Posted on April 28th, 2009 by
Generic Name: Bleomycin (blee-oh-MY-sin), bleomycin sulfate
Trade Name: Blenoxane®
For which conditions is this drug approved? Bleomycin is approved for treatment of the following cancers: squamous cell carcinoma of the head and neck (including mouth, tongue, tonsil, nasopharynx, oropharynx, sinus, palate, lip, buccal mucosa, gingivae, epiglottis, skin, larynx), penis, cervix, and vulva; Hodgkin’s disease, non-Hodgkin’s lymphoma; testicular carcinoma- embryonal cell, choriocarcinoma, and teratocarcinoma; and malignant pleural effusion. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Bleomycin belongs to a group of drugs referred to as antitumor antibiotics. Bleomycin is believed to produce its anticancer effects by binding to the DNA causing breaks in the strand of bases that make up DNA. This results in inhibition of the DNA production and cellular death.
How is bleomycin typically given (administered)? Bleomycin can be administered in several different ways. Bleomycin may be administered into a vein (intravenous), under the skin (subcutaneous), into a muscle (intramuscular), or into the pleura (lining between the lung and chest cavity) and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used and the overall health of the patient.
How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with bleomycin. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans, blood draws and other measures to assess side effects and response to therapy.
Rarely, patients will experience an allergic reaction to bleomycin, either immediately following administration or several hours following administration, so they will be closely monitored for symptoms including low blood pressure, fever, chills, difficulty breathing, wheezing, and mental confusion. Patients with lymphoma are at increased risk of developing a reaction.
In addition, other rare, but potentially serious side effects that patients will be monitored for include a heart attack or stroke, Raynaud’s phenomenon (a condition affecting the small blood vessels mainly of the fingers or toes), or lung problems. Patients experiencing chest pain, severe headache, vision changes, difficulty speaking, darkening of hands, feet or lips, or difficulty breathing should contact their healthcare provider immediately.
What are the common (occur in 30% or more of patients) side effects of treatment with bleomycin?
• Fever and chills
• Nail abnormalities: nail thickening, dark banding
• Hair loss
• Darkening or reddening of skin
• Peeling of skin
• Thickening of skin
• Ulceration of the skin
• Stretch marks
• Skin tenderness
• Skin itching
What are the less common (occur in 10% to 29% of patients) side effects of treatment with bleomycin?
• Loss of appetite
• Weight loss
• Lung problems – increased risk with increased age and increased doses of bleomycin
• Mouth sores
What are possible late side effects of treatment with bleomycin?
With the use of bleomycin, there is a risk of developing side effects months or years after treatment has been completed. In rare instances, a secondary malignancy may occur as a result of receiving bleomycin. A secondary malignancy is a new and unrelated cancer that occurs in an individual as a result of previous treatment with radiation or chemotherapy. Patients receiving bleomycin should discuss the risk of late occurring side effects with their physician.
This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.
Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.
What can patients do to help alleviate or prevent discomfort and side effects?
• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• Eat small meals frequently to help alleviate nausea.
Are there any special precautions patients should be aware of before starting chemotherapy?
• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Patients should rinse their mouth 3 times a day with a salt and soda solution (8 ounces of water mixed with ½ to 1 tsp of baking soda and/or ½ to 1 tsp of salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.
When should patients notify their physician?
• Difficulty breathing, cough, shortness of breath, any changes in respiratory status
• Mental confusion
• Mouth sores
• Persistent nausea, vomiting or loss of appetite
• Chest pain
• Visual changes
• Severe, sudden headache
• Difficulty speaking
• Darkening of fingers and toes, especially in the cold
• Skin ulcerations
• Persistent fever or chills
• Allergic reaction including swelling of the lips, mouth, or throat, rash, hives, itchy and/or watery eyes
What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. Click here to view the package insert
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