- Hodgkin's disease
- Germ-cell tumors
THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.
- Refrigerate vials
- Reconstitute 15 unit vial with 5 mL of Sterile Water for Injection, shake well. Final concentration 3 units/mL (1 unit = 1 mg)
- Diluted solutions in syringe or minibags stable for 24 hours at room temperature
- Solutions Compatible: 0.9% NaCl
- Additives/Above Cassette Compatible: no information
- Y-site Compatible: no flush between with: cisplatin, cyclophosphamide, doxorubicin, droperidol, filgrastim, leucovorin, metoclopromide, methotrexate, paclitaxel
- Incompatible: aminophylline, ascorbic acid, cefazolin, D5W, diazepam, hydrocortisone sodium succinate, hyoscine, mitomycin, penicillin G sodium
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | YES, NOT RECOMMENDED increased incidence of permanent hyperpigmentation |
| IM | YES, NOT RECOMMENDED |
| IV Direct |
YES |
| IV Intermittent Infusion | YES Infusion time: 10 minutes or 1 unit/minute, which ever is greater |
| IV Continuous Infusion | YES |
| Intra-arterial | NO |
| Intra-cavitary | NO |
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
- Usually 10 units/m2 every 2 weeks
- 15 unit load, then 16 units/m2/day x 5 days as a continuous infusion Q 4 weeks (nasopharyngeal sarcoma protocol)
- Dosage may differ according to protocol
NOTE:
- 1 mg = 1 unit of activity
- Pulmonary toxicity seems to be dose-related. Cumulative lifetime dose should generally not exceed 400 units in adults and children > 12 yrs. In younger children < 200 units total or 250 units/m2
- Give test dose of 1 unit over 10-15 minutes before first dose of bleomycin
- Test dose does not have to be prepared separately, infusion can be run extremely slow for the first 10-15 minutes
- Dosage modification is recommended in patients with renal impairment or changes in pulmonary function tests of >20% (consult protocol for details).
- Anaphylaxis (1-8% in lymphoma patients)
- Fever, chills, hypotension (allergic reaction)
- Nausea, vomiting (uncommon, usually mild)
- Phlebitis
- Skin reaction (radiation recall reaction, rare)
- Rash, reversible hyperpigmentation, nail changes
- Mucositis
- Vasoconstriction of extremities (Raynaud's syndrome, rare)
- Pulmonary toxicity, dyspnea, tachypnea, non-productive cough, rale
- Non-vesicant
- Fever and chills occur with each treatment in up to 50% of patients; give hydrocortisone sodium succinate 50 -100 mg pre-treatment and acetaminophen Q 3-4 hours post-treatment to control fevers
- If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.
- Treatment for unusual side effects are available through the study chair identified on the front of the protocol and/or pharmacy
- Monitor vital signs q15 minutes x 4 then q30 minutes x 2
- Monitor renal and hepatic function
- Baseline pulmonary function tests (PFT's) should be done and repeated prior to each treatment course
- Anaphylaxis kit should be available at bedside
- Interstitial pneumonitis may occur in approximately 10% of patients; more commonly in patients over 70 years of age, patients with non-Hodgkin's lymphoma, renal failure, receiving over 400 units in total; may progress to fibrosis
- Administration of a high oxygen concentration (as in general anesthesia) may enhance pulmonary damage in patients who have been exposed to bleomycin
- Prior pulmonary irradiation also increases risk of permanent pulmonary toxicity