Bleomycin
Bleomycin sulfate
Also known as: Blenoxane · Blenamax · Bleocin · Bileco · Blanoxan · bleomycin sulphate · bleomycini sulfas · Bleo-S · Bleo-cell · Bleolem · Blio · Blocamicina · Bonar · Oil Bleo · Tecnomicina
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
This dose is based on body surface area (mg/m²). Convert body weight to body surface area before dosing.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Antineoplastic therapy (General guide) | 10 Units mg/m2 (NOT mg/kg) or 0.3-0.5 mg/kg | Parenteral | Varies (e.g., once daily for a few days then once weekly, or once weekly at the start) | Do not exceed total maximum dosage of 125-200 mg/m2 | 🌎 NA |
- Antineoplastic therapy (General guide): 1 Unit = 1 mg. Consultation with a veterinary oncologist is strongly recommended.
Cats
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Antineoplastic therapy (General guide) | 10 Units mg/m2 (NOT mg/kg) or 0.3-0.5 mg/kg | Parenteral | Varies (e.g., once daily for a few days then once weekly, or once weekly at the start) | Do not exceed total maximum dosage of 125-200 mg/m2 | 🌎 NA |
- Antineoplastic therapy (General guide): 1 Unit = 1 mg. Consultation with a veterinary oncologist is strongly recommended.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Bleomycin is a glycopeptide antibiotic antineoplastic agent derived from Streptomyces verticillus.
Key Clinical Uses:
- Adjunctive treatment for lymphomas, squamous cell carcinomas (SCC), teratomas, and nonfunctional thyroid tumors in dogs and cats.
- Electrochemotherapy (ECT): Bleomycin is highly effective when combined with intralesional electropermeabilization, significantly increasing intracellular drug concentrations for localized tumors (e.g., feline nasal planum SCC, canine mast cell tumors).
Toxicity Profile: Unlike many traditional chemotherapeutics, bleomycin is generally sparing to the bone marrow. However, it carries significant risks of pulmonary fibrosis and dermatologic toxicity. This unique toxicity profile occurs because the lungs and skin lack the enzyme bleomycin hydrolase, which normally inactivates the drug in other tissues.
Mechanism of action
Bleomycin acts primarily by inducing single- and double-strand DNA breaks.
- Mechanism: The drug possesses a DNA-binding domain and an iron-binding domain. It binds to DNA and chelates intracellular Fe²⁺ (ferrous iron).
- Oxidative Cleavage: The Bleomycin-Fe²⁺ complex reacts with oxygen to generate highly reactive oxygen species (ROS), such as superoxide and hydroxyl radicals → oxidative cleavage of the DNA phosphodiester backbone.
- Cell Cycle: It is considered cell-cycle phase-specific, primarily arresting cells in the G2 and M phases.
- Resistance: Mediated by decreased cellular uptake, increased DNA repair mechanisms, or increased cellular expression of bleomycin hydrolase (the enzyme responsible for its degradation).
Safety & warnings
Contraindications
- Prior hypersensitivity reactions to the drug
- Preexisting pulmonary disease
- Adverse pulmonary effects from prior therapy
- Pregnancy (unless owners accept the associated teratogenic risks)
Adverse effects
- Fever
- Anorexia
- Vomiting
- Allergic reactions (including anaphylaxis)
- Alopecia
- Skin rashes
- Stomatitis
- Pneumonitis
- Pulmonary fibrosis (potentially fatal)
- Thrombocytopenia (mild)
- Leukopenia (mild)
- Decreased hemoglobin
- Renal toxicity
- Hepatotoxicity
Precautions
Bleomycin is a toxic drug with a low therapeutic index; it should only be used by personnel equipped to actively monitor patients and handle complications. Use very cautiously in patients with significant renal impairment (dosage reduction may be necessary). It is teratogenic (FDA Category D). To reduce the likelihood of fatal pulmonary toxicity, a total maximum cumulative dosage of 125-200 mg/m2 should not be exceeded.
Drug interactions
Bleomycin sensitizes lung tissue to oxygen. Use of general anesthetics can cause rapid deterioration of pulmonary function and post-operative pulmonary fibrosis, even at safe inspired oxygen concentrations.
Prior or concomitant use can lead to increased hematologic, mucosal, and pulmonary toxicities.
Monitoring
- Efficacy (tumor response)
- Pulmonary Toxicity: Chest radiographs (baseline and regularly, e.g., q1-2 weeks), lung auscultation (monitor for dyspnea and fine rales)
- Blood chemistry (renal and hepatic function markers)
- Hematologic profiles (CBC)
- Total cumulative dose accumulation (do not exceed 125-200 mg/m2)
Pharmacokinetics
Half-life
Absorption
Not appreciably absorbed from the gut; must be administered parenterally.
Distribution
Mainly distributed to the lungs, kidneys, skin, lymphatics, and peritoneum.
Metabolism
Inactivated by the enzyme bleomycin hydrolase, which is abundant in most tissues but notably deficient in the skin and lungs.
Elimination
In humans, 60-70% of a dose is excreted as active drug in the urine.
Overdose
No specific information was located in the monograph. Because of the high toxicity and low therapeutic index of the drug, it is critical to determine dosages carefully. Overdosage would likely manifest as severe exacerbations of acute toxicities (anaphylaxis, fever, vomiting) and accelerated onset of delayed toxicities (pulmonary fibrosis, stomatitis).
Available products
Formulations
- Powder for injection
Human-labeled
- Bleomycin Sulfate Lyophilized Powder for Injection after reconstitution: 15 Units & 30 Units per vial
Regulatory status
No regulatory data for: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Powder for injection should be kept refrigerated. After reconstituting with sterile saline, water, or dextrose, the resulting solution is stable for 24 hours. Bleomycin is less stable in dextrose solutions than in saline. While reportedly stable in normal saline for at least 2 weeks at room temperature and 4 weeks refrigerated, use within 24 hours is recommended because the solution contains no preservatives.
Client information
Critical Warning: Bleomycin can cause severe and potentially irreversible lung damage.
- Breathing Changes: Monitor your pet's breathing closely. Contact your veterinarian immediately if you notice coughing, wheezing, shortness of breath, or increased effort to breathe.
- Skin and Mouth Sores: Watch for hair loss, skin rashes, or sores in the mouth (stomatitis). Offer soft foods if your pet's mouth appears sensitive.
- General Signs: Mild fever, loss of appetite, and vomiting can occur shortly after administration.
- Anesthesia Risk: If your pet ever needs surgery or anesthesia in the future, you must inform the veterinary team that they have received bleomycin. This drug makes the lungs highly sensitive to oxygen therapy, which requires special anesthetic protocols.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.