Dosing & Uses
Dosage Forms & Strengths
powder for injection
Hodgkin's Disease, Non-Hodgkin's Lymphoma
Administer test dose of 1-2 units of bleomycin before first 1-2 doses; monitor vital signs q15min; wait 1 hour minimum before administering remainder of dose; if no acute reaction observe, may administer regular dosage schedule
60 unit in 50-100 mL as single instillation; may repeat dose at intervals of several days if fluid continues to accumulate (mix in 50-100 mL or NS); may add lidocaine 100-200 mg to reduce local discomfort
Elderly: May limit dose to 40 unit/m²
Pancreatic Cancer (Orphan)
Treatment of pancreatic cancer
Orphan indication sponsors
- Genetronics, Inc; 11199 Sorrento Valley Rd; San Diego, CA 92121-1334
- CIRJ Company Ltd; 1800 Loma Vista St; Pasadena, CA 91004
CrCl >50 mL/min: Dose adjustment not necessary
CrCl 40-50 mL/min: 70% of normal dose
CrCl 30-40 mL/min: 60% of normal dose
CrCl 20-30 mL/min: 55% normal dose
CrCl 10-20 mL/min: 45% normal dose
CrCl 5-10 mL/min: 40% normal dose
Dose adjustment not necessary
Chest X-ray q1-2Weeks
In lymphoma patients, give first 2 doses at 1-2 units to test for anaphylactoid reaction
Limit lifetime dose to <400 units because of risk of pulmonary fibrosis
Low ADRs w/intrapleural administration
Serious - Use Alternative
Significant - Monitor Closely
Mucocutaneous toxicity including rash, erythema, hyperpigmentation, urticaria (>50%)
Febrile reactions, acute (25-50%)
Interstitial pneumonitis (10%)
Pulmonary fibrosis (10%)
Fatal pulmonary fibrosis (1%)
Cerebral vascular accident
Fatal pulmonary fibrosis
Black Box Warnings
Severe idiosyncratic reactions including hypotension, confusion, fever, chills, and wheezing occurring usually after the first or second dose have been reported.
Monitoring is very important after administering these doses.
Pneumonitis that progresses to pulmonary fibrosis is the most severe toxicity reported. Risk increases in elderly persons and with doses >400 units.
The drug should be administered under the supervision of an experienced cancer chemotherapy physician.
Concomitant use of bleomycin with brentuximab because of pulmonary toxicity
Use cautioin in renal impairment
Hepatic toxicity reported
Use caution when administering oxygen during surgery (increases risk of pulmonary toxicity)
Risk of pulmonary fibrosis (at lower doses if used with other antineoplastics)
Pregnancy & Lactation
Pregnancy Category: D
Lactation: It is not known whether the drug is excreted in milk. Because of the potential for serious adverse reactions in nursing infants, it is recommended that nursing be discontinued by women receiving bleomycin therapy.
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Glycopeptide antibiotic; inhibits DNA, RNA, protein synthesis in G2, M phases
Half-Life: 2 hr
Protein Bound: 1%
Vd: 17 L/m²
Metabolites: Bleomycin-iron complex
Clearance: 35 mL/min
Excretion: Urine (50-70%)
Additive: aminophylline, ascorbic acid injection, cefazolin, diazepam, hydrocortisone sodium succinate, methotrexate, mitomycin, nafcillin, penicillin G sodium, terbutaline
Additive (partial list): diphenhydramine, fluorouracil, heparin, hydrocortisone Na-phosphate
Syringe (partial list): cisplatin, furosemide, heparin, methotrexate, metoclopramide, mitomycin
Y-site (partial list): allopurinol, cisplatin, etoposide PO4, gemcitabine, heparin, metoclopramide, mitomycin, ondansetron, paclitaxel
IV: reconstitute 15 U vial in 5 mL & 30 U vial in 10 mL NS to yield 3 U/mL solution
IM/SC: reconstitute 15 U vial in 1-5 mL & 30 U vial in 2-10 mL NS/SWI/BWI
Do not use dextrose-containing diluents
Although may be stable for longer periods, preferably use within 24 hr of reconstitution
IM/SC: may cause pain at injection site
IV: may be irritant; administer by slow inj over 10 min; pH: 4.5-6.0
Refrigerate intact vials of powder; stable under refrigeration (2-8°C)
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
|1||This drug is available at the lowest co-pay. Most commonly, these are generic drugs.|
|2||This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.|
|3||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.|
|4||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|5||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|6||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|NC||NOT COVERED – Drugs that are not covered by the plan.|
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.