bleomycin
Bleomycin is a chemotherapy medication that’s used to treat many types of cancers, such as testicular cancer and lymphoma. It appears to help stop the cancer from growing by damaging the genetic material inside cancer cells. Bleomycin is usually given as an injection through your vein (IV) and as part of a treatment plan with other chemotherapy medications. Bleomycin side effects can include tiredness and lower appetite. This medication also has a risk of serious lung toxicity, sometimes leading to pulmonary fibrosis.
What is Bleomycin?
What is Bleomycin used for?
Malignant pleural effusion (collection of cancer cells between the chest wall and lung)
Certain head and neck cancers
How Bleomycin works
Bleomycin is a chemotherapy medication that’s often called an “antitumor antibiotic.” We don’t know the exact way bleomycin works, but we do know that the medication damages the DNA and RNA (genetic material) inside cancer cells. When their genetic material is damaged, cancer cells can’t grow and spread as well.
Drug Facts
What are the side effects of Bleomycin?
Common Side Effects
- Trouble breathing
- Lower appetite
- Weight loss
- Tiredness
Other Side Effects
- Vomiting
- Skin redness or tenderness
- Skin color changes
- Itchy skin
- Rash
- Fever
- Chills
- Hair loss
- Confusion
Serious Side Effects
- Serious lung toxicity: trouble breathing, cough, chest tightness
- Serious reaction to the medication: fever, chills, trouble breathing, confusion, lightheadedness
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Also, because of the way these medicines act on the body, there is a chance that they might cause other unwanted effects that may not occur until months or years after the medicine is used. These delayed effects may include certain types of cancer, such as leukemia. Discuss these possible effects with your doctor.
Check with your doctor immediately if any of the following side effects occur:
More common
Fever and chills (occurring within 3 to 6 hours after a dose)
Check with your doctor as soon as possible if any of the following side effects occur:
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Darkening or thickening of skin
dark stripes on skin
itching of skin
skin rash or colored bumps on fingertips, elbows, or palms
skin redness or tenderness
swelling of fingers
vomiting and loss of appetite
Bleomycin may cause a temporary loss of hair in some people. After treatment has ended, normal hair growth should return, although it may take several months.
Side effects that affect your lungs (for example, cough and shortness of breath) may be more likely to occur if you smoke.
After you stop using this medicine, it may still produce some side effects that need attention. During this period of time, check with your doctor immediately if you notice the following side effects:
shortness of breath
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Bleomycin
Pros
Part of recommended treatment regimens for Hodgkin lymphoma and testicular cancer
Doesn’t cause low blood cell counts (low white blood cell count, low platelets) like most chemotherapy medications do
A lower-cost medication
Cons
Might cause serious lung toxicity
Often given as an intravenous infusion (IV), so requires a needle for treatment
Often given once a week, so less convenient
Pharmacist tips for Bleomycin
If you have an upcoming surgery that requires anesthesia, it’s important that your surgeon knows you’ve taken bleomycin in the past. You’re at higher risk of having lung complications while receiving oxygen during surgery if you’ve taken bleomycin in the past. These lung problems can happen at any time, even years after your last bleomycin dose.
It's not common, but bleomycin might cause changes to your skin, especially if you’ve been taking it for a long time. Contact your provider if you notice any skin color changes, a new rash, or nail changes.
Don't breastfeed while you’re taking bleomycin. We don’t know if the medication passes into human breast milk. But based on the way bleomycin works, it’s not safe for babies.
Talk to your provider about whether or not they recommend you take a growth factor medication along with your chemotherapy. There are mixed results from studies about whether there’s a higher risk for lung problems if bleomycin is given with growth factor medications like Neupogen (filgrastim). Your provider can discuss the risks and benefits of taking a growth factor medication with bleomycin if it’s needed.
Frequently asked questions about Bleomycin
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What are the risks and warnings for Bleomycin?
Bleomycin can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Must be under the care of a trained healthcare provider
Bleomycin treatment carries many serious risks. Your care team is trained to treat you with this medication to make sure it’s as safe for you as possible. Your providers will follow up with you closely during and after treatment.
Serious lung toxicity
Risk factors: Age over 70 | Multiple doses of bleomycin | Going over the maximum lifetime dose of 400 units
Some people taking bleomycin have developed serious lung problems. It usually starts as swelling in the lung tissue, causing shortness of breath. But it can progress to a condition called pulmonary fibrosis, which causes the lungs to become scarred and stiff. Pulmonary fibrosis can make it harder to breathe. Your provider will monitor you for this side effect with regular breathing tests. Contact your provider right away if you have any new symptoms, such as cough, chest tightness, or trouble breathing.
