Indications
Bleocip Injection is used for:
Lymphoma, Squamous cell or Testicular tumours, Malignant effusions
Adult Dose
Squamous Cell Carcinoma, Testicular Carcinoma
0.25-0.5 unit/kg (10 to 20 unit/m²) IV/IM/SC q1-2Weeks
Hodgkin's Disease, Non-Hodgkin's Lymphoma
Administer test dose of 1-2 units of bleomycin before first 1-2 doses; monitor vital signs q15min; wait 1 hour minimum before administering remainder of dose; if no acute reaction observe, may administer regular dosage schedule
0.25 to 0.5 unit/kg (10 to 20 unit/m²) IV/IM/SC q1-2Weeks; reduce to maintenance dose of 1 unit qDay or 5 unit qWeek IV/IM after 50% response
Hepatic Impairment: Dose adjustment not necessary
Child Dose
Not recommended
Renal Dose
Renal Impairment
CrCl >50 mL/min: Dose adjustment not necessary
CrCl 40-50 mL/min: 70% of normal dose
CrCl 30-40 mL/min: 60% of normal dose
CrCl 20-30 mL/min: 55% normal dose
CrCl 10-20 mL/min: 45% normal dose
CrCl 5-10 mL/min: 40% normal dose
Administration
IV/IM Preparation
IV: reconstitute 15 U vial in 5 mL & 30 U vial in 10 mL NS to yield 3 U/mL solution
IM/SC: reconstitute 15 U vial in 1-5 mL & 30 U vial in 2-10 mL NS/SWI/BWI
Do not use dextrose-containing diluents
Although may be stable for longer periods, preferably use within 24 hr of reconstitution
In lymphoma patients, give first 2 doses at 1-2 units to test for anaphylactoid reaction
Limit lifetime dose to <400 units because of risk of pulmonary fibrosis
Low ADRs w/intrapleural administration
Contra Indications
Hypersensitivity. Severe pulmonary disease; pregnancy and lactation.
Precautions
Pulmonary infection, preexisting pulmonary function impairment, renal impairment. Patients who received radiotherapy, particularly to the thorax. Regular chest x-rays should be done. Elderly. Discontinue treatment if chest x-rays show infiltrates or breathlessness occurs.
Lactation: It is not known whether the drug is excreted in milk. Because of the potential for serious adverse reactions in nursing infants, it is recommended that nursing be discontinued by women receiving bleomycin therapy.
Pregnancy-Lactation
Interactions
Increased incidence and severity of lung toxicity w/ previous or concurrent radiotherapy to the chest. Combination w/ vinca alkaloids may result to a syndrome corresponding to morbus Raynaud, ischaemia which can lead to necrosis of peripheral parts of the body (fingers, toes, nose tip). May reduce the absorption of phenytoin. Increased risk of agranulocytosis w/ clozapine.
Potentially Fatal: Increased pulmonary toxicity w/ oxygen, cisplatin or brentuximab.
Adverse Effects
Side effects of Bleomycin :
>10%
Mucocutaneous toxicity including rash, erythema, hyperpigmentation, urticaria (>50%),Febrile reactions, acute (25-50%),Mucositis (30%),Stomatitis (30%),Interstitial pneumonitis (10%),Pulmonary fibrosis (10%),Anorexia,Weight loss,Rales,Tachypnea
1-10%
Alopecia (1-10%),Fatal pulmonary fibrosis (1%),Confusion,Shivering,Anphylactoid rxns,Onycholysis,Pruritus,Skin thickening,Skleroderma
<1%
Nausea,Malaise,Myocardial infarction,Hypotension,Cerebral vascular accident,Raynaud's phenomenon,Fatal pulmonary fibrosis,Hepatotoxicity,Renal toxicity,Necrolysis,Hyperpigmentation
Potentially Fatal: Pulmonary toxicity, interstitial pneumonitis, fibrosis, cardiorespiratory collapse in patients with lymphoma.
Mechanism of Action
Bleomycin causes breakage of single- and double- stranded DNA by binding to DNA and inhibiting DNA synthesis. To a lesser extent, it also inhibits RNA and protein synthesis. It causes very little bone marrow suppression.
Note
Bleocip Injection manufactured by Cipla Ltd.. Its generic name is Bleomycin. Bleocip is availble in Nepal.
Farmaco Nepal drug index information on Bleocip Injection is not intended for diagnosis, medical advice or treatment; neither intended to be a substitute for the exercise of professional judgment.