Article Contents ::

Details About Generic Salt ::  Bleomyci

Main Medicine Class::    

(BLEE-oh-MY-sin SULL-fate)
Blenoxane
Sterile powder for reconstitution
15 unit vial (15 units = 15 mg) and 30 unit vial (30 units = 30 mg).
Class: Antitumor antibiotic

 Indications Lymphomas (Hodgkin and non-Hodgkin), testicular carcinoma (eg, embyronal cell, choriocarcinoma, teratocarcinoma), germ cell tumors; sclerosis of malginant pleural effusions (eg, treatment, prevention); palliative treatment of squamous cell carcinomas (eg, head, neck).

Mycosis fungoides, osteosarcoma, AIDS-related Kaposi sarcoma.

 Contraindications Standard considerations.

 Route/Dosage

Test Dose

ADULTS: IV, IM, or SC Because of the possibility of anaphylactoid reaction, treat lymphoma patents with 2 units or less for the first 2 doses. If no acute reaction occurs, follow the regular dosage schedule.

Squamous Cell Carcinoma, Lymphosarcoma, Reticular Cell Sarcoma, Testicular Carcinoma

ADULTS: IV, IM, SC 10 to 20 units/m2 1 or 2 times/wk. Response is usually seen within 3 wk.

Hodgkin Disease

ADULTS: IV, IM, SC 10 to 20 units/m2 1 or 2 times/wk. After a 50% regression of tumor size, a maintenance dose of 1 unit/day or 5 units/wk can be given IV or IM. Response is usually seen within 2 wk. Squamous cell cancers respond more slowly, sometimes requiring 3 wk for improvement. To minimize the risk of pulmonary toxicity, the maximum cumulative dose should not exceed 400 units. When bleomycin is used in combination with other antineoplastic agents, pulmonary toxicities may occur at lower doses.

Pleural Effusions

ADULTS: Thoracotomy tube 50 to 60 units diluted with 50 to 100 mL 0.9% Sodium Chloride or 5% Dextrose is instilled into chest via a thoracotomy tube following drainage of excess pleural fluid and confirmation of complete lung expansion. The amount of drainage from the chest tube should be as minimal as possible prior to installation of bleomycin. The thoracotomy tube is then clamped. The patient is moved from the supine to the left and right lateral positions several times during the next 4 hr. The clamp is then removed and suction reestablished. It is generally accepted that chest tube drainage should be below 100 mL in a 24-hr period prior to sclerosis. However, bleomycin instillation may be appropriate when drainage is between 100 and 300 mL under clinical conditions that necessitate sclerosis therapy.

Interactions

Digoxin and phenytoin

Bleomycin may decrease serum concentrations of digoxin and phenytoin.

Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: MI; cerebrovascular accident; thrombotic microangiopathy; cerebral arteritis (combination chemotherapy); Raynaud phenomenon. DERMATOLOGIC: Erythema; rash; striae; vesiculation; hyperpigmentation; skin tenderness; nail changes; alopecia. GI: Very low potential for nausea and vomiting; anorexia; mucositis. HYPERSENSITIVITY: Anaphylaxis (1% of lymphoma patients). RESPIRATORY: Pneumonitis; life-threatening pulmonary fibrosis. OTHER: Fever; chills.

 Precautions

Pregnancy: Category D. Lactation: It is recommended that breastfeeding be discontinued by women receiving therapy. Children: Safety and effacacy not established. Renal/Hepatic function impairment: Patients with a Ccr of less than 35 mL/min should receive a reduced dose of bleomycin. Guidelines for dosage reduction are empiric. Renal or hepatic toxicity has occurred infrequently. These toxicities may occur at any time. Extravasation: Local irritation or phlebitis may occur. Refer to your institution specific protocol. Respiratory adverse reactions: Pneumonitis; life-threatening pulmonary fibrosis. Pulmonary toxicities occur in 10% of treated patieints. In about 1%, the drug-induced nonspecific pneumonitis progresses to pulmonary fibrosis and death. Risk factors include the following: increased age, radiation to the lungs, oxygen therapy during or after bleomycin, recent cisplatin therapy, declining renal function. Toxicity may occur at cumulative doses less than 400 mg when risk factors are present, and it has occurred in young patients. Idiosyncratic reaction: A severe idiosyncratic reaction consisting of hypotension, mental confusion, fever, chills, and wheezing has occurred in about 1% of lymphoma patients. These reactions may be immediate or delayed for several hours and usually occur after the first or second dose; careful monitoring is essential. Skin toxicity: Skin toxicity, a relatively late manifestation, appears to be related to the cumulative dose. It usually develops in the second and third week of treatment after administration of 150 to 200 units of the drug.

