• cisplatin
• drugs that can decrease kidney function such as
  • acetaminophen (Tylenol)
  • aspirin
  • NSAIDs such as ibuprofen and naproxen
  • acyclovir
  • aminoglycoside medications
  • certain antibiotics
  • ACEIs such as lisinopril or quinapril
  • statins such as rosuvastatin and simvastatin
  • water pills (diuretic medications)

This is not a complete list of bleomycin drug interactions. Ask your doctor or pharmacist for more information.

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of bleomycin, there are no specific foods that you must exclude from your diet.

Before taking bleomycin,

• tell your doctor and pharmacist if you are allergic to bleomycin or any of the ingredients in bleomycin injection. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements, you are taking or plan to take. Your doctor may need to monitor you carefully for side effects.
• tell your doctor if you have or have ever had kidney or lung disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. You should not become pregnant while you are receiving bleomycin injection. If you become pregnant while receiving bleomycin, call your doctor. Bleomycin may harm the fetus.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are receiving bleomycin.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

This medication falls into category D. In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

Tell your doctor if you are breastfeeding or plan to breastfeed.

It is not known if bleomycin crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using bleomycin.

This medication is available in an injectable form to be given directly into a vein (IV), muscle (IM), under the skin, or into the pleural space by a healthcare professional. The pleural space is the space between the chest wall and the lungs.

The following dose schedule is recommended:

• Squamous cell carcinoma, non-Hodgkin’s lymphoma, testicular carcinoma – 0.25 to 0.50 units/kg (10 to 20 units/m²) given into the vein, into the muscle, or under the skin once or twice weekly.
• Hodgkin’s Disease – 0.25 to 0.50 units/kg (10 to 20 units/m²) given into the muscle, or under the skin once or twice weekly. After a certain degree of response, a dose of 1 unit daily or 5 units weekly into the vein or muscle should be given.
• Malignant Pleural Effusion – 60 units given as a single injection directly into the pleural space (the space between the chest wall and the lungs)

If you take too much this medication, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If this medication is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if an overdose is suspected, seek emergency medical attention.

It is recommended that Bleomycin for Injection, USP be administered under the supervision of a qualified physician experienced in the use of cancer chemotherapeutic agents.  Appropriate management of therapy and complications is possible only when adequate diagnostic and treatment facilities are readily available.

Pulmonary fibrosis is the most severe toxicity associated with bleomycin.  The most frequent presentation is pneumonitis occasionally progressing to pulmonary fibrosis.  Its occurrence is higher in elderly patients and in those receiving greater than 400 units total dose, but pulmonary toxicity has been observed in young patients and those treated with low doses.

A severe idiosyncratic reaction consisting of hypotension, mental confusion, fever, chills, and wheezing has been reported in approximately 1% of lymphoma patients treated with bleomycin.