Bleo 15k

Name: Bleo 15k

What should I discuss with my healthcare provider before receiving Bleo 15k (bleomycin)?

You should not receive bleomycin if you have ever had an allergic reaction to it.

To make sure bleomycin is safe for you, tell your doctor if you have:

  • lung disease or a breathing disorder;

  • kidney disease; or

  • liver disease.

Do not use bleomycin if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment.

It is not known whether bleomycin passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are being treated with bleomycin.

What should I avoid while receiving Bleo 15k (bleomycin)?

This medicine can pass into body fluids (urine, feces, vomit). For at least 48 hours after you receive a dose, avoid allowing your body fluids to come into contact with your hands or other surfaces. Caregivers should wear rubber gloves while cleaning up a patient's body fluids, handling contaminated trash or laundry or changing diapers. Wash hands before and after removing gloves. Wash soiled clothing and linens separately from other laundry.

What other drugs will affect Bleo 15k (bleomycin)?

Other drugs may interact with bleomycin, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Usual Adult Dose for Hodgkin's Disease

Because of the possibility of an anaphylactic reaction, the manufacturer recommends that lymphoma patients be treated with two units or less for the first two doses. However, there is at least one known case of fatal hyperpyrexia in a patient without lymphoma following an initial dose of 7.5 units. Test doses are controversial in non-lymphoma patients.

Following a 1 unit test dose, the patient should be observed for a reaction for one to two hours if the dose is administered intravenously or two to four hours if the dose is administered intramuscularly. If no acute reaction occurs, then the regular dosage schedule may be followed.

0.25 to 0.50 units/kg (10 to 20 units/m2) intravenously, intramuscularly, or subcutaneously weekly or twice weekly.

After a 50% response, a maintenance dose of 1 unit daily or 5 units weekly intravenously or intramuscularly should be given.

Improvement in Hodgkin's Disease is prompt and noted within 2 weeks. If no improvement is seen at this time, improvement is unlikely.

Usual Adult Dose for Malignant Pleural Effusion

60 units administered as a single bolus intrapleural injection.

Renal Dose Adjustments

The manufacturer recommends the following dose adjustments in patients with renal impairment:

For creatinine clearance of 50 ml/minute or greater: No dose adjustment is required.
For creatinine clearance of 40 to 50 mL/minute: Administer 70% of normal dose.
For creatinine clearance of 30 to 40 mL/minute: Administer 60% of normal dose.
For creatinine clearance of 20 to 30 mL/minute: Administer 55% of normal dose.
For creatinine clearance of 10 to 20 mL/minute: Administer 45% of normal dose.
For creatinine clearance of 5 to 10 mL/minute: Administer 40% of normal dose.

Dialysis

Data not available.

Other Comments

A unit of bleomycin is equal to the formerly used milligram activity. The term milligram activity is a misnomer and was changed to units to be more precise.

Dosages of bleomycin may depend upon the specific indication for its use, and whether other cytotoxic agents are coadministered. Reference to specific protocols is recommended

Patients must be observed carefully and frequently during and after therapy. Bleomycin should be used with extreme caution in patients with compromised pulmonary function. Pulmonary toxicity appears to be dose related with a substantial increase when the total dose is over 400 units. (One study recommends calculating total systemic exposure as the sum of the IV dosages and one-half of intercavitary doses.) Total doses over 400 units should be given with great caution. When bleomycin is used in combination with other antineoplastic agents, pulmonary toxicities may occur at lower doses. To monitor for the onset of pulmonary toxicity, roentgenograms of the chest should be taken every 1 to 2 weeks. If pulmonary changes are noted, treatment should be discontinued until it can be determined if they are drug related. Recent studies have suggested that sequential measurement of the pulmonary diffusion capacity for carbon monoxide (DLco) during treatment may be an indicator of subclinical pulmonary activity. DLco should be monitored monthly if it is to be employed to detect pulmonary toxicities. The drug should be discontinued when the DLco falls below 30% to 35% of the pretreatment value.

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