Bleomycin Sulfate – Uses, Dosage, Side Effects, Interactions

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 49 min read
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Bleomycin A2 is the primary bleomycin species in bleomycin sulfate, a mixture of the sulfate salts of several basic glycopeptide antineoplastic antibiotics isolated from Streptomyces verticillus. Bleomycin A2 forms complexes with iron that reduce molecular oxygen to superoxide and hydroxyl radicals which cause single- and double-stranded breaks in DNA; these reactive oxygen species...

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Article Summary

Bleomycin A2 is the primary bleomycin species in bleomycin sulfate, a mixture of the sulfate salts of several basic glycopeptide antineoplastic antibiotics isolated from Streptomyces verticillus. Bleomycin A2 forms complexes with iron that reduce molecular oxygen to superoxide and hydroxyl radicals which cause single- and double-stranded breaks in DNA; these reactive oxygen species also induce lipid peroxidation, carbohydrate oxidation, and alterations in prostaglandin synthesis and degradation. (NCI04) Bleomycin Sulfate is a mixture of...

Key Takeaways

  • This article explains Mechanism of Action in simple medical language.
  • This article explains Indications in simple medical language.
  • This article explains Contraindications in simple medical language.
  • This article explains Dosage in simple medical language.
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Definition

Bleomycin A2 is the primary bleomycin species in bleomycin sulfate, a mixture of the sulfate salts of several basic glycopeptide antineoplastic antibiotics isolated from Streptomyces verticillus. Bleomycin A2 forms complexes with iron that reduce molecular oxygen to superoxide and hydroxyl radicals which cause single- and double-stranded breaks in DNA; these reactive oxygen species also induce lipid peroxidation, carbohydrate oxidation, and alterations in prostaglandin synthesis and degradation. (NCI04)

Bleomycin Sulfate is a mixture of the sulfate salts of basic glycopeptide antineoplastic antibiotics isolated from Streptomyces verticillus. Bleomycin sulfate forms complexes with iron that reduce molecular oxygen to superoxide and hydroxyl radicals which cause single- and double-stranded breaks in DNA; these reactive oxygen species also induce lipid peroxidation, carbohydrate oxidation, and alterations in prostaglandin synthesis and degradation.

Bleomycin is a mixture of glycopeptide antineoplastic antibiotics isolated from the bacterium Streptomyces verticillus. Bleomycin forms complexes with iron that reduce molecular oxygen to superoxide and hydroxyl radicals which cause single- and double-stranded breaks in DNA; these reactive oxygen species also induce lipid peroxidation, carbohydrate oxidation, and alterations in prostaglandin synthesis and degradation.

Mechanism of Action

Although the exact mechanism of action of bleomycin is unknown, available evidence would seem to indicate that the main mode of action is the inhibition of DNA synthesis with some evidence of lesser inhibition of RNA and protein synthesis. As evident in _in vitro_ studies, the DNA-cleaving actions of bleomycin is dependent on oxygen and metal ions. It is believed that bleomycin chelates metal ions (primarily iron) producing a pseudonym that reacts with oxygen to produce superoxide and hydroxide free radicals that cleave DNA.

or

The cytotoxic action of bleomycin results from its ability to cause fragmentation of DNA. Studies in vitro indicate that bleomycin causes the accumulation of cells in the G2 phase of the cell cycle, and many of these cells display chromosomal aberrations, incl chromatid breaks, gaps, and fragments, as well as translocations. Bleomycin appears to cause the scission of DNA by interacting with oxygen and iron(2+). In the presence of oxygen and a reducing agent, such as dithiothreitol, the metallobleomycin complex becomes activated and functions mechanistically as a ferrous oxidase, transferring electrons from iron(2) to molecular oxygen to produce activated species of oxygen. It has also been shown that metallobleomycin complexes can be activated by a reaction with the flavin enzyme, NADPH-cytochrome p450 reductase. Bleomycin binds to DNA through its amino-terminal peptide, and the activated complex generates free radicals that are responsible for the scission of the DNA chain.

