Bleomycin

Registered South African indications:

• Testicular cancer
• Hodgkin's lymphoma
• Non-Hodgkin's lymphoma
• Squamous cell carcinoma of the mouth, nasopharynx, paranasal sinuses, larynx, oesophagus, external genitalia, cervix or skin

Contraindication 

• Hypersensitivity to the active ingredient or any of its excipients 
• Pregnancy
• Prior idiosyncratic reaction to an analogue of bleomycin
• Acute pulmonary infection
• X-ray findings suggesting diffuse fibrotic changes or greatly reduced lung function 

Cautions 

• Breastfeeding
• Renal impairment
• Hepatic impairment
• Elderly
• Pre-existing lung disease 
• Previous or concurrent radiotherapy to the chest 
• Oxygen administration 
• Severe cardiac disease 
• Varicella 
• Prolonged use
• Infection
• Bleeding tendency 
• Rapid administration
• Repeat intramuscular injection at the same site

Forms avail. in SA and covered in this monograph: inj

Used for the treatment of

• Squamous cell carcinoma
• Testicular teratoma
• Lymphoma
• Malignant pleural effusions

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Consult specialist for dosages and regimens

Paed. forms avail. in SA and covered in this monograph: inj

Used for the treatment of

• Hodgkin's lymphoma
• Germ cell tumours

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Consult specialist for dosages and regimens

Pregnancy 

• FDA Pregnancy Category D 

Breastfeeding 

• Caution; not recommended 

Renal Impairment 

• Caution; dose adjustment recommended

Hepatic Impairment 

• Caution; no dose adjustment recommended

Elderly 

• Caution; dose adjustment recommended

Central Nervous System Disorders

• Headache
• Dizziness

Cardiovascular Disorders

• Haemorrhage 
• Shock
• Vein wall hypertrophy
• Venous stenosis
• Hypotension 
• Cardiorespiratory collapse
• Chest pain
• Myocardial infarction 
• Raynaud's syndrome
• Embolism
• Thrombosis
• Digital ischaemia 
• Cerebral infarction
• Malaise

Respiratory Disorders

• Interstitial pneumonia
• Pulmonary fibrosis

Gastrointestinal Disorders

• Decreased weight 
• Nausea and vomiting
• Stomatitis
• Angular stomatitis
• Diarrhoea

Hepatobiliary Disorders

• Hepatocellular injury

Genitourinary Disorders

• Oliguria
• Dysuria
• Pollakiuria
• Urinary retention
• Polyuria
• Feeling of residual urine

Endocrine and Metabolic Disorders

• Anorexia

Musculoskeletal Disorders

• Scleroderma

Skin and Subcutaneous Tissue Disorders

• Alopecia
• Skin hypertrophy
• Pigmentation
• Deformation and discolouration of the nail
• Scratch dermatitis 
• Rash
• Urticaria
• Erythroderma
• Lesions of oral mucosa 
• Ridging of the nails 
• Bulla formation over pressure points such as elbows
• Injection site induration
• Reddening, tenderness and swelling of the tips of the fingers

Immune, Blood and Lymphatic System Disorders

• Leukopenia
• Sepsis
• Pancytopenia
• Thrombocytopenia
• Anaemia
• Neutropenia

Others

• Pain at the site of tumour 
• Fever

• Cisplatin
• Vinca alkaloids
• Phenytoin
• Clozapine

• Lung function test
• Chest X-rays
• Renal function
• Hepatic function

Bleomycin is a basic, water-soluble glycopeptide with cytotoxic activity. Its mechanism of action is believed to involve single-strand breaks in DNA, leading to inhibition of cell division, of growth and of DNA synthesis in tumour cells. Apart from its antibacterial and antitumour properties, it is relatively free from biological activity. When injected intravenously it may have a histamine-like effect on blood pressure and may cause a rise in body temperature.

Injection (per vial) 15 iu

• Blenamax (Pharmachemie)
• Bleolem (Teva)