Bleomycin Sulfate – Uses, Dosage, Side Effects, Interactions

Mechanism of Action
Indications
Contraindications
Dosage
Side Effects
Drug Interactions
Pregnancy and Lactation

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.

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 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 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

DRUG	INTERACTION
Abacavir	Bleomycin may decrease the excretion rate of Abacavir which could result in a higher serum level.
Abatacept	The risk or severity of adverse effects can be increased when Bleomycin is combined with Abatacept.
Aceclofenac	Aceclofenac may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Acemetacin	Acemetacin may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Acetaminophen	Bleomycin may decrease the excretion rate of Acetaminophen which could result in a higher serum level.
Acetazolamide	Acetazolamide may increase the excretion rate of Bleomycin which could result in a lower serum level and potentially a reduction in efficacy.
Acetyldigitoxin	Acetyldigitoxin may decrease the cardiotoxic activities of Bleomycin.
Acetylsalicylic acid	Acetylsalicylic acid may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Aclidinium	Bleomycin may decrease the excretion rate of Aclidinium which could result in a higher serum level.
Acrivastine	Bleomycin may decrease the excretion rate of Acrivastine which could result in a higher serum level.
Acyclovir	Acyclovir may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Adalimumab	The risk or severity of adverse effects can be increased when Adalimumab is combined with Bleomycin.
Adefovir dipivoxil	Adefovir dipivoxil may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Adenovirus type 7 vaccine live	The risk or severity of infection can be increased when Adenovirus type 7 vaccine live is combined with Bleomycin.
Albutrepenonacog alfa	Bleomycin may decrease the excretion rate of Albutrepenonacog alfa which could result in a higher serum level.
Alclofenac	Alclofenac may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Aldesleukin	The risk or severity of adverse effects can be increased when Aldesleukin is combined with Bleomycin.
Alefacept	The risk or severity of adverse effects can be increased when Alefacept is combined with Bleomycin.
Alemtuzumab	The risk or severity of adverse effects can be increased when Alemtuzumab is combined with Bleomycin.
Allogeneic processed thymus tissue	The therapeutic efficacy of Allogeneic processed thymus tissue can be decreased when used in combination with Bleomycin.
Allopurinol	Bleomycin may decrease the excretion rate of Allopurinol which could result in a higher serum level.
Almasilate	Bleomycin may decrease the excretion rate of Almasilate which could result in a higher serum level.
Almotriptan	Bleomycin may decrease the excretion rate of Almotriptan which could result in a higher serum level.
Alogliptin	Bleomycin may decrease the excretion rate of Alogliptin which could result in a higher serum level.
Alprazolam	Bleomycin may decrease the excretion rate of Alprazolam which could result in a higher serum level.
Altretamine	The risk or severity of adverse effects can be increased when Bleomycin is combined with Altretamine.
Amantadine	Bleomycin may decrease the excretion rate of Amantadine which could result in a higher serum level.
Amikacin	Bleomycin may decrease the excretion rate of Amikacin which could result in a higher serum level.
Amiloride	Amiloride may increase the excretion rate of Bleomycin which could result in a lower serum level and potentially a reduction in efficacy.
Aminophenazone	Aminophenazone may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Amitriptyline	Bleomycin may decrease the excretion rate of Amitriptyline which could result in a higher serum level.
Ammonium chloride	Bleomycin may decrease the excretion rate of Ammonium chloride which could result in a higher serum level.
Amoxicillin	Bleomycin may decrease the excretion rate of Amoxicillin which could result in a higher serum level.
Amphetamine	Amphetamine may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Amphotericin B	Amphotericin B may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Ampicillin	Bleomycin may decrease the excretion rate of Ampicillin which could result in a higher serum level.
Amrinone	Bleomycin may decrease the excretion rate of Amrinone which could result in a higher serum level.
Amsacrine	The risk or severity of adverse effects can be increased when Amsacrine is combined with Bleomycin.
Anakinra	The risk or severity of adverse effects can be increased when Anakinra is combined with Bleomycin.
Anastrozole	The risk or severity of cardiotoxicity can be increased when Bleomycin is combined with Anastrozole.
Ancestim	Bleomycin may decrease the excretion rate of Ancestim which could result in a higher serum level.
Anifrolumab	The risk or severity of adverse effects can be increased when Bleomycin is combined with Anifrolumab.
Anthrax immune globulin human	The therapeutic efficacy of Anthrax immune globulin human can be decreased when used in combination with Bleomycin.
Anthrax vaccine	The risk or severity of infection can be increased when Anthrax vaccine is combined with Bleomycin.
Antihemophilic factor (recombinant), PEGylated	Bleomycin may decrease the excretion rate of Antihemophilic factor (recombinant), PEGylated which could result in a higher serum level.
Antilymphocyte immunoglobulin (horse)	The risk or severity of adverse effects can be increased when Bleomycin is combined with Antilymphocyte immunoglobulin (horse).
Antipyrine	Antipyrine may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Antithrombin III human	Bleomycin may decrease the excretion rate of Antithrombin III human which could result in a higher serum level.
Antithymocyte immunoglobulin (rabbit)	The risk or severity of adverse effects can be increased when Antithymocyte immunoglobulin (rabbit) is combined with Bleomycin.
Antrafenine	Antrafenine may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Apalutamide	Bleomycin may decrease the excretion rate of Apalutamide which could result in a higher serum level.
Apremilast	The risk or severity of adverse effects can be increased when Bleomycin is combined with Apremilast.
Arformoterol	Bleomycin may decrease the excretion rate of Arformoterol which could result in a higher serum level.
Arsenic trioxide	The risk or severity of adverse effects can be increased when Bleomycin is combined with Arsenic trioxide.
Articaine	The risk or severity of methemoglobinemia can be increased when Bleomycin is combined with Articaine.
Ascorbic acid	The therapeutic efficacy of Bleomycin can be decreased when used in combination with Ascorbic acid.
AstraZeneca COVID-19 Vaccine	The therapeutic efficacy of AstraZeneca COVID-19 Vaccine can be decreased when used in combination with Bleomycin.
