Blenoxane: Black Box Warnings

Blenoxane: Adult Dosing

Dosage forms: IM; IV; SC; intrapleural

chemotherapy

uses, dosing may vary

Info: for all uses, refer to institution protocols and pkg insert prior to prescribing; see pkg insert for toxicity-related dose adjustments

pleural effusion, malignant

60 units intrapleurally x1

Info: for effusion tx and recurrence prevention

Hodgkin's lymphoma

10-20 units/m^2 IV/IM/SC 1-2x/wk

Start: <2 units IV/IM/SC x2 test doses; Max: 400 units total dose; Alt: 0.25-0.5 units/kg IV/IM/SC 1-2x/wk; Info: after 50% response give maint. dose 1 unit IV/IM qd or 5 units IV/IM qwk

non-Hodgkin's lymphoma

10-20 units/m^2 IV/IM/SC 1-2x/wk

Start: <2 units IV/IM/SC x2 test doses; Max: 400 units total dose; Alt: 0.25-0.5 units/kg IV/IM/SC 1-2x/wk

squamous cell CA

10-20 units/m^2 IV/IM/SC 1-2x/wk

Max: 400 units total dose; Alt: 0.25-0.5 units/kg IV/IM/SC 1-2x/wk; Info: for head/neck, penis, cervix, or vulvar CA

testicular CA

10-20 units/m^2 IV/IM/SC 1-2x/wk

Max: 400 units total dose; Alt: 0.25-0.5 units/kg IV/IM/SC 1-2x/wk; Info: for embryonal cell, choriocarcinoma, or teratocarcinoma

renal dosing

adjust dose amount

CrCl 40-50: decr. dose 30%; CrCl 30-40: decr. dose 40%; CrCl 20-30: decr. dose 45%; CrCl 10-20: decr. dose 55%; CrCl 5-10: decr. dose 60%; HD: no supplement

hepatic dosing

not defined

Blenoxane: Peds Dosing

This information is currently unavailable or not applicable for this drug.

Blenoxane: Contraindications/Cautions

• hypersens. to drug/class/compon.
• prior idiosyncratic rxn to bleomycin
• avoid pregnancy
• caution if CrCl <50
• caution if impaired pulm. fxn
• caution in elderly pts
• caution if oxygen use in surgery

Blenoxane: Drug Interactions

Contraindicated

• anthrax vaccine

• smallpox vaccine (live vaccinia virus)

• vaccines, live

Monitor/Modify Tx

• acyclovir

• adefovir

• aminoglycosides, oral

• aminoglycosides, parenteral

• amphotericins

• carboplatin

• cidofovir

• cisplatin

• cyclosporine

• efavirenz/emtricitabine/tenofovir

• emtricitabine/tenofovir

• flucytosine

• foscarnet

• gallium nitrate

• ganciclovir

• mitomycin

• oxaliplatin

• pemetrexed

• penicillamine

• pentamidine

• sirolimus

• sodium phosphate

• tacrolimus

• tenofovir

• vancomycin

• zoledronic acid

Caution Advised

• colony-stimulating factors

• vaccines/toxoids

• vinca alkaloids

Blenoxane: Adverse Reactions

Serious Reactions

• pneumonitis
• pulmonary fibrosis
• hypotension
• mental confusion
• fever
• chills
• wheezing
• Raynaud's phenomenon
• MI (rare)
• CVA (rare)
• thrombotic microangiopathy (rare)
• cerebral arteritis (rare)
• death (rare, intrapleural use)

Common Reactions

• erythema
• rash
• striae
• vesiculation
• hyperpigmentation
• skin tenderness
• hyperkeratosis
• nail changes
• alopecia
• pruritus
• stomatitis
• scleroderma-like skin changes
• pneumonitis
• fever
• chills
• vomiting
• anorexia
• weight loss
• malaise
• pain, local (intrapleural use)
• pain, tumor site
• phlebitis

Blenoxane: Safety Monitoring

Pregnancy: D

Lactation: Possibly Unsafe

Monitoring Parameters: BUN/Cr if elderly or CrCl <50; chest x-ray q1-2wk; pulm. diffusion capacity for CO qmo; monitor lymphoma pts after 1st and 2nd doses for idiosyncratic rxn

Blenoxane: Pharmacology

Metabolism: hydrolysis; CYP450: unknown

Excretion: urine 65% (40% w/ intrapleural dose); Half-life: 2h

Class: Antibiotic Oncologics

Mechanism Of Action
exact mechanism of action unknown; inhibits DNA synthesis, lesser inhibition of RNA and protein synthesis; sclerosing agent when used intrapleurally

Blenoxane: Manufacturer/Pricing

Manufacturer: Bristol-Myers Squibb Co. DEA/FDA: Rx

Blenoxane: Patient Education

• Generic Name: bleomycin

• Pronounced: blee oh MY sin

• Brand Name: Blenoxane

What is the most important information I should know about bleomycin?

