Bleomycin Side Effects
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)
- 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
- 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
- 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:
- shortness of breath
For Healthcare Professionals
Applies to bleomycin: injectable powder for injection
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.)[Ref]
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.[Ref]
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.[Ref]
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.[Ref]
Relative to other chemotherapeutic agents, bleomycin is felt to have low emetogenic potential.[Ref]
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.[Ref]
Hypersensitivity side effects have included an idiosyncratic reaction (hypotension, mental confusion, fever, chills, and wheezing) in approximately 1% of lymphoma patients.[Ref]
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.[Ref]
Cardiovascular side effects (myocardial infarction, cerebrovascular accident, thrombotic microangiopathy (HUS)) have been reported rarely (in combination antineoplastic therapy).[Ref]
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.[Ref]
Local side effects including pain at the tumor site and phlebitis have been reported infrequently.[Ref]
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.[Ref]
The most frequent mutations produced in mammalian cells are large multilocus deletions, which probably arise by misrepair of (DNA) double strand breaks.[Ref]
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3. Chisholm RA, Dixon AK, Williams MV, Oliver RTD "Bleomycin lung: the effect of different chemotherapeutic regimens." Cancer Chemother Pharmacol 30 (1992): 158-60
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10. Jones AW "Bleomycin lung damage: the pathology and nature of the lesion." Br J Dis Chest 72 (1978): 321-6
11. Brown WG, Hasan FM, Barbee RA "Reversibility of severe bleomycin-induced pneumonitis." JAMA 239 (1978): 2012-4
12. Leeser JE, Carr D "Fatal pneumothorax following bleomycin and other cytotoxic drugs." Cancer Treat Rep 69 (1985): 344-5
13. Bechard DE, Fairman RP, DeBlois GG, Via CT "Fatal pulmonary fibrosis from low-dose bleomycin therapy." South Med J 80 (1987): 646-9
14. Hartmann LC, Frytak S, Richardson RL, Coles DT, Cupps RE "Life-threatening bleomycin pulmonary toxicity with ultimate reversibility." Chest 98 (1990): 497-9
15. Khansur T, Little D, Tavassoli M "Fulminant and fatal angioedema caused by bleomycin treatment." Arch Intern Med 144 (1984): 2267
16. Dalgleish AG, Woods RL, Levi JA "Bleomycin pulmonary toxicity: its relationship to renal dysfunction." Med Pediatr Oncol 12 (1984): 313-7
17. Wolkowicz J, Sturgeon J, Rawji M, Chan CK "Bleomycin-induced pulmonary function abnormalities." Chest 101 (1992): 97-101
18. Arseculeratne G, Berroeta L, Meiklejohn D, et al. "Bleomycin-induced "flagellate dermatitis"." Arch Dermatol 143 (2007): 1461-2
19. Rosenfelt F, Palmer J, Weinstein I, Rosenbloom B "A fatal hyperpyrexial response to bleomycin following prior therapy: a case report and literature review." Yale J Biol Med 55 (1982): 529-31
20. Carter JJ, McLaughlin ML, Bern MM "Bleomycin-induced fatal hyperpyrexia." Am J Med 74 (1983): 523-5
21. Kerr LD, Spiera H "Scleroderma in association with the use of bleomycin: a report of 3 cases." J Rheumatol 19 (1992): 294-6
22. "Multum Information Services, Inc. Expert Review Panel"
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.
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