Skip to Content

Bleomycin Dosage

Medically reviewed on August 23, 2018.

Applies to the following strengths: 15 units; 30 units; 15,000 intl units

Usual Adult Dose for Squamous Cell Carcinoma

0.25 to 0.5 units/kg (10 to 20 units/m2) IV, IM, or subcutaneously 1 to 2 times a week

Comments:
-Squamous cell carcinoma sometimes requires 3 weeks before any improvement is noted.
-When this drug is used in combination with other antineoplastic agents, pulmonary toxicities may occur at lower doses.

Uses: Squamous Cell Carcinoma: Head and neck (including mouth, tongue, tonsil, nasopharynx, oropharynx, sinus, palate, lip, buccal mucosa, gingivae, epiglottis, skin, larynx), penis, cervix, and vulva; the response to this drug is poorer in patients with previously irradiated head and neck cancer

Usual Adult Dose for non-Hodgkin's Lymphoma

NOTE: Because of the possibility of an anaphylactic reaction, the manufacturer recommends that lymphoma patients be treated with 2 units or less for the first 2 doses. If no acute reaction occurs, then the regular dosage schedule may be followed.

0.25 to 0.5 units/kg (10 to 20 units/m2) IV, IM, or subcutaneously 1 to 2 times a week

Comments:
-When this drug is used in combination with other antineoplastic agents, pulmonary toxicities may occur at lower doses.

Use: Non-Hodgkin's lymphoma

Usual Adult Dose for Testicular Cancer

0.25 to 0.5 units/kg (10 to 20 units/m2) IV, IM, or subcutaneously 1 to 2 times a week

Comments:
-Improvement in testicular tumors is prompt and noted within 2 weeks. If no improvement is seen at this time, improvement is unlikely.
-When this drug is used in combination with other antineoplastic agents, pulmonary toxicities may occur at lower doses.

Uses: Testicular Carcinoma (embryonal cell, choriocarcinoma, and teratocarcinoma)

Usual Adult Dose for Hodgkin's Disease

NOTE: Because of the possibility of an anaphylactic reaction, the manufacturer recommends that lymphoma patients be treated with 2 units or less for the first 2 doses. If no acute reaction occurs, then the regular dosage schedule may be followed.

0.25 to 0.5 units/kg (10 to 20 units/m2) IV, IM, or subcutaneously 1 to 2 times a week; after a 50% response, a maintenance dose of 1 unit daily or 5 units weekly IV or IM should be given

Comments:
-Improvement in Hodgkin's Disease is prompt and noted within 2 weeks. If no improvement is seen at this time, improvement is unlikely.
-When this drug is used in combination with other antineoplastic agents, pulmonary toxicities may occur at lower doses.

Use: Hodgkin's disease

Usual Adult Dose for Malignant Pleural Effusion

60 units administered as a single bolus intrapleural injection

Comments:
-When this drug is used in combination with other antineoplastic agents, pulmonary toxicities may occur at lower doses.

Use: This drug is effective as a sclerosing agent for the treatment of malignant pleural effusion and prevention of recurrent pleural effusions

Usual Pediatric Dose for Squamous Cell Carcinoma

0.25 to 0.5 units/kg (10 to 20 units/m2) IV, IM, or subcutaneously 1 to 2 times a week

Comments:
-Squamous cell carcinoma sometimes requires 3 weeks before any improvement is noted.
-When this drug is used in combination with other antineoplastic agents, pulmonary toxicities may occur at lower doses.

Uses: Squamous Cell Carcinoma: Head and neck (including mouth, tongue, tonsil, nasopharynx, oropharynx, sinus, palate, lip, buccal mucosa, gingivae, epiglottis, skin, larynx), penis, cervix, and vulva; the response to this drug is poorer in patients with previously irradiated head and neck cancer

Usual Pediatric Dose for non-Hodgkin's Lymphoma

NOTE: Because of the possibility of an anaphylactic reaction, the manufacturer recommends that lymphoma patients be treated with 2 units or less for the first 2 doses. If no acute reaction occurs, then the regular dosage schedule may be followed.

0.25 to 0.5 units/kg (10 to 20 units/m2) IV, IM, or subcutaneously 1 to 2 times a week

Comments:
-When this drug is used in combination with other antineoplastic agents, pulmonary toxicities may occur at lower doses.

Use: Non-Hodgkin's lymphoma

Usual Pediatric Dose for Testicular Cancer

0.25 to 0.5 units/kg (10 to 20 units/m2) IV, IM, or subcutaneously 1 to 2 times a week

Comments:
-Improvement in testicular tumors is prompt and noted within 2 weeks. If no improvement is seen at this time, improvement is unlikely.
-When this drug is used in combination with other antineoplastic agents, pulmonary toxicities may occur at lower doses.

Uses: Testicular Carcinoma (embryonal cell, choriocarcinoma, and teratocarcinoma)

Usual Pediatric Dose for Hodgkin's Disease

recommends that lymphoma patients be treated with 2 units or less for the first 2 doses. If no acute reaction occurs, then the regular dosage schedule may be followed.

0.25 to 0.5 units/kg (10 to 20 units/m2) IV, IM, or subcutaneously 1 to 2 times a week; after a 50% response, a maintenance dose of 1 unit daily or 5 units weekly IV or IM should be given

Comments:
-Improvement in Hodgkin's Disease is prompt and noted within 2 weeks. If no improvement is seen at this time, improvement is unlikely.
-When this drug is used in combination with other antineoplastic agents, pulmonary toxicities may occur at lower doses.

Use: Hodgkin's disease

Usual Pediatric Dose for Malignant Pleural Effusion

60 units administered as a single bolus intrapleural injection

Comments:
-Children less than 3 years have higher total body clearance than in adults, 71 mL/min/m2 versus 51 mL/min/m2, respectively, following IV bolus administration. Children more than 8 years have comparable clearance as in adults.
-When this drug is used in combination with other antineoplastic agents, pulmonary toxicities may occur at lower doses.

Use: This drug is effective as a sclerosing agent for the treatment of malignant pleural effusion and prevention of recurrent pleural effusions

Renal Dose Adjustments

The manufacturer recommends the following dose adjustments in patients with renal impairment:
CrCl 50 mL/minute or greater: No dose adjustment is required.
CrCl 40 to 50 mL/minute: Administer 70% of normal dose.
CrCl 30 to 40 mL/minute: Administer 60% of normal dose.
CrCl 20 to 30 mL/minute: Administer 55% of normal dose.
CrCl 10 to 20 mL/minute: Administer 45% of normal dose.
CrCl 5 to 10 mL/minute: Administer 40% of normal dose.

Liver Dose Adjustments

Data not available

Precautions

US BOXED WARNINGS:
-This drug should only be administered under the supervision of a qualified physician experienced in the use of cancer chemotherapeutic agents. Appropriate management of therapy and complications is possible only when adequate diagnostic and treatment facilities are readily available.
-Pulmonary fibrosis is the most severe toxicity associated with this drug. The most frequent presentation is pneumonitis occasionally progressing to pulmonary fibrosis. Occurrence is higher in elderly patients and in those receiving greater than 400 units total dose, but pulmonary toxicity has been observed in young patients and those treated with low doses.
-A severe idiosyncratic reaction consisting of hypotension, mental confusion, fever, chills, and wheezing has been reported in approximately 1% of lymphoma patients treated with this drug.

CONTRAINDICATIONS:
-Hypersensitivity to the active component or any of the ingredients

Consult WARNINGS section for additional precautions.

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.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Hide