PATIENT CARE CONSIDERATIONS


 Administration/Storage

  • Refrigerate sterile powder. It is stable at room temperature for 28 days, but this is not recommended for storage.
  • Solution is stable for 24 hr at room temperature in 0.9% Sodium Chloride.
  • Do not reconstitute or dilute with 5% Dextrose or other dextrose-containing solutions for injection.
  • Pleural fluid removed after sclerotherapy with bleomycin is both potentially infectious and hazardous chemical waste; dispose of properly.

IM, SC

  • Dissolve with Sterile Water, 0.9% Sodium Chloride, or Bacteriostatic Water for Injection, for a final concentration of 3 to 15 units/mL.

Intrapleural

  • Dissolve 60 units of bleomycin in 50 to 100 mL of 0.9% Sodium Chloride for injection.

IV

  • Dilute with 5 mL or more of 0.9% Sodium Chloride (max concentration, 3 units/mL).
  • Slowly give IV injections over a 10-min period.

Intralesional wart therapy

  • Bleomycin reconstituted with 0.9% Sodium Chloride to a concentration of 3 units/mL and protected from light is stable in the refrigerator for 35 days in polyvinyl chloride (PVC) containers and 140 days in polyolefin containers.

Pretreatment regimen

  • Premedication with acetaminophen or diphenhydramine may limit fever.

Test dose

  • Lymphoma patients should receive a test dose of bleomycin less than 2 units for the first 2 doses with anaphylaxis therapy. Test dose may be given IM, SC, or IV. Monitor vital signs before and for 30 min after giving test dose. If no acute reaction occurs, the regular dosage schedule may be followed.

 Assessment/Interventions

  • Bleomycin may increase the risk of pulmonary toxicity caused by oxygen administration during surgery. The FiO2 should not exceed 25% during and after surgery. Colloids may be preferred over crystalloid for fluid replacement.
  • The earliest symptom of pulmonary toxicity is dyspnea; the earliest sign is fine rales.
  • Radiographically, the pneumonitis produces nonspecific patchy opacities, usually of the lower lung field. Pulmonary function tests show a decrease in total lung volume and vital capacity.
  • Take chest x-rays q 1 to 2 wk to monitor the onset of pulmonary toxicity. If changes are noted, discontinue treatment until it is determined if they are drug-related. Monitor the DLco monthly; discontinue the drug when the DLco falls less than 30% to 35% of the pretreatment value. Patients are at greater risk of developing pulmonary toxicity when oxygen is given in surgery. After bleomycin administration, lung damage can occur at concentrations usually considered safe. Suggested preventive measures are to maintain FlO2 at concentrations approximating that of room air (25%) during surgery and the postoperative period and to carefully monitor fluid replacement, focusing more on colloid administration rather than crystalloid.
  • Frequent roentgenograms are recommended.

 Patient/Family Education

  • Explain name, dose, action, and potential side effects of drug.
  • Advise patient, family, or caregiver that medication will be prepared and administered by health care provider in a health care setting.
  • Advise patient, family, or caregiver that medication may be used in combination with other agents to achieve maximum benefit possible.
  • Review dosing schedule with patient, family, or caregiver.
  • Advise patient, family, or caregiver that skin tests may be used prior to administration of medication.
  • Advise patient, family, or caregiver to immediately report any of the following to the health care provider: rash; hives; difficulty breathing; fever; chills.
  • Advise patient, family, or caregiver to report any of the following to the health care provider: skin changes; nail changes; sores in mouth; persistent nausea, vomiting or appetite loss.
  • Instruct patient not to take any prescription or otc medications or dietary supplements unless advised by the health care provider.
  • Instruct female patient of childbearing potential to notify health care provider if becoming pregnant, planning on becoming pregnant, or are breastfeeding.
  • Advise patient that frequent follow-up visits, laboratory tests, and x-rays will be required to monitor therapy, and to be sure to keep appointments.