Serious reaction to the medication
Rarely, people taking bleomycin have had a serious reaction to the medication called an idiosyncratic reaction. The symptoms usually happen around the time of your bleomycin infusion. Symptoms are very similar to those of anaphylaxis (trouble breathing, chills, confusion, and low blood pressure). Your nurse will monitor you during your bleomycin treatment, especially during the first two doses when this reaction is most common. If you do have a reaction, you might need other medications to treat it such as diphenhydramine (Benadryl) or corticosteroids such as methylprednisolone (Solu-Medrol).
Harm to unborn baby
Risk factors: Pregnancy
Based on animal studies, bleomycin might harm an unborn baby or raise the risk for miscarriage (pregnancy loss). Because of this risk, avoid becoming pregnant while you’re getting treated with bleomycin. Tell your provider right away if you become pregnant while you're taking this medication.
Kidney or liver problems
Some people have had blood test results showing changes in kidney or liver function while you're taking bleomycin. Your provider will regularly check your kidney and liver function through lab tests during treatment. Talk to your provider if you have kidney or liver problems. Also speak to your provider if you’re concerned about these changes while you’re taking bleomycin. Your care team can make sure the medication is safe for you to take.
Bleomycin dosage forms
Typical dosing for Bleomycin
The dose is based on your body surface area (BSA, m2), which takes into account your height and weight. It also depends on which cancer is being treated, what other chemotherapy medications you’re taking with bleomycin, and your kidney function.
The most common dose is 10 to 20 units per m2 given once or twice a week. Bleomycin is given as an injection, most commonly intravenously (through the vein).
The maximum lifetime dose is 400 units. Once you’ve reached the maximum amount of bleomycin you can take, you have to stop taking the medication. There’s a high risk of serious lung problems beyond this dosage.
Interactions between Bleomycin and other drugs
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Brentuximab Vedotin
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Ascorbic Acid
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Bleomycin contraindications
People who’ve had an allergic reaction or idiosyncratic reaction to bleomycin
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References
Best studies we foundAmerican Cancer Society. (2019). Treatment options for testicular cancer, by type and stage.
American Lung Association. (2022). 7 things everyone should know about pulmonary fibrosis.
American Thoracic Society. (2021). Malignant pleural effusion.
Budavari, A. I., et al. (2007). Oxygen‐induced pulmonary toxicity 20 years after bleomycin exposure. Journal of Hospital Medicine.
Gao, Y., et al. (2020). Antibiotics for cancer treatment: A double-edged sword. Journal of Cancer.
Hecht, S. M. (2000). Bleomycin: New perspectives on the mechanism of action. Journal of Natural Products.
Hospira, Inc. (2022). Bleomycin injection, powder, lyophilized, for solution [package insert]. DailyMed.
Lam, M. S. (2005). The need for routine bleomycin test dosing in the 21st century. The Annals of Pharmacotherapy.
MedlinePlus. (2016). Vulvar cancer.
MedlinePlus. (2022). Penile cancer.
Modi, P., et al. (2023). Diffusing capacity of the lungs for carbon monoxide. StatPearls.
National Cancer Institute. (n.d.). ABVD regimen.
National Cancer Institute. (n.d.). Lymphoma—Patient version.
National Cancer Institute. (n.d.). Myelosuppression.
National Cancer Institute. (2020). Hair loss (alopecia) and cancer treatment.
National Cancer Institute. (2021). Head and neck cancers.
National Cancer Institute. (2023). BEP.
National Cancer Institute. (2023). Testicular cancer treatment (PDQ®)–Patient version.
National Comprehensive Cancer Network. (2023). Hodgkin lymphoma.
National Human Genome Research Institute. (2024). Deoxyribonucleic acid (DNA).
National Human Genome Research Institute. (2024). Ribonucleic acid (RNA).
Pulmonary Fibrosis Foundation. (n.d.). What is pulmonary fibrosis?
Roselló, S., et al. (2017). Management of infusion reactions to systemic anticancer therapy: ESMO Clinical Practice Guidelines. Annals of Oncology.
Uetrecht, J., et al. (2013). Idiosyncratic adverse drug reactions: Current concepts. Pharmacological Reviews.
Verma, S. P., et al. (2016). Bleomycin-induced skin toxicity: Is it always flagellate erythema? British Medical Journal Case Reports.
Watson, R. A., et al. (2018). Development of a best-practice clinical guideline for the use of bleomycin in the treatment of germ cell tumours in the UK. British Journal of Cancer.
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