Indications

Antibiotics, Antineoplastic; Antibiotics, Glycopeptide; Antimetabolites, Antineoplastic

  • For palliative treatment in the management of malignant neoplasm (trachea, bronchus, lung), squamous cell carcinoma, and lymphomas.
  • Bleomycin is a cytotoxic bacterial infections. সহজ বাংলা: ব্যাকটেরিয়ার সংক্রমণের ওষুধ।" data-rx-term="antibiotic" data-rx-definition="An antibiotic is a medicine used to treat bacterial infections. সহজ বাংলা: ব্যাকটেরিয়ার সংক্রমণের ওষুধ।">antibiotic that is used as an anticancer agent in the therapy of testicular and germ cell cancers, Hodgkin’s disease, lymphomas, and tumors of the head and neck.
  • Therapy with bleomycin in combination with other agents is often associated with mild-to-moderate serum enzyme elevations but is a rare cause of clinically apparent liver injury.
  • Bleomycin is indicated in the treatment of squamous cell carcinomas of the head and neck (including the mouth, tongue, tonsil, nasopharynx, oropharynx, sinus, palate, lip, buccal mucosa, gingiva, epiglottis, and larynx and paralarynx), cervix, penis, skin and vulva. It is also indicated for the treatment of testicular carcinoma (including embryonal cell carcinoma, choriocarcinoma, and teratocarcinoma), esophageal, and thyroid carcinomas.
  • Bleomycin is indicated for the treatment of Hodgkin’s and non-Hodgkin’s lymphomas.
  • Bleomycin is indicated in the treatment of AIDS-associated Kaposi’s sarcoma.
  • For more Therapeutic Uses (Complete) data for BLEOMYCIN (12 total),

Bleomycin sulfate is approved to be used alone or with other drugs as palliative treatment of:

  • Hodgkin lymphoma.
  • Non-Hodgkin lymphoma (NHL).
  • Squamous cell carcinoma of the penis.
  • Squamous cell carcinoma of the cervix.
  • Squamous cell carcinoma of the head and neck (SCCHN).
  • Squamous cell carcinoma of the vulva.
  • Testicular cancer.

Bleomycin sulfate is also approved to treat malignant pleural effusion and keep it from recurring (coming back).

Bleomycin sulfate is also being studied in the treatment of other types of cancer.

Contraindications

  • Bleomycin for Injection is contraindicated in patients who have demonstrated a hypersensitive or idiosyncratic reaction to it.
  • Bleomycin for Injection is contraindicated in patients who have demonstrated a hypersensitive or idiosyncratic reaction to it.

Dosage

Strengths: 15 units; 30 units; 15,000 intl units

Squamous Cell Carcinoma

  • 0.25 to 0.5 units/kg (10 to 20 units/m2) IV, IM, or subcutaneously 1 to 2 times a week

Non-Hodgkin’s Lymphoma

  • 0.25 to 0.5 units/kg (10 to 20 units/m2) IV, IM, or subcutaneously 1 to 2 times a week

Testicular Cancer

  • 0.25 to 0.5 units/kg (10 to 20 units/m2) IV, IM, or subcutaneously 1 to 2 times a week

Hodgkin’s Disease

  • 0.25 to 0.5 units/kg (10 to 20 units/m2) IV, IM, or subcutaneously 1 to 2 times a week; after a 50% response, a maintenance dose of 1 unit daily or 5 units weekly IV or IM should be given

Malignant Pleural Effusion

  • 60 units administered as a single bolus intrapleural injection

Side Effects

The Most Common

  • sudden chest pain, shortness of breath, dry cough, tiredness;
  • a light-headed feeling, feeling like you might pass out;
  • loss of appetite, weight loss;
  • sudden numbness or weakness on one side of the body, problems with vision or speech;
  • blisters or ulcers in your mouth, red or swollen gums, trouble swallowing;
  • unusual hardening of your skin; or
  • swelling, numbness, tingling or cold feeling in your fingers.

More Common

  • skin redness, dark streaks, or discoloration;
  • fingernail or toenail changes;
  • Darkening or thickening of skin
  • dark stripes on skin
  • itching of skin
  • skin rash or colored bumps on fingertips, elbows, or palms
  • skin redness or pain when an area is touched or pressed. সহজ বাংলা: চাপ দিলে ব্যথা।" data-rx-term="tenderness" data-rx-definition="Tenderness means pain when an area is touched or pressed. সহজ বাংলা: চাপ দিলে ব্যথা।">tenderness
  • swelling of fingers
  • vomiting and loss of appetite

Less common

  • Changes in fingernails or toenails
  • weight loss
  • Cough
  • shortness of breath
  • fever, chills, vomiting, not feeling well;
  • rash, itching; or
  • hair loss.