Atazanavir	Atazanavir may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Atomoxetine	Atomoxetine may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Auranofin	Bleomycin may decrease the excretion rate of Auranofin which could result in a higher serum level.
Aurothioglucose	Bleomycin may decrease the excretion rate of Aurothioglucose which could result in a higher serum level.
Azacitidine	The risk or severity of adverse effects can be increased when Bleomycin is combined with Azacitidine.
Azathioprine	The risk or severity of adverse effects can be increased when Bleomycin is combined with Azathioprine.
Azelaic acid	Bleomycin may decrease the excretion rate of Azelaic acid which could result in a higher serum level.
Aztreonam	Bleomycin may decrease the excretion rate of Aztreonam which could result in a higher serum level.
Bacillus calmette-guerin substrain connaught live antigen	The risk or severity of infection can be increased when Bacillus calmette-guerin substrain connaught live antigen is combined with Bleomycin.
Bacillus calmette-guerin substrain russian BCG-I live antigen	The therapeutic efficacy of Bacillus calmette-guerin substrain russian BCG-I live antigen can be decreased when used in combination with Bleomycin.
Bacillus calmette-guerin substrain tice live antigen	The risk or severity of infection can be increased when Bacillus calmette-guerin substrain tice live antigen is combined with Bleomycin.
Bacitracin	Bacitracin may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Baclofen	Baclofen may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Balsalazide	Balsalazide may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Baricitinib	The risk or severity of adverse effects can be increased when Bleomycin is combined with Baricitinib.
Basiliximab	The risk or severity of adverse effects can be increased when Basiliximab is combined with Bleomycin.
BCG vaccine	The risk or severity of infection can be increased when BCG vaccine is combined with Bleomycin.
Beclomethasone dipropionate	The risk or severity of adverse effects can be increased when Bleomycin is combined with Beclomethasone dipropionate.
Belatacept	The risk or severity of adverse effects can be increased when Bleomycin is combined with Belatacept.
Belimumab	The risk or severity of adverse effects can be increased when Bleomycin is combined with Belimumab.
Belinostat	The risk or severity of adverse effects can be increased when Bleomycin is combined with Belinostat.
Belumosudil	The risk or severity of adverse effects can be increased when Bleomycin is combined with Belumosudil.
Bendamustine	The risk or severity of adverse effects can be increased when Bleomycin is combined with Bendamustine.
Bendroflumethiazide	Bendroflumethiazide may increase the excretion rate of Bleomycin which could result in a lower serum level and potentially a reduction in efficacy.
Benorilate	Benorilate may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Benoxaprofen	Benoxaprofen may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Benserazide	Bleomycin may decrease the excretion rate of Benserazide which could result in a higher serum level.
Benzatropine	Benzatropine may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Benznidazole	Bleomycin may decrease the excretion rate of Benznidazole which could result in a higher serum level.
Benzocaine	The risk or severity of methemoglobinemia can be increased when Bleomycin is combined with Benzocaine.
Benzthiazide	Benzthiazide may increase the excretion rate of Bleomycin which could result in a lower serum level and potentially a reduction in efficacy.
Benzydamine	Benzydamine may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Benzyl alcohol	The risk or severity of methemoglobinemia can be increased when Bleomycin is combined with Benzyl alcohol.
Bepotastine	Bleomycin may decrease the excretion rate of Bepotastine which could result in a higher serum level.
Betamethasone	The risk or severity of adverse effects can be increased when Bleomycin is combined with Betamethasone.
Bevacizumab	The risk or severity of cardiotoxicity can be increased when Bevacizumab is combined with Bleomycin.
Bexarotene	The risk or severity of adverse effects can be increased when Bleomycin is combined with Bexarotene.
Bicisate	Bleomycin may decrease the excretion rate of Bicisate which could result in a higher serum level.
Bimekizumab	The risk or severity of adverse effects can be increased when Bleomycin is combined with Bimekizumab.
Bismuth subgallate	Bleomycin may decrease the excretion rate of Bismuth subgallate which could result in a higher serum level.
Bisoprolol	Bleomycin may decrease the excretion rate of Bisoprolol which could result in a higher serum level.
Bisoxatin	Bleomycin may decrease the excretion rate of Bisoxatin which could result in a higher serum level.
Blinatumomab	The risk or severity of adverse effects can be increased when Bleomycin is combined with Blinatumomab.

Bortezomib	The risk or severity of adverse effects can be increased when Bortezomib is combined with Bleomycin.
Bosutinib	The risk or severity of adverse effects can be increased when Bleomycin is combined with Bosutinib.
Brentuximab vedotin	The risk or severity of pulmonary toxicity can be increased when Brentuximab vedotin is combined with Bleomycin.
Brivaracetam	Bleomycin may decrease the excretion rate of Brivaracetam which could result in a higher serum level.
Brodalumab	The risk or severity of adverse effects can be increased when Bleomycin is combined with Brodalumab.
Bromazepam	Bleomycin may decrease the excretion rate of Bromazepam which could result in a higher serum level.
Bromotheophylline	Bromotheophylline may increase the excretion rate of Bleomycin which could result in a lower serum level and potentially a reduction in efficacy.
Budesonide	The risk or severity of adverse effects can be increased when Bleomycin is combined with Budesonide.
Bumadizone	Bumadizone may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Bumetanide	Bumetanide may increase the excretion rate of Bleomycin which could result in a lower serum level and potentially a reduction in efficacy.
Bupivacaine	The risk or severity of methemoglobinemia can be increased when Bleomycin is combined with Bupivacaine.
Bupropion	Bleomycin may decrease the excretion rate of Bupropion which could result in a higher serum level.
Buspirone	Bleomycin may decrease the excretion rate of Buspirone which could result in a higher serum level.
Busulfan	The risk or severity of adverse effects can be increased when Bleomycin is combined with Busulfan.
Butabarbital	Butabarbital may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Butacaine	The risk or severity of methemoglobinemia can be increased when Bleomycin is combined with Butacaine.
Butamben	The risk or severity of methemoglobinemia can be increased when Bleomycin is combined with Butamben.
