Perioperative Considerations for Patients Treated with Bleomycin (4)

In: Bleomycin

6 Apr 2013

The severity of bleomycin-induced pulmonary toxicity is dose-related in mice, rats, and hamsters. In humans the relationship is less clear. Some studies have shown a significantly increased toxicity when the total dose exceeds 450 to 500 mg, while toxicity has not been dose-related in other studies. There is a 3 to 5 percent incidence of toxicity in the 100-mg to 500-mg total dose range without a dose-related response. Fatal pulmonary toxicity has occurred with a total dose of less than 63 mg. To put these doses into a clinical context, the maximum dose recommended by the manufacturer is 400 mg, and a commonly used chemotherapeutic regimen for the treatment of testicular cancer includes bleomycin in the dose range of 120 mg to 420 mg for an average-sized adult male patient.

Toxicity may also be related to the duration of drug administration. Patients who received 100 to 150 mg/m2 of body surface area (total dose of 187 mg to 280 mg for the average adult male patient) within a short period (in this study, five to eight days) were at increased risk. proventil inhaler
Histologic Changes
The histologic appearance of fibrosis caused by bleomycin toxicity is the same as that of idiopathic pulmonary fibrosis and fibrosis secondary to other toxic substances. In humans, the earliest damage seen is alveolar and interstitial edema.

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