Drug Interactions

Pregnancy and Lactation

Pregnancy

Bleomycin is FDA pregnancy risk category D and can harm the fetus when given during pregnancy. Animal studies reveal abortifacient and/or teratogenic effects. Bleomycin should be given to pregnant women only when the benefit to the mother outweighs the risk to the fetus. Females of childbearing potential should be advised to avoid becoming pregnant while receiving bleomycin. If bleomycin is used during pregnancy or if a patient becomes pregnant while receiving bleomycin, the patient should be made aware of the potential harm to the fetus.

Breast-feeding

It is not known whether bleomycin is excreted into breast milk. Many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from bleomycin, breastfeeding is not advised, and patients should be instructed to discontinue breastfeeding during bleomycin therapy.

References

  1. https://pubchem.ncbi.nlm.nih.gov/compound/Bleomycin-sulfate
  2. https://pubchem.ncbi.nlm.nih.gov/compound/46930981
  3. https://pubchem.ncbi.nlm.nih.gov/compound/Bleomycin
  4. https://www.pdr.net/drug-summary/Bleomycin-bleomycin-sulfate
  5. https://www.pfizermedicalinformation.com/en-us/node/310376/pi_section/field_spl_boxed_warning
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  8. https://www.cancer.gov/about-cancer/treatment/drugs/bleomycin
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    LICENSE
    Creative Common’s Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/legalcode)
    https://www.drugbank.ca/legal/terms_of_use
    Bleomycin
    https://www.drugbank.ca/drugs/DB00290
  10. EPA DSSTox
    LICENSE
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    Bleomycin
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    Bleomycin sulfate
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  11. European Chemicals Agency (ECHA)
    LICENSE
    Use of the information, documents and data from the ECHA website is subject to the terms and conditions of this Legal Notice, and subject to other binding limitations provided for under applicable law, the information, documents and data made available on the ECHA website may be reproduced, distributed and/or used, totally or in part, for non-commercial purposes provided that ECHA is acknowledged as the source: “Source: European Chemicals Agency, http://echa.europa.eu/”. Such acknowledgement must be included in each copy of the material. ECHA permits and encourages organisations and individuals to create links to the ECHA website under the following cumulative conditions: Links can only be made to webpages that provide a link to the Legal Notice page.
    https://echa.europa.eu/web/guest/legal-notice
    Bleomycin, sulfate (salt)
    https://echa.europa.eu/substance-information/-/substanceinfo/100.029.920
    Bleomycin, sulfate (salt)
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    BLEOMYCIN
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    Bleomycin
    https://www.ncbi.nlm.nih.gov/books/n/livertox/Bleomycin/
  14. NCI Thesaurus (NCIt)
    LICENSE
    Unless otherwise indicated, all text within NCI products is free of copyright and may be reused without our permission. Credit the National Cancer Institute as the source.
    https://www.cancer.gov/policies/copyright-reuse
    https://ncithesaurus.nci.nih.gov/ncitbrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&ns=ncit&code=C311
    https://ncithesaurus.nci.nih.gov/ncitbrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&ns=ncit&code=C313
    https://ncithesaurus.nci.nih.gov/ncitbrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&ns=ncit&code=C312
  15. ChEMBL
    LICENSE
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    http://www.ebi.ac.uk/Information/termsofuse.html
    https://www.ebi.ac.uk/chembl/compound_report_card/CHEMBL3085504/
  16. Comparative Toxicogenomics Database (CTD)
    LICENSE
    It is to be used only for research and educational purposes. Any reproduction or use for commercial purpose is prohibited without the prior express written permission of NC State University.
    http://ctdbase.org/about/legal.jsp
    https://ctdbase.org/detail.go?type=chem&acc=D001761
  17. ClinicalTrials.gov
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    https://clinicaltrials.gov/ct2/about-site/terms-conditions#Use
    https://clinicaltrials.gov/
  18. DailyMed
    LICENSE
    https://www.nlm.nih.gov/copyright.html
    BLEOMYCIN SULFATE
    https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=BLEOMYCIN+SULFATE
  19. The Natural Products Atlas
    LICENSE
    The Natural Products Atlas is licensed under a Creative Commons Attribution 4.0 International License.
    https://www.npatlas.org/terms
    Bleomycin A2
    https://www.npatlas.org/explore/compounds/NPA020036
  20. Drugs and Lactation Database (LactMed)
    LICENSE
    https://www.nlm.nih.gov/copyright.html
    Bleomycin
    https://www.ncbi.nlm.nih.gov/books/NBK500695/
  21. DTP/NCI
    LICENSE
    Unless otherwise indicated, all text within NCI products is free of copyright and may be reused without our permission. Credit the National Cancer Institute as the source.
    https://www.cancer.gov/policies/copyright-reuse