Cabazitaxel	The risk or severity of adverse effects can be increased when Bleomycin is combined with Cabazitaxel.
Calcium ascorbate	The therapeutic efficacy of Bleomycin can be decreased when used in combination with Calcium ascorbate.
Canagliflozin	Canagliflozin may increase the excretion rate of Bleomycin which could result in a lower serum level and potentially a reduction in efficacy.
Canakinumab	The risk or severity of adverse effects can be increased when Bleomycin is combined with Canakinumab.
Canrenoic acid	Canrenoic acid may increase the excretion rate of Bleomycin which could result in a lower serum level and potentially a reduction in efficacy.
Capecitabine	The risk or severity of adverse effects can be increased when Bleomycin is combined with Capecitabine.
Capreomycin	Bleomycin may decrease the excretion rate of Capreomycin which could result in a higher serum level.
Capsaicin	The risk or severity of methemoglobinemia can be increased when Bleomycin is combined with Capsaicin.
Carbamazepine	The risk or severity of adverse effects can be increased when Bleomycin is combined with Carbamazepine.
Carbidopa	Carbidopa may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Carboplatin	The risk or severity of adverse effects can be increased when Bleomycin is combined with Carboplatin.
Carfilzomib	The risk or severity of adverse effects can be increased when Bleomycin is combined with Carfilzomib.
Carmustine	The risk or severity of adverse effects can be increased when Carmustine is combined with Bleomycin.
Carprofen	Carprofen may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefaclor	Cefaclor may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefadroxil	Cefadroxil may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefalotin	Cefalotin may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefamandole	Cefamandole may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefapirin	Cefapirin may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefazolin	Cefazolin may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefdinir	Bleomycin may decrease the excretion rate of Cefdinir which could result in a higher serum level.
Cefditoren	Cefditoren may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefepime	Cefepime may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefmenoxime	Cefmenoxime may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefmetazole	Cefmetazole may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefonicid	Cefonicid may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefoperazone	Cefoperazone may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Ceforanide	Ceforanide may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefotaxime	Cefotaxime may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefotetan	Cefotetan may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefotiam	Cefotiam may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefoxitin	Cefoxitin may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefpiramide	Cefpiramide may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefpirome	Cefpirome may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefpodoxime	Cefpodoxime may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefprozil	Cefprozil may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefradine	Cefradine may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Ceftaroline fosamil	Ceftaroline fosamil may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Ceftazidime	Ceftazidime may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Ceftibuten	Ceftibuten may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Ceftizoxime	Ceftizoxime may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Ceftobiprole	Ceftobiprole may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Ceftolozane	Bleomycin may decrease the excretion rate of Ceftolozane which could result in a higher serum level.
Ceftriaxone	Ceftriaxone may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cefuroxime	Cefuroxime may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Celecoxib	Celecoxib may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cephalexin	Cephalexin may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cephaloglycin	Cephaloglycin may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Certolizumab pegol	The risk or severity of adverse effects can be increased when Bleomycin is combined with Certolizumab pegol.
Cetirizine	Bleomycin may decrease the excretion rate of Cetirizine which could result in a higher serum level.
Cevimeline	Cevimeline may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Chloral hydrate	Bleomycin may decrease the excretion rate of Chloral hydrate which could result in a higher serum level.
Chlorambucil	The risk or severity of adverse effects can be increased when Bleomycin is combined with Chlorambucil.
Chloramphenicol	The risk or severity of adverse effects can be increased when Bleomycin is combined with Chloramphenicol.
Chloroprocaine	The risk or severity of methemoglobinemia can be increased when Bleomycin is combined with Chloroprocaine.
Chloroquine	Bleomycin may decrease the excretion rate of Chloroquine which could result in a higher serum level.
Chlorothiazide	Chlorothiazide may increase the excretion rate of Bleomycin which could result in a lower serum level and potentially a reduction in efficacy.
Chloroxylenol	Bleomycin may decrease the excretion rate of Chloroxylenol which could result in a higher serum level.
Chlorpromazine	Bleomycin may decrease the excretion rate of Chlorpromazine which could result in a higher serum level.
Chlorpropamide	Bleomycin may decrease the excretion rate of Chlorpropamide which could result in a higher serum level.
Chlorthalidone	Chlorthalidone may increase the excretion rate of Bleomycin which could result in a lower serum level and potentially a reduction in efficacy.
Chlorzoxazone	Bleomycin may decrease the excretion rate of Chlorzoxazone which could result in a higher serum level.
Choline C 11	Bleomycin may decrease the excretion rate of Choline C 11 which could result in a higher serum level.
Choline magnesium trisalicylate	Choline magnesium trisalicylate may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Choline salicylate	Bleomycin may decrease the excretion rate of Choline salicylate which could result in a higher serum level.
Chondroitin sulfate	Bleomycin may decrease the excretion rate of Chondroitin sulfate which could result in a higher serum level.
Chromic chloride	Bleomycin may decrease the excretion rate of Chromic chloride which could result in a higher serum level.
Chromic nitrate	Bleomycin may decrease the excretion rate of Chromic nitrate which could result in a higher serum level.
Chromium	Bleomycin may decrease the excretion rate of Chromium which could result in a higher serum level.
Chromium gluconate	Bleomycin may decrease the excretion rate of Chromium gluconate which could result in a higher serum level.
Chromium nicotinate	Bleomycin may decrease the excretion rate of Chromium nicotinate which could result in a higher serum level.
Chromous sulfate	Bleomycin may decrease the excretion rate of Chromous sulfate which could result in a higher serum level.
Ciclesonide	The risk or severity of adverse effects can be increased when Bleomycin is combined with Ciclesonide.
Cidofovir	Cidofovir may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Cilostazol	Bleomycin may decrease the excretion rate of Cilostazol which could result in a higher serum level.
Cimetidine	Bleomycin may decrease the excretion rate of Cimetidine which could result in a higher serum level.
Cinchocaine	The risk or severity of methemoglobinemia can be increased when Bleomycin is combined with Cinchocaine.
Ciprofloxacin	Bleomycin may decrease the excretion rate of Ciprofloxacin which could result in a higher serum level.
