Bleomycin is a chemotherapy drug that is given as a treatment for some types of cancer. This information describes bleomycin, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer, which give more information and advice.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

Bleomycin is a colourless fluid after being dissolved from powder.

Bleomycin is given:

• As a drip (infusion) through a fine tube (cannula) inserted into the vein. It may be given through a central line, which is inserted under the skin into a vein near the collarbone, or through a PICC line, which is inserted into a vein in the crook of your arm. The infusion usually takes about 30 minutes.
• By injection into a muscle (intramuscular injection), or rarely, under the skin (subcutaneously).
• By injection into a chest drain. This is done after the fluid that can build up between the layers covering the lungs (a pleural effusion) is drained. This can help to seal the two layers (the pleura) together to stop the pleural effusion from happening again.

Chemotherapy is usually given as a course of several sessions (or cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer for which you are being treated. Bleomycin is commonly given alongside other chemotherapy drugs as part of a combination regimen. Your nurse or doctor will discuss your treatment plan with you.

Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given bleomycin, and may be different if you are having more than one chemotherapy drug.

We have outlined the most common side effects and some of the less common ones, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Fever and chills These may occur, starting up to several hours after the drug is given, but they do not usually last long. Your doctor may prescribe medicines to reduce this side effect, which can be taken before the bleomycin is given.

Skin changes Bleomycin can cause a rash, which may be itchy. Your doctor can prescribe medicine to help with this. Your skin may darken, due to overproduction of pigment. You may also notice long streaks on your skin, as if you have been scratched. Your skin will go back to normal a few months after the treatment has finished.

Loss of appetite A dietitian or specialist nurse at your hospital can give advice about how to boost your appetite, cope with eating difficulties and maintain your weight.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Mouth sores and ulcers Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as special mouthwashes and medicines can be prescribed to prevent or clear infection.

Taste changes You may also notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Changes in nails Your nails may become darker, or ridged. They usually return to normal within a few months of finishing the treatment.

Feeling sick (nausea) and being sick (vomiting) If you do feel sick this may begin after the treatment is given and last for up to 12 hours. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting. If the sickness is not controlled, or continues, tell your doctor; they can prescribe other anti-sickness drugs which may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Hair loss Hair loss is rare but hair may thin, or occasionally be lost completely. If this happens it usually begins about 3–4 weeks after starting treatment, although it may occur earlier. It is temporary and your hair will start to regrow a few weeks after treatment ends.

Sensitivity of the skin to sunlight During treatment with bleomycin, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily than normal. You can still go out in the sun, but always wear a high protection factor suncream, protective clothing and a hat.

Changes to the lungs Bleomycin may cause some changes to lung tissue. Tell your doctor if you smoke and if you notice any coughing or breathlessness. You may have a chest x-ray to check your lungs before you are given any bleomycin.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking bleomycin, as the developing foetus may be harmed. It is necessary to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

This section is based on our Bleomycin factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• The Medicines.org.uk website - www.medicines.org.uk (November 2007).
• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott, Williams and Wilkins, 2001.

For further references, please see general bibliography.