Drug Guide
Bleomycin Sulfate
Classification
Therapeutic: Antineoplastic agent (Chemotherapy)
Pharmacological: Antibiotic, Antitumor
FDA Approved Indications
- Treats Hodgkin's lymphoma, testicular cancer, ovarian cancer, and certain other cancers
Mechanism of Action
Bleomycin induces DNA strand breaks through free radical formation, leading to inhibition of DNA synthesis and cell death, especially in rapidly dividing cells.
Dosage and Administration
Adult: Dose varies based on condition; typically 10-20 units IV once weekly, adjusted for body surface area.
Pediatric: Dose based on body surface area; requires careful monitoring.
Geriatric: Use with caution; dose adjustments may be necessary due to increased risk of toxicity.
Renal Impairment: Adjust dose based on degree of impairment.
Hepatic Impairment: No specific adjustment; monitor closely.
Pharmacokinetics
Absorption: Not applicable (administered IV).
Distribution: Widely distributed, low cerebrospinal fluid penetration.
Metabolism: Minimal hepatic metabolism.
Excretion: Primarily renal excretion.
Half Life: Approximately 2-4 hours.
Contraindications
- Hypersensitivity to bleomycin
Precautions
- Pulmonary toxicity risk, especially with cumulative doses.
- Increased risk of severe lung toxicity in patients with prior pneumonitis or prior lung disease.
- Monitor pulmonary function closely.
Adverse Reactions - Common
- Skin reactions, hyperkeratosis (Common)
- Mild fever and chills after infusion (Common)
Adverse Reactions - Serious
- Pulmonary fibrosis, which can be fatal (Serious—incidence increasing with cumulative dose)
- Anaphylactic reactions (Rare)
Drug-Drug Interactions
- Other pulmonary toxic agents (e.g., radiation, other chemotherapy drugs) increase risk of lung toxicity.
Drug-Food Interactions
- None well established.
Drug-Herb Interactions
- None well established.
Nursing Implications
Assessment: Monitor pulmonary function, skin condition, and renal function.
Diagnoses:
- Risk for pulmonary toxicity
- Risk for skin breakdown
Implementation: Administer IV as prescribed, monitor for adverse reactions, educate patient about signs of toxicity.
Evaluation: Efficacy measured by tumor response; monitor for adverse effects.
Patient/Family Teaching
- Report any persistent cough, shortness of breath, or skin changes.
- Avoid unnecessary sun exposure.
- Maintain regular follow-up for pulmonary status.
Special Considerations
Black Box Warnings:
- Pulmonary toxicity, which can be severe and irreversible.
Genetic Factors: None specific.
Lab Test Interference: May alter pulmonary function tests.
Overdose Management
Signs/Symptoms: Severe pulmonary toxicity, skin reactions.
Treatment: Supportive care; no specific antidote available. Hemodialysis may remove some drug, but efficacy is uncertain.
Storage and Handling
Storage: Store at room temperature, protected from light.
Stability: Stable under standard conditions for the duration of shelf life.