Parenteral Manual

Bleomycin

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
BLENOXANE, BLEO
Classification: 
Antineoplastic, antibiotic - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
June 2015
Indications: 
  • 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.

Reconstitution and Stability: 
  • 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)
  • Reconstituted vial is stable for 7 days at room temperature or in the fridge
  • Diluted in 50-100 mL of NS, stable for 2 weeks at room temperature or 4 weeks in the fridge
  • Stable in syringe for 24 hours
Compatibility: 

- 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

Administration: 

(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
Infusion time: 10 minutes or 1 unit/minute, which ever is greater

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
Dosage: 

(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).
Potential hazards of parenteral administration: 
  • 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, click HERE for treatment guidelines.

- Treatment for unusual side effects are available through the study chair identified on the front of the protocol and/or pharmacy

Notes: 
  • 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

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