Bleomycin (Blenoxane®)

How to Take Bleomycin

Bleomycin is given by intravenous (IV, into a vein) infusion, intramuscular (IM, into a muscle), or subcutaneous (SQ, under the skin) injections. It can be given alone or in combination with other medications.

Bleomycin can also be used as a "sclerosing" agent to treat pleural effusions. In this case, it causes scarring of the pleural space to prevent the effusion (fluid) from building back up.

Possible Side Effects

There are a number of things you can do to manage the side effects of bleomycin. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:

Pulmonary (Lung) Toxicity

Bleomycin may cause serious lung problems. The risk may be higher in the elderly or those who received high doses, but lung effects have also happened in young patients and with low doses. There is a lifetime maximum dose of this medication due to the possibility of lung problems, which can include pneumonitis (inflammation of lung tissue) and pulmonary fibrosis (scarring and stiffening of the lung tissue). These problems can begin months to a few years after treatment is done. You may have breathing tests (pulmonary function tests, or PFTs) before starting bleomycin. Tell your healthcare provider if you have any shortness of breath, cough, or wheezing. If you are having a hard time breathing, call 911 or go to the closest emergency room right away.

If you are planning for any type of surgery, tell your healthcare team that you have received bleomycin, as there is a greater risk for having pulmonary (lung) problems from oxygen given during surgery.

It is strongly recommended that you do not smoke if you have received bleomycin, as this increases the risk of lung complications. You should report any shortness of breath, difficulty breathing, cough, or wheezing to your care provider. Lung complications can happen several years after treatment with bleomycin, so you should be sure all of your care providers know you received this medication and have any new lung symptoms checked. Of note, patients who have received this medication are recommended to have clearance by a dive medicine specialist prior to scuba diving.

Allergic-Like Reactions

An allergic-like reaction with fever, chills, low blood pressure, wheezing, or difficulty breathing may occur immediately or up to a few days after receiving treatment. If needed, medications are given to help with these effects. If you have any of these effects, tell your care team right away.

Nail and Skin Changes

Your fingernails/toenails may become dark, thick, brittle, or fall off. Your skin may be dry, feel thick, or appear darker (hyperpigmentation). Your skin may be more sensitive to the sun, which can cause severe sunburn or rash. Sun sensitivity can last even after you have stopped taking the medication. Avoid the sun between 10 am to 2 pm when it is strongest. Wear sunscreen (at least SPF 15) every day, wear sunglasses and long sleeves/pants to protect your skin. Keep your fingernails and toenails clean and dry. You may use nail polish, but do not wear fake nails. Tell your provider if any nails fall off.

This medication can also cause radiation recall. This is redness, swelling, or blistering of the skin in an area that was previously treated (even years ago) with radiation. The goal of treatment for radiation recall is to manage the symptoms until it heals. Topical steroids or anti-inflammatory medications or cool compresses may help. Avoid sun exposure and tight-fitting clothes that would rub on the area.

Loss or Thinning of Scalp and Body Hair (Alopecia)

Your hair may become thin, brittle, or may fall out. This typically begins two to three weeks after treatment starts. This hair loss can be all body hair, including pubic, underarm, legs/arms, eyelashes, and nose hairs. The use of scarves, wigs, hats, and hairpieces may help. Hair generally starts to regrow soon after treatment is completed. Remember your hair helps keep you warm in cold weather, so a hat is particularly important in cold weather or to protect you from the sun.

Mouth Ulcers (Mucositis)

Certain cancer treatments can cause sores or soreness in your mouth and/or throat. Notify your oncology care team if your mouth, tongue, inside of your cheek or throat becomes white, ulcerated, or painful. Performing regular mouth care can help prevent or manage mouth sores. If mouth sores become painful, your doctor or nurse can recommend a pain reliever.

• Brush with a soft-bristle toothbrush or cotton swab twice a day.
• Avoid mouthwashes that contain alcohol. A baking soda and/or salt with warm water mouth rinse (2 level teaspoons of baking soda or 1 level teaspoon of salt in an eight-ounce glass of warm water) is recommended 4 times daily.
• If your mouth becomes dry, eat moist foods, drink plenty of fluids (6-8 glasses), and suck on sugarless hard candy.
• Avoid smoking and chewing tobacco, drinking alcoholic beverages, and citrus juices.

Decrease in Appetite

Nutrition is an important part of your care. Cancer treatment can affect your appetite and, in some cases, the side effects of treatment can make eating difficult. Ask your nurse about nutritional counseling services at your treatment center to help with food choices.

• Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals.
• If you are not eating enough, nutritional supplements may help.
• You may experience a metallic taste or find that food has no taste at all. You may dislike foods or beverages that you liked before receiving cancer treatment. These symptoms can last for several months or longer after treatment ends.
• Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products, and fish without a strong smell. Sometimes cold food has less of an odor.
• Add extra flavor to meat or fish by marinating it in sweet juices, sweet and sour sauce, or dressings. Use seasonings like basil, oregano, or rosemary to add flavor. Bacon, ham, and onion can add flavor to vegetables.

Nausea and/or Vomiting

Talk to your care team so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.

Call your provider if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should not breastfeed while receiving bleomycin.