Medicscientist Drug Facts

 

Drugs Class ::

(BLEE-oh-MY-sin SULL-fate)
Blenoxane
Sterile powder for reconstitution
15 unit vial (15 units = 15 mg) and 30 unit vial (30 units = 30 mg).
Class: Antitumor antibiotic

Indications for Drugs ::

 Indications Lymphomas (Hodgkin and non-Hodgkin), testicular carcinoma (eg, embyronal cell, choriocarcinoma, teratocarcinoma), germ cell tumors; sclerosis of malginant pleural effusions (eg, treatment, prevention); palliative treatment of squamous cell carcinomas (eg, head, neck).

Mycosis fungoides, osteosarcoma, AIDS-related Kaposi sarcoma.

Drug Dose ::

 Route/Dosage

Test Dose

ADULTS: IV, IM, or SC Because of the possibility of anaphylactoid reaction, treat lymphoma patents with 2 units or less for the first 2 doses. If no acute reaction occurs, follow the regular dosage schedule.

Squamous Cell Carcinoma, Lymphosarcoma, Reticular Cell Sarcoma, Testicular Carcinoma

ADULTS: IV, IM, SC 10 to 20 units/m2 1 or 2 times/wk. Response is usually seen within 3 wk.

Hodgkin Disease

ADULTS: IV, IM, SC 10 to 20 units/m2 1 or 2 times/wk. After a 50% regression of tumor size, a maintenance dose of 1 unit/day or 5 units/wk can be given IV or IM. Response is usually seen within 2 wk. Squamous cell cancers respond more slowly, sometimes requiring 3 wk for improvement. To minimize the risk of pulmonary toxicity, the maximum cumulative dose should not exceed 400 units. When bleomycin is used in combination with other antineoplastic agents, pulmonary toxicities may occur at lower doses.

Pleural Effusions

ADULTS: Thoracotomy tube 50 to 60 units diluted with 50 to 100 mL 0.9% Sodium Chloride or 5% Dextrose is instilled into chest via a thoracotomy tube following drainage of excess pleural fluid and confirmation of complete lung expansion. The amount of drainage from the chest tube should be as minimal as possible prior to installation of bleomycin. The thoracotomy tube is then clamped. The patient is moved from the supine to the left and right lateral positions several times during the next 4 hr. The clamp is then removed and suction reestablished. It is generally accepted that chest tube drainage should be below 100 mL in a 24-hr period prior to sclerosis. However, bleomycin instillation may be appropriate when drainage is between 100 and 300 mL under clinical conditions that necessitate sclerosis therapy.

Contraindication ::

 Contraindications Standard considerations.

Drug Precautions ::

 Precautions

Pregnancy: Category D. Lactation: It is recommended that breastfeeding be discontinued by women receiving therapy. Children: Safety and effacacy not established. Renal/Hepatic function impairment: Patients with a Ccr of less than 35 mL/min should receive a reduced dose of bleomycin. Guidelines for dosage reduction are empiric. Renal or hepatic toxicity has occurred infrequently. These toxicities may occur at any time. Extravasation: Local irritation or phlebitis may occur. Refer to your institution specific protocol. Respiratory adverse reactions: Pneumonitis; life-threatening pulmonary fibrosis. Pulmonary toxicities occur in 10% of treated patieints. In about 1%, the drug-induced nonspecific pneumonitis progresses to pulmonary fibrosis and death. Risk factors include the following: increased age, radiation to the lungs, oxygen therapy during or after bleomycin, recent cisplatin therapy, declining renal function. Toxicity may occur at cumulative doses less than 400 mg when risk factors are present, and it has occurred in young patients. Idiosyncratic reaction: A severe idiosyncratic reaction consisting of hypotension, mental confusion, fever, chills, and wheezing has occurred in about 1% of lymphoma patients. These reactions may be immediate or delayed for several hours and usually occur after the first or second dose; careful monitoring is essential. Skin toxicity: Skin toxicity, a relatively late manifestation, appears to be related to the cumulative dose. It usually develops in the second and third week of treatment after administration of 150 to 200 units of the drug.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CARDIOVASCULAR: MI; cerebrovascular accident; thrombotic microangiopathy; cerebral arteritis (combination chemotherapy); Raynaud phenomenon. DERMATOLOGIC: Erythema; rash; striae; vesiculation; hyperpigmentation; skin tenderness; nail changes; alopecia. GI: Very low potential for nausea and vomiting; anorexia; mucositis. HYPERSENSITIVITY: Anaphylaxis (1% of lymphoma patients). RESPIRATORY: Pneumonitis; life-threatening pulmonary fibrosis. OTHER: Fever; chills.

