bleomycin sulfate: clinical use

Prescribing considerations

• Use only under experienced specialist supervision.
• Assess pulmonary history, respiratory symptoms, renal function, previous thoracic radiotherapy and anticipated oxygen exposure.
• Consider fertility preservation and contraception counselling before treatment.
• Account for additive pulmonary, renal and mucosal toxicity in combination treatment.

Contraindications and cautions

• Hypersensitivity to bleomycin sulfate
• Ataxia telangiectasia
• Pulmonary infection, severely impaired lung function or previous bleomycin-induced lung damage
• Breastfeeding

Monitoring

• Document baseline respiratory status and investigate new cough or dyspnoea promptly.
• Monitor renal function because impaired clearance increases exposure and pulmonary risk.
• Use clinical review, chest imaging and pulmonary-function assessment according to product information and specialist protocol.
• Monitor for hypersensitivity, skin and mucosal toxicity, vascular events and tumour lysis syndrome where relevant.

Clinical pharmacology

A water-soluble glycopeptide cytotoxic antibiotic that causes single- and double-strand DNA breaks. It is distributed particularly to skin and lung, undergoes enzymatic inactivation and is eliminated mainly unchanged through the kidneys.

Formulation and product differences

• The selected product is a white lyophilised powder requiring reconstitution for parenteral administration.
• It contains no listed excipients and is intended for single use.
• Multiple injection, infusion and intrapleural routes are authorised; oral absorption is very limited.

Injection

Route: Parenteral

Strengths: 15000 units