Bleomycin Disease Interactions

Pulmonary pneumonitis occurs in 10% of patients during bleomycin therapy and 1% progress to pulmonary fibrosis and death. Although pulmonary toxicity is age and dose related, occurring primarily in patients over 70 years of age and in those receiving a total dose > 400 units, it has occurred in younger patients at a lower dose. Extreme caution should be exercised when administering bleomycin in patients with compromised pulmonary function. Patients should be instructed to immediately report symptoms of dyspnea, cough, or congestion. Close clinical monitoring of pulmonary function is recommended.

Bleomycin is primarily eliminated by the kidney. Approximately 60% to 70% of bleomycin is excreted in the urine as active drug. Moderate renal failure reduces elimination to < 20% of the drug. Extreme caution should be exercised when administering bleomycin in patients with existing or predisposition to significantly compromised renal function. Close clinical monitoring of renal function is recommended.

The effect of hepatic insufficiency on the pharmacokinetics of bleomycin has not been evaluated. However, hepatic toxicity, beginning as a deterioration in liver function tests, has been reported. These toxicities may occur at any time after initiation of therapy. Caution and monitoring is advised if bleomycin is used in patients with liver impairment.