Cisplatin	The risk or severity of adverse effects can be increased when Bleomycin is combined with Cisplatin.
Cladribine	The risk or severity of adverse effects can be increased when Cladribine is combined with Bleomycin.
Clevidipine	Bleomycin may decrease the excretion rate of Clevidipine which could result in a higher serum level.
Clobazam	Bleomycin may decrease the excretion rate of Clobazam which could result in a higher serum level.

Dabigatran etexilate	Bleomycin may decrease the excretion rate of Dabigatran etexilate which could result in a higher serum level.
Dacarbazine	The risk or severity of adverse effects can be increased when Bleomycin is combined with Dacarbazine.
Dactinomycin	The risk or severity of adverse effects can be increased when Bleomycin is combined with Dactinomycin.
Dalfampridine	Bleomycin may decrease the excretion rate of Dalfampridine which could result in a higher serum level.
Dapagliflozin	Dapagliflozin may increase the excretion rate of Bleomycin which could result in a lower serum level and potentially a reduction in efficacy.
Daptomycin	Daptomycin may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Darbepoetin alfa	The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Bleomycin.
Dasatinib	The risk or severity of adverse effects can be increased when Bleomycin is combined with Dasatinib.
Daunorubicin	The risk or severity of adverse effects can be increased when Bleomycin is combined with Daunorubicin.
Decitabine	The risk or severity of adverse effects can be increased when Bleomycin is combined with Decitabine.
Deferiprone	Bleomycin may decrease the excretion rate of Deferiprone which could result in a higher serum level.
Deflazacort	The risk or severity of adverse effects can be increased when Bleomycin is combined with Deflazacort.
Delafloxacin	Bleomycin may decrease the excretion rate of Delafloxacin which could result in a higher serum level.
Denosumab	The risk or severity of adverse effects can be increased when Denosumab is combined with Bleomycin.
Desipramine	Bleomycin may decrease the excretion rate of Desipramine which could result in a higher serum level.
Deslanoside	Deslanoside may decrease the cardiotoxic activities of Bleomycin.
Desmopressin	Desmopressin may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Desoximetasone	The risk or severity of adverse effects can be increased when Bleomycin is combined with Desoximetasone.
Desvenlafaxine	Bleomycin may decrease the excretion rate of Desvenlafaxine which could result in a higher serum level.
Deucravacitinib	The risk or severity of adverse effects can be increased when Bleomycin is combined with Deucravacitinib.
Deutetrabenazine	Bleomycin may decrease the excretion rate of Deutetrabenazine which could result in a higher serum level.
Dexamethasone	The risk or severity of adverse effects can be increased when Bleomycin is combined with Dexamethasone.
Dexibuprofen	Dexibuprofen may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Dexketoprofen	Dexketoprofen may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Dexmedetomidine	Bleomycin may decrease the excretion rate of Dexmedetomidine which could result in a higher serum level.
Dexpanthenol	Bleomycin may decrease the excretion rate of Dexpanthenol which could result in a higher serum level.
Dexrazoxane	The risk or severity of adverse effects can be increased when Bleomycin is combined with Dexrazoxane.
Dextran	Bleomycin may decrease the excretion rate of Dextran which could result in a higher serum level.
Diatrizoate	Diatrizoate may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Diazepam	Bleomycin may decrease the excretion rate of Diazepam which could result in a higher serum level.
Dichlorobenzyl alcohol	Bleomycin may decrease the excretion rate of Dichlorobenzyl alcohol which could result in a higher serum level.
Diclofenac	Diclofenac may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Diclofenamide	Diclofenamide may increase the excretion rate of Bleomycin which could result in a lower serum level and potentially a reduction in efficacy.
Dicyclomine	Bleomycin may decrease the excretion rate of Dicyclomine which could result in a higher serum level.
Didanosine	Bleomycin may decrease the excretion rate of Didanosine which could result in a higher serum level.
Dienogest	Bleomycin may decrease the excretion rate of Dienogest which could result in a higher serum level.
Diflunisal	Diflunisal may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Difluocortolone	The risk or severity of adverse effects can be increased when Bleomycin is combined with Difluocortolone.
Digitoxin	Digitoxin may decrease the cardiotoxic activities of Bleomycin.
Digoxin	Bleomycin may decrease the excretion rate of Digoxin which could result in a higher serum level.
Dihydrostreptomycin	Dihydrostreptomycin may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Dimercaprol	Bleomycin may decrease the excretion rate of Dimercaprol which could result in a higher serum level.
Dimethyl fumarate	The risk or severity of adverse effects can be increased when Bleomycin is combined with Dimethyl fumarate.
Dimethyl sulfoxide	Bleomycin may decrease the excretion rate of Dimethyl sulfoxide which could result in a higher serum level.
Dinutuximab	The risk or severity of adverse effects can be increased when Bleomycin is combined with Dinutuximab.
Diphenhydramine	The risk or severity of methemoglobinemia can be increased when Bleomycin is combined with Diphenhydramine.
Diroximel fumarate	The risk or severity of adverse effects can be increased when Bleomycin is combined with Diroximel fumarate.
Disopyramide	Disopyramide may decrease the excretion rate of Bleomycin which could result in a higher serum level.
DL-Methylephedrine	Bleomycin may decrease the excretion rate of DL-Methylephedrine which could result in a higher serum level.
Dobutamine	Bleomycin may decrease the excretion rate of Dobutamine which could result in a higher serum level.
Docetaxel	The risk or severity of adverse effects can be increased when Bleomycin is combined with Docetaxel.
Dopamine	Bleomycin may decrease the excretion rate of Dopamine which could result in a higher serum level.
Doripenem	Bleomycin may decrease the excretion rate of Doripenem which could result in a higher serum level.
Doxacurium	Bleomycin may decrease the excretion rate of Doxacurium which could result in a higher serum level.
Doxepin	Bleomycin may decrease the excretion rate of Doxepin which could result in a higher serum level.
Doxorubicin	The risk or severity of adverse effects can be increased when Bleomycin is combined with Doxorubicin.
Doxycycline	Doxycycline may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Drospirenone	Drospirenone may increase the excretion rate of Bleomycin which could result in a lower serum level and potentially a reduction in efficacy.
