Bleomycin Dosage

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Usual Adult Dose for Squamous Cell Carcinoma

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

Squamous cell carcinoma sometimes requires as long as 3 weeks before any improvement is noted.

Usual Adult Dose for non-Hodgkin's Lymphoma

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.

Usual Adult Dose for Testicular Cancer

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

Improvement in testicular tumors is prompt and noted within 2 weeks. If no improvement is seen at this time, improvement is unlikely.

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.

Usual Pediatric Dose for Squamous Cell Carcinoma

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

Squamous cell carcinoma sometimes requires as long as 3 weeks before any improvement is noted.

Usual Pediatric Dose for non-Hodgkin's Lymphoma

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.

Usual Pediatric Dose for Testicular Cancer

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

Improvement in testicular tumors is prompt and noted within 2 weeks. If no improvement is seen at this time, improvement is unlikely.

Usual Pediatric 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 Pediatric 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.

Liver Dose Adjustments

Data not available.

Precautions

Bleomycin should be used with extreme caution in patients with significant renal impairment.

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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