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|Bleomycin Sulfate |
Drugs search, click the first letter of a drug name: | A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | 1 | 2 | 3 | 4 | 5 | 6 | 8 | 9 Home Bleomycin SulfatePronouncation: (BLEE-oh-MY-sin SULL-fate)Class: Antibiotic Trade Names: Mechanism of ActionPharmacologyBleomycin sulfate is a mixture of cytotoxic glycopeptide antibiotics. It inhibits DNA synthesis. When administered intrapleurally, bleomycin acts as a sclerosing agent. PharmacokineticsDistributionHigh concentrations are found in the skin and lungs; low concentrations are found in bone marrow. EliminationThe t ½ is about 115 min; 60% to 70% is excreted in urine as active bleomycin. Special PopulationsRenal Function ImpairmentIn those with Ccr less than 35 mL/min, the t ½ increases. Indications and UsageLymphomas (Hodgkin and non-Hodgkin); testicular carcinoma (eg, embryonal cell, choriocarcinoma, teratocarcinoma); sclerosis of malignant pleural effusions (eg, treatment, prevention); treatment of squamous cell carcinomas (eg, head, neck). Unlabeled UsesMycosis fungoides, osteosarcoma, AIDS-related Kaposi sarcoma. ContraindicationsStandard considerations. Dosage and AdministrationTest DoseAdults IV / IM / Subcutaneous 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. Hodgkin DiseaseAdults IV / IM / Subcutaneous 10 to 20 units/m 2 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. To minimize the risk of pulmonary toxicity, the max 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 EffusionsAdults Thoracostomy tube 60 units diluted with 50 to 100 mL sodium chloride 0.9% 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 h. The clamp is then removed and suction re-established. It is generally accepted that chest tube drainage should be below 100 mL in a 24-h 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. Squamous Cell Carcinoma, non-Hodgkin Lymphoma, Testicular CarcinomaAdults IV / IM / Subcutaneous 10 to 20 units/m 2 1 or 2 times/wk. Response is usually seen within 3 wk. Squamous cell cancers respond more slowly, sometimes requiring 3 wk for improvement and testicular tumors is noticed within 2 weeks. General Advice
Storage/StabilityStore powder for injection in refrigerator (36° to 46°F). Bleomycin is stable for 24 h at room temperature when reconstituted with sodium chloride 0.9% injection. Discard any unused solution. Do not save any unused solution for future use. Drug InteractionsDigoxin and phenytoinBleomycin may decrease serum concentrations of digoxin and phenytoin. Laboratory Test InteractionsNone well documented. Adverse ReactionsCardiovascularHypotension; cerebral arteritis, cerebrovascular accidents, MI, thrombotic microangiopathy, Raynaud phenomenon (with combination chemotherapy). CNSMalaise (postmarketing). DermatologicAlopecia, erythema, hyperkeratosis, hyperpigmentation, nail changes, pruritus, rash, skin tenderness, stomatitis, striae, vesiculation (approximately 50%); scleroderma-like skin changes (postmarketing). GIVomiting; anorexia. LocalPain; pain at tumor site; phlebitis. Metabolic-NutritionalWeight loss (common). PulmonaryPneumonitis, pulmonary fibrosis, dyspnea, rales. MiscellaneousIdiosyncratic reaction including chills, fever, hypotension, mental confusion, and wheezing (about 1% of lymphoma patients); chills; fever; acute chest pain. Precautions
PregnancyCategory D . LactationUndetermined. It is recommended that breast-feeding be discontinued by women receiving therapy. ChildrenSafety and efficacy not established. ElderlyPulmonary toxicity was more common in patients older than 70 years of age. HypersensitivityBecause of the risk of anaphylactoid-like reactions (ie, hypotension, mental confusion, fever, chills, and wheezing) in lymphoma patient, ensure that lymphoma patient receives no more than 2 units of bleomycin for the first 2 doses. Frequently monitor patient during and after therapy. Be prepared to treat reactions symptomatically. Regular dosing schedule can be followed if no acute reactions occur after either dose. Renal FunctionPatients with a Ccr of less than 35 mL/min should receive a reduced dose of bleomycin. Guidelines for dosage reduction are empiric. Renal toxicity has occurred infrequently. This toxicity may occur at any time. Hepatic FunctionHepatic toxicity has occurred infrequently. This toxicity may occur at any time. DeathDeath has been rarely reported in association with bleomycin pleurodesis in very seriously ill patients. ExtravasationLocal irritation or phlebitis may occur. Refer to your institution specific protocol. Skin toxicitySkin 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. Surgical interventionIf patient is to undergo surgical intervention, ensure that surgical team (including anesthesiologist) is aware of treatment with bleomycin and that FI O 2 should be maintained, if possible, at concentrations no greater than 25%. Fluid replacement should consist of colloids rather than crystalloids to reduce the risk of lung damage. Patient Information
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