Droxidopa	Bleomycin may decrease the excretion rate of Droxidopa which could result in a higher serum level.
Duloxetine	Bleomycin may decrease the excretion rate of Duloxetine which could result in a higher serum level.
Dyclonine	The risk or severity of methemoglobinemia can be increased when Bleomycin is combined with Dyclonine.
Dyphylline	Bleomycin may decrease the excretion rate of Dyphylline which could result in a higher serum level.
Ebola Zaire vaccine (live, attenuated)	The therapeutic efficacy of Ebola Zaire vaccine (live, attenuated) can be decreased when used in combination with Bleomycin.
Eculizumab	The risk or severity of adverse effects can be increased when Bleomycin is combined with Eculizumab.
Edoxaban	Bleomycin may decrease the excretion rate of Edoxaban which could result in a higher serum level.
Edrophonium	Bleomycin may decrease the excretion rate of Edrophonium which could result in a higher serum level.
Efalizumab	The risk or severity of adverse effects can be increased when Efalizumab is combined with Bleomycin.
Emapalumab	The risk or severity of adverse effects can be increased when Bleomycin is combined with Emapalumab.
Enalaprilat	Bleomycin may decrease the excretion rate of Enalaprilat which could result in a higher serum level.
Enzalutamide	Bleomycin may decrease the excretion rate of Enzalutamide which could result in a higher serum level.
Epirubicin	The risk or severity of adverse effects can be increased when Bleomycin is combined with Epirubicin.
Eplerenone	Eplerenone may increase the excretion rate of Bleomycin which could result in a lower serum level and potentially a reduction in efficacy.
Epoprostenol	Bleomycin may decrease the excretion rate of Epoprostenol which could result in a higher serum level.
Eribulin	The risk or severity of adverse effects can be increased when Bleomycin is combined with Eribulin.
Ertapenem	Bleomycin may decrease the excretion rate of Ertapenem which could result in a higher serum level.
Ertugliflozin	Ertugliflozin may increase the excretion rate of Bleomycin which could result in a lower serum level and potentially a reduction in efficacy.

Hydromorphone	Bleomycin may decrease the excretion rate of Hydromorphone which could result in a higher serum level.
Hydroxocobalamin	Hydroxocobalamin may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Hydroxychloroquine	The risk or severity of adverse effects can be increased when Bleomycin is combined with Hydroxychloroquine.
Hydroxyethyl Starch	Bleomycin may decrease the excretion rate of Hydroxyethyl Starch which could result in a higher serum level.
Hydroxyurea	The risk or severity of adverse effects can be increased when Bleomycin is combined with Hydroxyurea.
Ibritumomab tiuxetan	The risk or severity of adverse effects can be increased when Ibritumomab tiuxetan is combined with Bleomycin.
Ibrutinib	The risk or severity of adverse effects can be increased when Bleomycin is combined with Ibrutinib.
Ibuprofen	Ibuprofen may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Ibutilide	Bleomycin may decrease the excretion rate of Ibutilide which could result in a higher serum level.
Icatibant	Bleomycin may decrease the excretion rate of Icatibant which could result in a higher serum level.
Icosapent	Icosapent may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Idarubicin	The risk or severity of adverse effects can be increased when Bleomycin is combined with Idarubicin.
Idarucizumab	Bleomycin may decrease the excretion rate of Idarucizumab which could result in a higher serum level.
Idebenone	Bleomycin may decrease the excretion rate of Idebenone which could result in a higher serum level.
Idelalisib	The risk or severity of adverse effects can be increased when Bleomycin is combined with Idelalisib.
Ifosfamide	The risk or severity of adverse effects can be increased when Bleomycin is combined with Ifosfamide.
Imatinib	The risk or severity of adverse effects can be increased when Bleomycin is combined with Imatinib.
Imipramine	Bleomycin may decrease the excretion rate of Imipramine which could result in a higher serum level.
Indapamide	Indapamide may increase the excretion rate of Bleomycin which could result in a lower serum level and potentially a reduction in efficacy.
Indigotindisulfonic acid	Bleomycin may decrease the excretion rate of Indigotindisulfonic acid which could result in a higher serum level.
Indomethacin	The risk or severity of adverse effects can be increased when Bleomycin is combined with Indomethacin.
Inebilizumab	The risk or severity of infection can be increased when Bleomycin is combined with Inebilizumab.
Infliximab	The risk or severity of adverse effects can be increased when Infliximab is combined with Bleomycin.
Influenza A virus A/Brisbane/59/2007(H1N1) antigen (propiolactone inactivated)	The therapeutic efficacy of Influenza A virus A/Brisbane/59/2007(H1N1) antigen (propiolactone inactivated) can be decreased when used in combination with Bleomycin.
Influenza A virus A/Brisbane/59/2007(H1N1) hemagglutinin antigen (propiolactone inactivated)	The therapeutic efficacy of Influenza A virus A/Brisbane/59/2007(H1N1) hemagglutinin antigen (propiolactone inactivated) can be decreased when used in combination with Bleomycin.
Influenza A virus A/California/7/2009 (H1N1) live (attenuated) antigen	The therapeutic efficacy of Influenza A virus A/California/7/2009 (H1N1) live (attenuated) antigen can be decreased when used in combination with Bleomycin.
Influenza A virus A/California/7/2009 X-181 (H1N1) antigen (propiolactone inactivated)	The therapeutic efficacy of Influenza A virus A/California/7/2009 X-181 (H1N1) antigen (propiolactone inactivated) can be decreased when used in combination with Bleomycin.
Influenza A virus A/California/7/2009 X-181 (H1N1) hemagglutinin antigen (propiolactone inactivated)	The therapeutic efficacy of Influenza A virus A/California/7/2009 X-181 (H1N1) hemagglutinin antigen (propiolactone inactivated) can be decreased when used in combination with Bleomycin.
Influenza A virus A/Perth/16/2009 (H3N2) live (attenuated) antigen	The therapeutic efficacy of Influenza A virus A/Perth/16/2009 (H3N2) live (attenuated) antigen can be decreased when used in combination with Bleomycin.
