DBL Bleomycin Sulfate Drug Interactions

Pharmacodynamic interactions: Anaesthetics, general, and oxygen: Use in patients previously treated with bleomycin may result in rapid pulmonary deterioration, since bleomycin causes sensitisation of lung tissue to oxygen.
Radiation therapy: Radiation therapy, especially to the chest area, either prior to, during, or after bleomycin therapy may result in increased bleomycin toxicity. Dosage adjustment may be necessary.
Antineoplastic agents: Concurrent use may result in increased bleomycin toxicity, or in occurrence of pulmonary toxicity at lower doses of bleomycin (see Precautions).
Combination therapy: Pulmonary toxicity may be observed at lower doses of bleomycin when bleomycin is administered as part of a multi-drug treatment regimen. Patients should be closely monitored for signs of pulmonary toxicity (see Precautions).
Granulocyte colony stimulating factor (G-CSF): It has been suggested that concomitant administration of G-CSF and bleomycin may increase the risk of bleomycin-induced pulmonary toxicity, especially at higher doses, although this has not been confirmed in clinical trials. If G-CSF is added to bleomycin-containing treatment regimens, patients should be closely observed for signs of pulmonary toxicity (see Precautions).
Pharmacokinetic interactions: Cisplatin: Cisplatin-induced renal function impairment may result in delayed clearance and bleomycin toxicity even at low doses. An increased incidence of bleomycin-induced pulmonary toxicity has been observed when these two agents are administered as part of an antineoplastic treatment regimen. Dosage reduction may be required (see Precautions).
Digoxin: Serum levels of Digoxin may be reduced and its actions may be decreased. It is thought that drug-induced alterations of the intestinal mucosa may be involved in the reduced GI absorption.
Phenytoin: Serum concentrations of phenytoin may be decreased due to decreased absorption or increased metabolism of Phenytoin.