Bleomycin should only be administered under the supervision of a qualified healthcare provider experienced in the use of cancer chemotherapeutic agents.

Serious side effects have been reported with the use of bleomycin including: allergic reactions (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); a severe reaction consisting of low blood pressure, mental confusion, fever, chills, and wheezing; pulmonary fibrosis (a lung condition); and others. Talk to your doctor about the possible side effects from treatment with bleomycin.

What is bleomycin?

Bleomycin is a cancer (antineoplastic) medication. Bleomycin interferes with the growth of cancer cells and slows their growth and spread in the body.

Bleomycin is used to treat squamous cell carcinoma (skin cancer) of the head and neck, penis, cervix, and vulva; lymphomas; and testicular cancer. Bleomycin is also used in the treatment of malignant pleural effusion.

Bleomycin may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before using bleomycin?

Do not use bleomycin without first talking to your doctor if you have:

• a breathing or respiratory problem;
• kidney problems;
• had previous treatment with bleomycin; or
• had radiation treatment.

The use of bleomycin may be dangerous if you have any of the conditions listed above.

Bleomycin is in the FDA pregnancy category D. This means that bleomycin is known to be harmful to an unborn baby. Do not use bleomycin without first talking to your doctor if you are pregnant or could become pregnant during treatment. Discuss with your doctor the appropriate use of birth control during treatment with bleomycin.

It is not know whether bleomycin passes into breast milk. Breast feeding should be avoided during treatment with bleomycin.

How should I use bleomycin?

Bleomycin should only be administered under the supervision of a qualified healthcare provider experienced in the use of cancer chemotherapeutic agents.

Your doctor will determine the correct amount and frequency of treatment with bleomycin depending upon the type of cancer being treated and other factors. Talk to your doctor if you have any questions or concerns regarding the treatment schedule.

Your doctor will probably want you to have regularly scheduled blood tests and other medical evaluations during treatment with bleomycin to monitor progress and side effects.

Your healthcare provider will store bleomycin as directed by the manufacturer. If you are storing bleomycin at home, follow the directions provided by your healthcare provider.

What happens if I miss a dose?

Contact your doctor if you miss a dose of bleomycin.

What happens if I overdose?

If, for any reason, an overdose of bleomycin is suspected, seek emergency medical attention or contact your healthcare provider immediately.

Symptoms of a bleomycin overdose tend to be similar to side effects caused by the medication, although often more severe.

What should I avoid while using bleomycin?

There are no restrictions on food, beverages, or activity while using bleomycin unless otherwise directed by your doctor.

What are the possible side effects of bleomycin?

If you experience any of the following serious side effects from bleomycin, seek emergency medical attention or contact your doctor immediately:

• an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
• fever or chills;
• difficulty breathing or shortness of breath; or
• dizziness or mental confusion.

Other, less serious side effects may be more likely to occur. Continue taking bleomycin and talk to your doctor if you experience:

• hair loss; or
• skin redness, rash, darkening of the skin, hardening of the skin, or tenderness of the skin;
• nail changes;
• itching;
• mouth sores;
• pain at the tumor site;
• vomiting, decreased appetite, and weight loss.

Other side effects have also been reported. Discuss with your doctor any side effect that occurs during treatment with bleomycin.

What other drugs will affect bleomycin?

Before using bleomycin, tell your doctor if you have had previous treatment with other cancer drugs or radiation treatment. You may not be able to take bleomycin, or you may require a dosage adjustment or special monitoring during treatment.

Drugs other than those listed here may also interact with bleomycin. Talk to your doctor and pharmacist before taking any other prescription or over-the-counter medicines, including vitamins, minerals, and herbal products, during treatment with bleomycin.

Where can I get more information?

Your healthcare provider may have additional information about bleomycin that you may read.

What does my medication look like?

Bleomycin is available with a prescription under the brand name Blenoxane. Other brand or generic formulations may also be available. Ask your healthcare provider or pharmacist any questions you have about this medication, especially if it is new to you.

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Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise.

Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides.

The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Blenoxane: Pill Pictures

This information is currently unavailable or not applicable for this drug.