Bleomycin dosage

A patient weighing 120 pounds is to receive bleomycin sulfate (Blenoxane) 0.25 units per kilogram of body weight. What is the correct dosage of bleomycin ... 

For bleomycin-containing regimens, total the cumulative dosage received by the patient to monitor for pulmonary fibrosis. 

Machida, Y. Masuda, H. Fujiyama, N. Ito, S. Iwata, M. Nagai, T. Preparation and phase II clinical examination of topical dosage form for treatment of carcinoma coli containing bleomycin with hydroxypropyl cellulose. Chem. Pharm. Bull. 1979, 27, 93-100. 

Because this is a severe adverse effect it is generally recommended that a total dose of more than 400 mg of bleomycin should be avoided in patients with normal renal function. In those over 70 years of age reduced creatinine clearance makes dosage reduction necessary. 

The long-term prognosis for sperm counts after chemotherapy with and without radiation in 71 males treated for non-Hodgkin s lymphoma on the CHOP-Bleomycin combination has been studied (262). Pelvic radiotherapy and cumulative cyclophosphamide dosages of greater than 9.5 g/m are associated independently and in combination with a greater risk of permanent sterility. 

Other toxic reactions to bleomycin include hyperthermia, headache, nausea and vomiting, and an acute and sometimes fatal reaction observed in patients with lymphomas that is characterized by profound hyperthermia, hypotension, and sustained cardiorespiratory collapse. This does not appear to be classical anaphylaxis and has occurred in 1% of patients with lymphomas. Patients should receive a test dose of bleomycin (1 U), followed by a 1-hour period of observation, before the drug is administered on standard dosage schedules. Exacerbations of rheumatoid arthritis also have been reported. Raynaud s phenomenon and coronary artery occlusive events have been reported in patients with testicular tumors treated with bleomycin in combination regimens. 

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