Influenza A virus A/Uruguay/716/2007(H3N2) antigen (propiolactone inactivated)	The therapeutic efficacy of Influenza A virus A/Uruguay/716/2007(H3N2) antigen (propiolactone inactivated) can be decreased when used in combination with Bleomycin.
Influenza A virus A/Victoria/210/2009 X-187 (H3N2) antigen (formaldehyde inactivated)	The therapeutic efficacy of Influenza A virus A/Victoria/210/2009 X-187 (H3N2) antigen (formaldehyde inactivated) can be decreased when used in combination with Bleomycin.
Influenza A virus A/Victoria/210/2009 X-187 (H3N2) hemagglutinin antigen (formaldehyde inactivated)	The therapeutic efficacy of Influenza A virus A/Victoria/210/2009 X-187 (H3N2) hemagglutinin antigen (formaldehyde inactivated) can be decreased when used in combination with Bleomycin.
Influenza B virus B/Brisbane/60/2008 antigen (formaldehyde inactivated)	The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 antigen (formaldehyde inactivated) can be decreased when used in combination with Bleomycin.
Influenza B virus B/Brisbane/60/2008 antigen (propiolactone inactivated)	The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 antigen (propiolactone inactivated) can be decreased when used in combination with Bleomycin.
Influenza B virus B/Brisbane/60/2008 hemagglutinin antigen (formaldehyde inactivated)	The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 hemagglutinin antigen (formaldehyde inactivated) can be decreased when used in combination with Bleomycin.
Influenza B virus B/Brisbane/60/2008 hemagglutinin antigen (propiolactone inactivated)	The therapeutic efficacy of Influenza B virus B/Brisbane/60/2008 hemagglutinin antigen (propiolactone inactivated) can be decreased when used in combination with Bleomycin.
Inosine pranobex	Bleomycin may decrease the excretion rate of Inosine pranobex which could result in a higher serum level.
Inositol	Bleomycin may decrease the excretion rate of Inositol which could result in a higher serum level.
Inotersen	Inotersen may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Interferon alfa-2a	The risk or severity of adverse effects can be increased when Interferon alfa-2a is combined with Bleomycin.
Interferon alfa-2b	The risk or severity of adverse effects can be increased when Interferon alfa-2b is combined with Bleomycin.
Interferon alfa-n1	The risk or severity of adverse effects can be increased when Interferon alfa-n1 is combined with Bleomycin.
Interferon alfa-n3	The risk or severity of adverse effects can be increased when Interferon alfa-n3 is combined with Bleomycin.
Interferon alfacon-1	The risk or severity of adverse effects can be increased when Interferon alfacon-1 is combined with Bleomycin.
Interferon beta-1b	The risk or severity of adverse effects can be increased when Interferon beta-1b is combined with Bleomycin.
Interferon gamma-1b	The risk or severity of adverse effects can be increased when Interferon gamma-1b is combined with Bleomycin.
Iobenguane sulfate I-123	Bleomycin may decrease the excretion rate of Iobenguane sulfate I-123 which could result in a higher serum level.
Iodixanol	Bleomycin may decrease the excretion rate of Iodixanol which could result in a higher serum level.
Ioflupane I-123	Bleomycin may decrease the excretion rate of Ioflupane I-123 which could result in a higher serum level.
Iopromide	Bleomycin may decrease the excretion rate of Iopromide which could result in a higher serum level.
Iothalamic acid	Bleomycin may decrease the excretion rate of Iothalamic acid which could result in a higher serum level.
Ioversol	Bleomycin may decrease the excretion rate of Ioversol which could result in a higher serum level.
Ioxilan	Bleomycin may decrease the excretion rate of Ioxilan which could result in a higher serum level.
Ipecac	Bleomycin may decrease the excretion rate of Ipecac which could result in a higher serum level.
Ipilimumab	Bleomycin may decrease the excretion rate of Ipilimumab which could result in a higher serum level.
Irinotecan	The risk or severity of adverse effects can be increased when Bleomycin is combined with Irinotecan.
Isoniazid	Bleomycin may decrease the excretion rate of Isoniazid which could result in a higher serum level.
Isosorbide	Isosorbide may increase the excretion rate of Bleomycin which could result in a lower serum level and potentially a reduction in efficacy.
Isosorbide mononitrate	Bleomycin may decrease the excretion rate of Isosorbide mononitrate which could result in a higher serum level.
Isosulfan blue	Bleomycin may decrease the excretion rate of Isosulfan blue which could result in a higher serum level.
Isotretinoin	Bleomycin may decrease the excretion rate of Isotretinoin which could result in a higher serum level.
Isoxicam	Isoxicam may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Isradipine	Isradipine may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Ixabepilone	The risk or severity of adverse effects can be increased when Bleomycin is combined with Ixabepilone.
Ixazomib	Bleomycin may decrease the excretion rate of Ixazomib which could result in a higher serum level.
Ixekizumab	The risk or severity of adverse effects can be increased when Bleomycin is combined with Ixekizumab.
Janssen COVID-19 Vaccine	The therapeutic efficacy of Janssen COVID-19 Vaccine can be decreased when used in combination with Bleomycin.
Japanese encephalitis virus strain sa 14-14-2 antigen (formaldehyde inactivated)	The therapeutic efficacy of Japanese encephalitis virus strain sa 14-14-2 antigen (formaldehyde inactivated) can be decreased when used in combination with Bleomycin.
Kanamycin	Bleomycin may decrease the excretion rate of Kanamycin which could result in a higher serum level.
Ketamine	Bleomycin may decrease the excretion rate of Ketamine which could result in a higher serum level.
Ketazolam	Bleomycin may decrease the excretion rate of Ketazolam which could result in a higher serum level.
Ketoprofen	Ketoprofen may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Ketorolac	Ketorolac may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Labetalol	Bleomycin may decrease the excretion rate of Labetalol which could result in a higher serum level.
Lamivudine	Bleomycin may decrease the excretion rate of Lamivudine which could result in a higher serum level.
Lamotrigine	Bleomycin may decrease the excretion rate of Lamotrigine which could result in a higher serum level.
