Bleomycin Side Effects

Some side effects of bleomycin may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

For the Consumer

Applies to bleomycin: injection powder for solution

Along with its needed effects, bleomycin 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 while taking bleomycin:

More common
  • Fever and chills (occurring within 3 to 6 hours after a dose)
Less common
  • Confusion
  • faintness
  • wheezing
Rare
  • Chest pain (sudden severe)
  • weakness in arms or legs (sudden)

Check with your doctor as soon as possible if any of the following side effects occur while taking bleomycin:

More common
  • Cough
  • shortness of breath
  • sores in mouth and on lips

Some side effects of bleomycin 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
Less common
  • Changes in fingernails or toenails
  • weight loss

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:

  • Cough
  • shortness of breath

For Healthcare Professionals

Applies to bleomycin: injectable powder for injection

Respiratory

Pulmonary toxicity occurs most frequently in patients over 70 years of age and in those receiving over 400 units of total dosage. Patients often present with dry cough, dyspnea, rales, and infiltrate. One case of fatal pulmonary fibrosis has been reported in a patient (with normal renal function) who received a total cumulative dose of only 20 units.

Sudden onset of an acute chest pain syndrome suggestive of pleuropericarditis has rarely been reported during bleomycin infusions. Although each patient must be individually evaluated, further courses of bleomycin do not appear to be contraindicated.

The earliest sign and symptom of pulmonary toxicity are fine rales and dyspnea. A specific clinical syndrome has not been defined. Radiographically, the pneumonitis produces nonspecific patchy opacities, usually of the lower lung field. The most common changes in pulmonary function tests are decreases in total lung volume and vital capacity. However, these changes are not predictive of the development of pulmonary fibrosis.

Microscopic tissue changes include bronchiolar squamous metaplasia, reactive macrophages, atypical alveolar epithelial cells, fibrinous edema, and interstitial fibrosis. The acute stage may involve capillary changes and subsequent fibrinous exudation into alveoli producing a change similar to hyaline membrane formation and progressing to a diffuse interstitial fibrosis resembling Hamman-Rich syndrome. These microscopic findings are nonspecific. (Similar changes are seen in radiation pneumonitis and pneumocystic pneumonitis.)

Respiratory side effects (10%) are potentially the most serious. The most frequent respiratory presentation has been pneumonitis, which has sometimes progressed to pulmonary fibrosis. Approximately 1% of treated patients have died of pulmonary fibrosis. Two cases of fatal pneumothorax and one case reported of fatal diffuse alveolar injury have also been reported.

Dermatologic

Skin toxicity is a relatively late manifestation, usually developing in the 2nd and 3rd week of treatment, after a cumulative dose of 150 to 200 units.

Dermatologic side effects including erythema, rash, striae, vesiculation, hyperpigmentation, and skin tenderness are the most frequent (50%) type of side effect. Hyperkeratosis, nail changes, alopecia, and pruritus have also been reported. One case of fatal fulminant angioedema involving the skin and lungs has been reported. A case of bleomycin-induced flagellate dermatitis has also been reported.

Gastrointestinal

Relative to other chemotherapeutic agents, bleomycin is felt to have low emetogenic potential.

Gastrointestinal side effects have frequently included vomiting, which can generally be controlled with oral phenothiazines. Anorexia and weight loss have also been frequently reported and may persist long after discontinuation of treatment. Mucosal lesions including stomatitis and ulceration of the lips and tongue have been reported rarely.

Hypersensitivity

Hypersensitivity side effects have included an idiosyncratic reaction (hypotension, mental confusion, fever, chills, and wheezing) in approximately 1% of lymphoma patients.

The reaction may be immediate or delayed for several hours. It usually occurs after the first or second dose. Treatment is symptomatic and can include volume expansion, epinephrine, antihistamines and corticosteroids.

Two known cases have been reported of fatal hyperpyrexia in patients with lymphoma who had previously received bleomycin (without prior hyperpyrexia). One of the patients had previously received multiple doses. There has also been a case report of fatal hyperpyrexia in a patient premedicated with high-dose dexamethasone, to an initial 7.5 mg dose for a poorly differentiated metastatic carcinoma.

Cardiovascular

Cardiovascular side effects (myocardial infarction, cerebrovascular accident, thrombotic microangiopathy (HUS)) have been reported rarely (in combination antineoplastic therapy).

Other

Other side effects include fever (up to 50%), and chills which have frequently been reported. Cerebral arteritis and Raynaud's phenomenon have also been reported. Three known cases of scleroderma have been reported.

Local

Local side effects including pain at the tumor site and phlebitis have been reported infrequently.

Oncologic

Oncologic side effects have been reported. Bleomycin has tested positive in the great majority of genetic toxicity assays. These genotoxic effects are similar to those induced by ionizing radiation.

The most frequent mutations produced in mammalian cells are large multilocus deletions, which probably arise by misrepair of (DNA) double strand breaks.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. 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 substances you are taking, check with your doctor, nurse, or pharmacist.

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