Bleomycin is a cytotoxic glycopeptide antibiotic derived from *Streptomyces verticillus*, used primarily as an antineoplastic agent. It is a key component in the treatment of various malignancies, most notably Hodgkin lymphoma, germ cell tumors, and certain squamous cell carcinomas. Its unique mechanism of action, which involves DNA strand scission without significant myelosuppression, makes it a valuable agent in combination chemotherapy regimens. In the Indian context, it is widely available as a lyophilized powder for injection and is a Schedule G drug, requiring strict medical supervision due to its potential for severe pulmonary toxicity.
Adult: Hodgkin Lymphoma (ABVD): 10 IU/m² IV or 5 IU/m² IM/SC on days 1 & 15 of a 28-day cycle. Testicular Cancer (BEP): 30 IU IV weekly on days 2, 9, 16 of a 21-day cycle (often given as a continuous IV infusion over 24 hours). Malignant Pleural Effusion: 60 IU as a single intrapleural instillation.
Note: Reconstitute 15 IU vial with 1-5 mL of Sterile Water for Injection, 0.9% Sodium Chloride, or 5% Dextrose. For IV use: Administer IV push slowly over 10 minutes or as a continuous infusion. For IM/SC: Use preservative-free diluent. For intrapleural: Instill via chest tube. Pre-medication with an antipyretic (paracetamol) and antihistamine (chlorpheniramine) is common to reduce febrile reactions.
Bleomycin exerts its cytotoxic effect by causing single-strand and double-strand breaks in DNA. It complexes with ferrous iron (Fe²⁺) and molecular oxygen to form an activated complex. This complex reduces oxygen to superoxide and hydroxyl free radicals, which attack the deoxyribose sugar backbone of DNA, leading to strand scission and fragmentation. It also inhibits DNA synthesis and, to a lesser extent, RNA and protein synthesis.
Pregnancy: FDA Pregnancy Category D. There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience. Bleomycin is teratogenic and embryotoxic. Should be avoided, especially in the first trimester. Use only if the potential benefit justifies the potential risk to the fetus. Effective contraception is mandatory.
Driving: May cause fatigue. Patients should be cautioned about driving or operating machinery if they experience significant drowsiness or dizziness.
| Cisplatin | Increased risk of bleomycin toxicity due to reduced renal clearance of bleomycin. | Major |
| Oxygen (High Concentration) | Potentiates pulmonary toxicity. Use lowest possible FiO2 during and after surgery in patients recently treated with bleomycin. | Major |
| Other Pulmonary Toxic Drugs (e.g., Amiodarone, Busulfan, Methotrexate) | Additive risk of pulmonary fibrosis. | Major |
| Radiotherapy (Chest/Mediastinal) | Markedly increased risk of severe pneumonitis and pulmonary fibrosis. | Major |
| Filgrastim (G-CSF) | May increase pulmonary toxicity; monitor closely. | Moderate |