Latamoxef	Latamoxef may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Ledipasvir	Bleomycin may decrease the excretion rate of Ledipasvir which could result in a higher serum level.
Leflunomide	The risk or severity of adverse effects can be increased when Bleomycin is combined with Leflunomide.
Lenalidomide	The risk or severity of adverse effects can be increased when Bleomycin is combined with Lenalidomide.
Lesinurad	Bleomycin may decrease the excretion rate of Lesinurad which could result in a higher serum level.
Leuprolide	Leuprolide may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Levobupivacaine	The risk or severity of methemoglobinemia can be increased when Bleomycin is combined with Levobupivacaine.
Levocarnitine	Bleomycin may decrease the excretion rate of Levocarnitine which could result in a higher serum level.
Levocetirizine	Bleomycin may decrease the excretion rate of Levocetirizine which could result in a higher serum level.
Levofloxacin	Bleomycin may decrease the excretion rate of Levofloxacin which could result in a higher serum level.
Levomilnacipran	Bleomycin may decrease the excretion rate of Levomilnacipran which could result in a higher serum level.
Levosalbutamol	Bleomycin may decrease the excretion rate of Levosalbutamol which could result in a higher serum level.
Lidocaine	The risk or severity of methemoglobinemia can be increased when Bleomycin is combined with Lidocaine.
Linezolid	The risk or severity of adverse effects can be increased when Bleomycin is combined with Linezolid.
Liothyronine	Liothyronine may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Lisinopril	Bleomycin may decrease the excretion rate of Lisinopril which could result in a higher serum level.
Lithium carbonate	Bleomycin may decrease the excretion rate of Lithium carbonate which could result in a higher serum level.
Lithium citrate	Lithium citrate may decrease the excretion rate of Bleomycin which could result in a higher serum level.
Lixisenatide	Bleomycin may decrease the excretion rate of Lixisenatide which could result in a higher serum level.

Zolmitriptan	The metabolism of Zolmitriptan can be decreased when combined with Zonisamide.
Zofenopril	The risk or severity of hyperkalemia can be increased when Zonisamide is combined with Zofenopril.
Ziprasidone	The risk or severity of QTc prolongation can be increased when Zonisamide is combined with Ziprasidone.
Zimelidine	The risk or severity of adverse effects can be increased when Zonisamide is combined with Zimelidine.
Zidovudine	The metabolism of Zonisamide can be increased when combined with Zidovudine.
Ziconotide	The risk or severity of CNS depression can be increased when Zonisamide is combined with Ziconotide.
Zanamivir	Zonisamide may increase the excretion rate of Zanamivir which could result in a lower serum level and potentially a reduction in efficacy.
Zaleplon	The risk or severity of adverse effects can be increased when Zonisamide is combined with Zaleplon.
Zafirlukast	The metabolism of Zonisamide can be decreased when combined with Zafirlukast.
Yohimbine	The risk or severity of adverse effects can be increased when Zonisamide is combined with Yohimbine.
Xylometazoline	Zonisamide may increase the arrhythmogenic activities of Xylometazoline.
Warfarin	Zonisamide may decrease the excretion rate of Warfarin which could result in a higher serum level.
Voxilaprevir	The serum concentration of Voxilaprevir can be increased when it is combined with Zonisamide.
Voxelotor	The metabolism of Voxelotor can be decreased when combined with Zonisamide.
Vortioxetine	The risk or severity of adverse effects can be increased when Zonisamide is combined with Vortioxetine.
Vorinostat	The risk or severity of QTc prolongation can be increased when Zonisamide is combined with Vorinostat.
Voriconazole	The metabolism of Zonisamide can be decreased when combined with Voriconazole.
Voclosporin	The serum concentration of Voclosporin can be increased when it is combined with Zonisamide.
Vinflunine	The serum concentration of Vinflunine can be increased when it is combined with Zonisamide.
Vincristine	The excretion of Vincristine can be decreased when combined with Zonisamide.
Vinblastine	The serum concentration of Vinblastine can be increased when it is combined with Zonisamide.
Viloxazine	The metabolism of Zonisamide can be decreased when combined with Viloxazine.
Vildagliptin	The therapeutic efficacy of Vildagliptin can be increased when used in combination with Zonisamide.
Vilazodone	The risk or severity of adverse effects can be increased when Zonisamide is combined with Vilazodone.
Vilanterol	The risk or severity of QTc prolongation can be increased when Zonisamide is combined with Vilanterol.
Vigabatrin	The risk or severity of adverse effects can be increased when Zonisamide is combined with Vigabatrin.
Vernakalant	Zonisamide may increase the arrhythmogenic activities of Vernakalant.
Verapamil	Verapamil may increase the arrhythmogenic activities of Zonisamide.
Venlafaxine	The risk or severity of adverse effects can be increased when Venlafaxine is combined with Zonisamide.
Venetoclax	The serum concentration of Venetoclax can be increased when it is combined with Zonisamide.
Vemurafenib	The risk or severity of QTc prolongation can be increased when Vemurafenib is combined with Zonisamide.
Velpatasvir	The serum concentration of Velpatasvir can be increased when it is combined with Zonisamide.
Vecuronium	Zonisamide may increase the neuromuscular blocking activities of Vecuronium.
Varenicline	Zonisamide may increase the excretion rate of Varenicline which could result in a lower serum level and potentially a reduction in efficacy.
Vardenafil	The serum concentration of Vardenafil can be increased when it is combined with Zonisamide.
Vandetanib	The risk or severity of QTc prolongation can be increased when Zonisamide is combined with Vandetanib.
Vancomycin	Zonisamide may decrease the excretion rate of Vancomycin which could result in a higher serum level.
Valsartan	The risk or severity of hyperkalemia can be increased when Valsartan is combined with Zonisamide.
Valproic acid	The risk or severity of QTc prolongation can be increased when Zonisamide is combined with Valproic acid.
Valganciclovir	Zonisamide may increase the excretion rate of Valganciclovir which could result in a lower serum level and potentially a reduction in efficacy.