    bleomycin a2
    https://dtp.cancer.gov/dtpstandard/servlet/dwindex?searchtype=NSC&outputformat=html&searchlist=146842
  22. EU Clinical Trials Register
    https://www.clinicaltrialsregister.eu/
  23. FDA Orange Book
    LICENSE
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    https://www.fda.gov/about-fda/about-website/website-policies#linking
    https://www.fda.gov/drugs/drug-approvals-and-databases/approved-drug-products-therapeutic-equivalence-evaluations-orange-book
  24. International Agency for Research on Cancer (IARC)
    LICENSE
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    https://publications.iarc.fr/Terms-Of-Use
    Bleomycins
    https://monographs.iarc.who.int/list-of-classifications
    IARC Classification
    https://www.iarc.fr/
  25. National Drug Code (NDC) Directory
    LICENSE
    Unless otherwise noted, the contents of the FDA website (www.fda.gov), both text and graphics, are not copyrighted. They are in the public domain and may be republished, reprinted and otherwise used freely by anyone without the need to obtain permission from FDA. Credit to the U.S. Food and Drug Administration as the source is appreciated but not required.
    https://www.fda.gov/about-fda/about-website/website-policies#linking
    BLEOMYCIN
    https://www.fda.gov/drugs/drug-approvals-and-databases/national-drug-code-directory
  26. NCI Cancer Drugs
    LICENSE
    https://www.cancer.gov/policies/copyright-reuse
    Bleomycin Sulfate
    https://www.cancer.gov/about-cancer/treatment/drugs/bleomycin
  27. NIPH Clinical Trials Search of Japan
    https://rctportal.niph.go.jp/en/
  28. PubChem
    https://pubchem.ncbi.nlm.nih.gov
  29. SpectraBase
    Bleomycin A2 cation
    https://spectrabase.com/spectrum/50ByvxpHsot
    Bleomycin A2 cation
    https://spectrabase.com/spectrum/h1WdKO7sBf
  30. WHO Anatomical Therapeutic Chemical (ATC) Classification
    LICENSE
    Use of all or parts of the material requires reference to the WHO Collaborating Centre for Drug Statistics Methodology. Copying and distribution for commercial purposes is not allowed. Changing or manipulating the material is not allowed.
    https://www.whocc.no/copyright_disclaimer/
    https://www.whocc.no/atc/
    ATC Code
    https://www.whocc.no/atc_ddd_index/
  31. WHO Model Lists of Essential Medicines
    LICENSE
    WHO supports open access to the published output of its activities as a fundamental part of its mission and a public benefit to be encouraged wherever possible. WHO’s open access applies to WHO CC BY-NC-SA 3.0 IGO.
    https://www.who.int/about/who-we-are/publishing-policies/copyright
    Bleomycin
    https://list.essentialmeds.org/medicines/74
  32. Wikidata
    LICENSE
    CCZero
    https://creativecommons.org/publicdomain/zero/1.0/
    bleomycin A2 (incomplete stereochemistry)
    https://www.wikidata.org/wiki/Q26998364
    Q105203557
    https://www.wikidata.org/wiki/Q105203557
  33. Medical Subject Headings (MeSH)
    LICENSE
    Works produced by the U.S. government are not subject to copyright protection in the United States. Any such works found on National Library of Medicine (NLM) Web sites may be freely used or reproduced without permission in the U.S.
    https://www.nlm.nih.gov/copyright.html
    Bleomycin
    https://www.ncbi.nlm.nih.gov/mesh/68001761
    MeSH Tree
    http://www.nlm.nih.gov/mesh/meshhome.html
    Antibiotics, Antineoplastic
    https://www.ncbi.nlm.nih.gov/mesh/68000903
  34. UN Globally Harmonized System of Classification and Labelling of Chemicals (GHS)
    GHS Classification Tree
    http://www.unece.org/trans/danger/publi/ghs/ghs_welcome_e.html

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What to tell the doctor

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Questions to ask

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Safe first steps

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OTC medicine safety

  • For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
  • Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

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Get urgent help if

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Questions to ask
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  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?
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Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

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Care roadmap for: Bleomycin Sulfate – Uses, Dosage, Side Effects, Interactions

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
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Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

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  4. Step 4

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    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
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Foodborne Illness (also foodborne disease and colloquially referred to as food poisoning)[rx] is any illness resulting from the spoilage of contaminated food, pathogenic bacteria, viruses, or parasites that…

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