Drug Mode of Action ::  

(BLEE-oh-MY-sin SULL-fate)
Blenoxane
Sterile powder for reconstitution
15 unit vial (15 units = 15 mg) and 30 unit vial (30 units = 30 mg).
Class: Antitumor antibiotic

Drug Interactions ::

Interactions

Digoxin and phenytoin

Bleomycin may decrease serum concentrations of digoxin and phenytoin.

Drug Assesment ::

 Assessment/Interventions

  • Bleomycin may increase the risk of pulmonary toxicity caused by oxygen administration during surgery. The FiO2 should not exceed 25% during and after surgery. Colloids may be preferred over crystalloid for fluid replacement.
  • The earliest symptom of pulmonary toxicity is dyspnea; the earliest sign is fine rales.
  • Radiographically, the pneumonitis produces nonspecific patchy opacities, usually of the lower lung field. Pulmonary function tests show a decrease in total lung volume and vital capacity.
  • Take chest x-rays q 1 to 2 wk to monitor the onset of pulmonary toxicity. If changes are noted, discontinue treatment until it is determined if they are drug-related. Monitor the DLco monthly; discontinue the drug when the DLco falls less than 30% to 35% of the pretreatment value. Patients are at greater risk of developing pulmonary toxicity when oxygen is given in surgery. After bleomycin administration, lung damage can occur at concentrations usually considered safe. Suggested preventive measures are to maintain FlO2 at concentrations approximating that of room air (25%) during surgery and the postoperative period and to carefully monitor fluid replacement, focusing more on colloid administration rather than crystalloid.
  • Frequent roentgenograms are recommended.

Drug Storage/Management ::

 Administration/Storage

  • Refrigerate sterile powder. It is stable at room temperature for 28 days, but this is not recommended for storage.
  • Solution is stable for 24 hr at room temperature in 0.9% Sodium Chloride.
  • Do not reconstitute or dilute with 5% Dextrose or other dextrose-containing solutions for injection.
  • Pleural fluid removed after sclerotherapy with bleomycin is both potentially infectious and hazardous chemical waste; dispose of properly.

IM, SC

  • Dissolve with Sterile Water, 0.9% Sodium Chloride, or Bacteriostatic Water for Injection, for a final concentration of 3 to 15 units/mL.

Intrapleural

  • Dissolve 60 units of bleomycin in 50 to 100 mL of 0.9% Sodium Chloride for injection.

IV

  • Dilute with 5 mL or more of 0.9% Sodium Chloride (max concentration, 3 units/mL).
  • Slowly give IV injections over a 10-min period.

Intralesional wart therapy

  • Bleomycin reconstituted with 0.9% Sodium Chloride to a concentration of 3 units/mL and protected from light is stable in the refrigerator for 35 days in polyvinyl chloride (PVC) containers and 140 days in polyolefin containers.

Pretreatment regimen

  • Premedication with acetaminophen or diphenhydramine may limit fever.

Test dose

  • Lymphoma patients should receive a test dose of bleomycin less than 2 units for the first 2 doses with anaphylaxis therapy. Test dose may be given IM, SC, or IV. Monitor vital signs before and for 30 min after giving test dose. If no acute reaction occurs, the regular dosage schedule may be followed.

Drug Notes ::

 Patient/Family Education

  • Explain name, dose, action, and potential side effects of drug.
  • Advise patient, family, or caregiver that medication will be prepared and administered by health care provider in a health care setting.
  • Advise patient, family, or caregiver that medication may be used in combination with other agents to achieve maximum benefit possible.
  • Review dosing schedule with patient, family, or caregiver.
  • Advise patient, family, or caregiver that skin tests may be used prior to administration of medication.
  • Advise patient, family, or caregiver to immediately report any of the following to the health care provider: rash; hives; difficulty breathing; fever; chills.
  • Advise patient, family, or caregiver to report any of the following to the health care provider: skin changes; nail changes; sores in mouth; persistent nausea, vomiting or appetite loss.
  • Instruct patient not to take any prescription or otc medications or dietary supplements unless advised by the health care provider.
  • Instruct female patient of childbearing potential to notify health care provider if becoming pregnant, planning on becoming pregnant, or are breastfeeding.
  • Advise patient that frequent follow-up visits, laboratory tests, and x-rays will be required to monitor therapy, and to be sure to keep appointments.

Medicscientist Drug Facts

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