Valdecoxib	The risk or severity of hyperkalemia can be increased when Valdecoxib is combined with Zonisamide.
Valbenazine	Zonisamide may increase the excretion rate of Valbenazine which could result in a lower serum level and potentially a reduction in efficacy.
Valaciclovir	Zonisamide may increase the excretion rate of Valaciclovir which could result in a lower serum level and potentially a reduction in efficacy.
Vaborbactam	Zonisamide may increase the excretion rate of Vaborbactam which could result in a lower serum level and potentially a reduction in efficacy.
Urethane	The risk or severity of adverse effects can be increased when Zonisamide is combined with Urethane.
Umeclidinium	Zonisamide may increase the central nervous system depressant (CNS depressant) activities of Umeclidinium.
Ulipristal	The metabolism of Ulipristal can be increased when combined with Zonisamide.
Udenafil	The metabolism of Udenafil can be decreased when combined with Zonisamide.
Ubrogepant	The serum concentration of Ubrogepant can be increased when it is combined with Zonisamide.
Tucatinib	The metabolism of Tucatinib can be decreased when combined with Zonisamide.
Tubocurarine	Zonisamide may increase the neuromuscular blocking activities of Tubocurarine.
Tryptophan	The risk or severity of adverse effects can be increased when Tryptophan is combined with Zonisamide.
Trovafloxacin	The risk or severity of QTc prolongation can be increased when Zonisamide is combined with Trovafloxacin.
Trospium	Zonisamide may increase the central nervous system depressant (CNS depressant) activities of Trospium.
Tropisetron	Zonisamide may increase the arrhythmogenic activities of Tropisetron.
Troleandomycin	The metabolism of Zonisamide can be decreased when combined with Troleandomycin.
Troglitazone	The therapeutic efficacy of Troglitazone can be increased when used in combination with Zonisamide.
Triptorelin	The risk or severity of QTc prolongation can be increased when Zonisamide is combined with Triptorelin.
Triprolidine	The risk or severity of adverse effects can be increased when Triprolidine is combined with Zonisamide.
Trimipramine	The serum concentration of Trimipramine can be increased when it is combined with Zonisamide.
Trimetrexate	Zonisamide may increase the excretion rate of Trimetrexate which could result in a lower serum level and potentially a reduction in efficacy.
Trimethoprim	Zonisamide may increase the excretion rate of Trimethoprim which could result in a lower serum level and potentially a reduction in efficacy.
Trimethobenzamide	The risk or severity of adverse effects can be increased when Trimethobenzamide is combined with Zonisamide.
Trimethaphan	The risk or severity of adverse effects can be increased when Zonisamide is combined with Trimethaphan.
Trimethadione	Trimethadione may increase the arrhythmogenic activities of Zonisamide.
Trimebutine	Zonisamide may increase the arrhythmogenic activities of Trimebutine.
Trilaciclib	The serum concentration of Trilaciclib can be increased when it is combined with Zonisamide.
Trihexyphenidyl	Zonisamide may increase the central nervous system depressant (CNS depressant) activities of Trihexyphenidyl.
Trifluridine	Zonisamide may increase the excretion rate of Trifluridine which could result in a lower serum level and potentially a reduction in efficacy.
Triflupromazine	Zonisamide may increase the central nervous system depressant (CNS depressant) activities of Triflupromazine.
Trifluoperazine	The risk or severity of hypotension can be increased when Trifluoperazine is combined with Zonisamide.
Triethylenetetramine	The excretion of Triethylenetetramine can be increased when combined with Zonisamide.
Triclofos	The risk or severity of adverse effects can be increased when Zonisamide is combined with Triclofos.
Triclabendazole	The metabolism of Zonisamide can be decreased when combined with Triclabendazole.
Trichloroethylene	The risk or severity of adverse effects can be increased when Zonisamide is combined with Trichloroethylene.
Trichlormethiazide	Trichlormethiazide may increase the excretion rate of Zonisamide which could result in a lower serum level and potentially a reduction in efficacy.
Triazolam	The risk or severity of adverse effects can be increased when Triazolam is combined with Zonisamide.
Triamterene	Triamterene may increase the excretion rate of Zonisamide which could result in a lower serum level and potentially a reduction in efficacy.
Triamcinolone	The metabolism of Zonisamide can be increased when combined with Triamcinolone.
Tretinoin	The metabolism of Zonisamide can be decreased when combined with Tretinoin.
Treprostinil	The risk or severity of QTc prolongation can be increased when Treprostinil is combined with Zonisamide.
Trazodone	The risk or severity of QTc prolongation can be increased when Trazodone is combined with Zonisamide.
Trastuzumab emtansine	The serum concentration of Trastuzumab emtansine can be increased when it is combined with Zonisamide.
Tranylcypromine	The risk or severity of adverse effects can be increased when Tranylcypromine is combined with Zonisamide.
Trandolapril	The risk or severity of hyperkalemia can be increased when Trandolapril is combined with Zonisamide.
Trametinib	Zonisamide may increase the excretion rate of Trametinib which could result in a lower serum level and potentially a reduction in efficacy.
Tramadol	The risk or severity of CNS depression can be increased when Zonisamide is combined with Tramadol.
Trabectedin	The metabolism of Trabectedin can be decreased when combined with Zonisamide.
Tositumomab	Zonisamide may increase the excretion rate of Tositumomab which could result in a lower serum level and potentially a reduction in efficacy.
Toremifene	The risk or severity of QTc prolongation can be increased when Zonisamide is combined with Toremifene.
Torasemide	Torasemide may increase the excretion rate of Zonisamide which could result in a lower serum level and potentially a reduction in efficacy.
Topotecan	The serum concentration of Topotecan can be increased when it is combined with Zonisamide.
Topiramate	The risk or severity of adverse effects can be increased when Topiramate is combined with Zonisamide.
Tolvaptan	The serum concentration of Tolvaptan can be increased when it is combined with Zonisamide.
Tolterodine	Zonisamide may increase the central nervous system depressant (CNS depressant) activities of Tolterodine.
Tolmetin	The risk or severity of hyperkalemia can be increased when Tolmetin is combined with Zonisamide.

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.

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