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More Specific Terms
Introduction
Indications
-
-
Dosage
- test dose of 1-2 units in 50 mL IV over 15 minutes
- 10-20 units/m2* weekly or every other week IV/IM/SC
- continuous infusion 15-20 units/m2*/day for 4-5 days
- stable for 24 hours reconstituted at room temperature
- stable for 24-48 hours reconstituted & refrigerated
- stability decreases iin PVC bags
- incompatible with amino acid solutions, ascorbic acid, cefazolin, furosemide, diazepam, hydrocortisone, mitomycin, nafcillin, penicillin G, aminophylline
- prepare solution in glass bottles, not plastic bags
<br>
* creatinine (mg/dL) % of usual dosage
* 2.5-4 25
* 4-6 20
* 6-10 10 <.)
== Pharmacokinetics ==
:* 50-70% of the drug is eliminated into the urine unchanged
:* [[Metabolism | metabolized]] drug is degraded by [[Cellular | cellular]] [[Enzyme | enzymes]] <br>
* elimination via [[Kidney | kidney]]
* [[Halflife | 1/2life]] = 3-6 hours
== Adverse-effects ==
* common (> 10%)
:* [[Systemic | systemic]]:
::* mild [[Fever | febrile]] reactions, [[Chills | chills]], [[Nausea/vomiting | nausea/vomiting]] (mild), [[Stomatitis | stomatitis]], [[Anorexia | anorexia]]
:* skin, [[Mucous_Membrane | mucous membranes]] & [[Skin_Appendage | skin appendages]]
::* [[Erythema | erythema]], [[Induration | induration]], [[Hyperkeratosis | hyperkeratosis]], peeling of skin, [[Hyperpigmentation | hyperpigmentation]], alopecia#, [[Nail_Bed | nailbed]] changes
* less common (1-10%)
:* [[Weight_Loss | weight loss]], [[Anaphylactoid_Reaction | anaphylactoid reactions]] in 1% of patients with [[Lymphoma | lymphoma]]
* uncommon (< 1%)
:* [[Myocardial_Infarction | myocardial infarction]], [[Nephrotoxicity | renal toxicity]], [[Stroke | stroke]], [[Hepatotoxicity | hepatotoxicity]], skin thickening, [[Dyspnea | dyspnea]], [[Tachypnea | tachypnea]], non-productive [[Cough | cough]], [[Rales | rales]]
* other
:* [[Pulmonary_Fibrosis | pulmonary fibrosis]] with cumulative dose > 150 units/m2*, > 400 units or < 30 units/single dose
::* resolves in most cases, but may be fatal
::* [[Health_Risk_Factor | risk factors]]:
:::* advanced age, [[Tobacco | tobacco]], [[Renal_Insufficiency | renal insufficiency]], mediatinal [[Electromagnetic_Radiation | radiation]], [[O2 | oxygen]]
::* management:
:::* discontinue [[Bleomycin | bleomycin]] treatment
:::* treatment with [[Steroid | steroids]] is controversial
:* mild [[Myelosuppression | myelosuppression]] (rare)
::* onset 7 days
::* [[Nadir | nadir]] 14 days
::* recovery 21 days
:* pain at tumor site
:* [[Raynaud's_Phenomenon | Raynaud's phenomenon]]
:* [[Phlebitis | phlebitis]]
* # [[Alopecia | alopecia]] should resolve after discontinuation of drug
* * meter squared [[Body_Surface_Area | body surface area]]
== Drug-interactions ==
:* [[Radiation_Therapy | radiation therapy]] may increase [[Pulmonary | pulmonary]] toxicity of bleomycin
:* [[Vinblastine | vinblastine]] in combination may cause [[Raynaud's_Phenomenon | Raynaud's syndrome]]
:* [[Cisplatin | cisplatin]]
:* [[Digoxin | digoxin]]
:* [[Phenytoin | phenytoin]]
:* [[Vincristine | vincristine]] <br>
:* [[Drug_Interaction_Antibiotic_Warfarin | drug interaction(s) of antibiotics with warfarin]]
== Test-interactions ==
:* increases [[Potassium_In_Serum | serum K+]]
== Mechanism-of-action ==
:* A group of related [[Glycopeptide | glycopeptide]] [[Antibiotic | antibiotics]] isolated from [[Streptomyces]] verticillus. Bleomycin A2 is main component of bleomycin employed clinically. It is believed to react with DNA & cause single & [[Double_Strand_Dna | double strand DNA]] scission. Bleomycin has also been shown to have a type of [[O2 | oxygen]] [[Transferase | transferase]] activity. Most of the [[Cytotoxicity | cytotoxic]] effects of bleomycin are seen in the [[G2_Phase | G2 phase]] of the [[Cell_Cycle | cell cycle]]. Mechanism of [[Drug_Resistance | drug resistance]]:
:* increased drug inactivation via activation of bleomycin hydrolase
== More General Terms ==
* [[Antibacterial_Glycopeptide | antibacterial glycopeptide]]
* [[Antineoplastic_Agent | antineoplastic agent (chemotherapeutic agent)]]
* [[Sclerosing_Agent | sclerosing agent]]
== Additional Terms ==
* [[Bleomycin_Hydrolase | bleomycin hydrolase; BLM hydrolase (BMH, BH, BLMH)]]
== Internet Database==
PubChem: [http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=456190 456190] <br />PubChem: [http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=25451 25451] <br />PubChem: [http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=2410 2410] <br />PubChem: [http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=72466 72466]
== References ==
#Merck Index 10th ed. 1983
#Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
#Kaiser Permanente Northern California Regional Drug Formulary, 1998
#Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 533
#Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
<span id="long_desc" style="display: none">bleomycin (Blenoxane)</span>
