{"id":1679,"date":"2023-06-25T17:31:26","date_gmt":"2023-06-25T17:31:26","guid":{"rendered":"https:\/\/kidneydiseaseclinic.net\/kdc\/bleomycin\/"},"modified":"2023-06-25T19:47:54","modified_gmt":"2023-06-25T19:47:54","slug":"bleomycin","status":"publish","type":"post","link":"https:\/\/kidneydiseaseclinic.net\/kdc\/bleomycin\/","title":{"rendered":"Bleomycin"},"content":{"rendered":"

<\/p>\n

Bleomycin<\/h1>\n

CLINICAL USE<\/h3>\n

Antineoplastic agent<\/p>\n

DOSE IN NORMAL RENAL FUNCTION<\/h3>\n

Squamous cell carcinoma and testicular teratoma:<\/p>\n

  • range 45\u201360 \u00d7 10 3 IU per week IM\/IV (total cumulative dose up to 500 \u00d7 103 IU)<\/li>\n
  • OR, continuous IV infusion 15 \u00d7 10 3 IU\/24 hours for up to 10 days<\/li>\n
  • OR, 30 \u00d7 10 3 IU\/24 hours for up to 5 days<\/li>\n
  • Malignant lymphomas:15\u201330 \u00d7 10 3 IU\/week IM to total dose of 225 \u00d7 103 IU Lower doses required in combination chemotherapy<\/li>\n
  • Malignant effusions:60 \u00d7 10 3 IU in 100 mL sodium chloride 0.9% intrapleurally (total cumulative dose of 500 \u00d7 103 IU)
    \n

    PHARMACOKINETICS<\/h3>\n<\/li>\n
  • Molecular weight                           :Approximately 1500<\/li>\n
  • %Protein binding                           :<1<\/li>\n
  • %Excreted unchanged in urine     : 60\u201370<\/li>\n
  • Volume of distribution (L\/kg)       :0.3<\/li>\n
  • half-life \u2013 normal\/ESRD (hrs)      :4 (bolus), 9 (continuous infusion)\/20
    \n

    DOSE IN RENAL IMPAIRMENT<\/h3>\n

    GFR (mL\/MIN)<\/h4>\n<\/li>\n
  • 20 to 50     : Dose as in normal renal function<\/li>\n
  • 10 to 20     : 75% of normal dose (100% for malignant effusions)<\/li>\n
  • <10           : 50% of normal dose (100% for malignant effusions)
    \n

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES<\/h3>\n<\/li>\n
  • CAPD                :Not dialysed. Dose as in GFR <10 mL\/min<\/li>\n
  • HD                     :Not dialysed. Dose as in GFR <10 mL\/min<\/li>\n
  • HDF\/high flux   :Unknown dialysability. Dose as in GFR <10 mL\/min<\/li>\n
  • CAV\/VVHD      :Unknown dialysability. Dose as in GFR 10 to 20 mL\/min
    \n

    IMPORTANT DRUG INTERACTIONS<\/h3>\n

    Potentially hazardous interactions with other drugs<\/li>\n

  • Antipsychotics: avoid concomitant use with clozapine, increased risk of agranulocytosis<\/li>\n
  • Cytotoxics: increased pulmonary toxicity with cisplatin; in combination with vinca alkaloids can lead to Raynaud\u2019s syndrome and peripheral ischaemia
    \n

    ADMINISTRATION<\/h3>\n

    Reconstition<\/h4>\n<\/li>\n
  • IM: dissolve required dose in up to 5 mL sodium chloride 0.9% (or 1% solution of lidocaine if pain on injection)<\/li>\n
  • IV: dissolve dose in 5\u2013200 mL sodium chloride 0.9%<\/li>\n
  • Intracavitary: 60 \u00d7 10 3 IU in 100 mL sodium chloride 0.9%<\/li>\n
  • Locally: dissolve in sodium chloride 0.9% to make a 1\u20133 \u00d7103 IU\/mL solution
    \n

    Route<\/h4>\n<\/li>\n
  • IM, IV, also intra-arterially, intrapleurally, intraperitoneally, locally into tumour
    \n

    Rate of Administration<\/h4>\n<\/li>\n
  • Give by slow IV injection, or add to reservoir of a running IV infusion
    \n

    Comments<\/h4>\n

    Avoid direct contact with the skin<\/p>\n

    OTHER INFORMATION<\/h4>\n<\/li>\n
  • Lesions of skin and oral mucosa common after full course of bleomycin<\/li>\n
  • Pulmonary toxicity: interstitial pneumonia and fibrosis \u2013 most serious delayed effectIn patients with moderately severe renal impairment less than 20% of the dose is excreted in the urine<\/li>\n
  • Rapid distribution to body tissues (highest concentration is in skin, lungs, peritoneum and lymph)<\/li>\n
  • Inactivation takes place primarily in the liver. Approximately 60\u201370% of drug is excreted unchanged in the urine, probably by glomerular filtration<\/li>\n","protected":false},"excerpt":{"rendered":"

    Bleomycin CLINICAL USE Antineoplastic agent DOSE IN NORMAL RENAL FUNCTION<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[7],"class_list":["post-1679","post","type-post","status-publish","format-standard","hentry","category-blog","tag-post-by-auto-php"],"_links":{"self":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1679","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/comments?post=1679"}],"version-history":[{"count":1,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1679\/revisions"}],"predecessor-version":[{"id":2873,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1679\/revisions\/2873"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/media?parent=1679"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/categories?post=1679"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/tags?post=1679"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}