Bleomycin
A Streptomyces glycopeptide used in chemotherapy for testicular cancer, lymphomas and squamous cell cancers
Bleomycin is a mixture of cytotoxic glycopeptides from the bacterium Streptomyces verticillus. It is a prescription chemotherapy drug, part of the BEP and ABVD combination regimens for germ cell cancers and Hodgkin lymphoma, and it is best known for a dose-related lung injury that can be fatal.
Manufacturer's recommended dosing (FDA label): 0.25–0.50 units/kg (10–20 units/m²), Weekly or twice weekly, Intravenous, intramuscular or subcutaneous Details ↓
Recommended Dosing
Manufacturer's recommended dosing (FDA label)
From the prescribing information. Other doses studied, if any, are in the full dosing data below.
What is it?
Bleomycin is not a peptide anyone takes for fitness or recovery. It is a chemotherapy drug, a mixture of glycopeptide antibiotics isolated from a strain of Streptomyces verticillus, and it appears in peptide lists because it is a glycopeptide. Its US label calls it a palliative treatment for squamous cell carcinomas of the head and neck, penis, cervix and vulva, for Hodgkin and non-Hodgkin lymphoma and for testicular carcinoma, and a sclerosing agent for malignant pleural effusion. Blenoxane, the original brand approved in 1973, is discontinued; generic bleomycin for injection remains on the market.
Its most important use is in combination regimens. In testicular cancer, an Australian trial found that leaving bleomycin out of cisplatin and vinblastine raised deaths from cancer from 5% to 15%, although the bleomycin arm had more toxicity and more treatment-related deaths. An American intergroup trial later compared the bleomycin regimen BEP with VIP, which uses ifosfamide instead, and found similar survival; the authors kept BEP as the standard and suggested VIP for men with lung disease.
The cost is the lung. The label puts lung toxicity at about 10% of treated patients, with about 1% dying of fibrosis, and says the risk rises with age and with total doses over 400 units, while warning that it has been seen in young patients on low doses. Real-world series agree: lung toxicity in 11% of Hodgkin lymphoma patients in Toronto, 27% in a South Indian germ-cell cohort, and more respiratory visits in Ontario men who had more doses. Many childhood survivors have mild, symptomless changes on lung function tests years later.
Bleomycin has a second life outside cancer wards. Injected into the lesion, it shrinks lymphatic and venous malformations, and pooled studies found no lung fibrosis with that use. It has also been compared with steroids for keloid scars and is the standard drug in electrochemotherapy, where electric pulses push it into skin tumours. In the pleural space, it prevented early return of malignant effusions better than tetracycline, but talc did as well at lower cost. Researchers also use it to cause lung fibrosis in rodents, the most common animal model of idiopathic pulmonary fibrosis.
None of this makes bleomycin something to obtain outside a hospital. Its doses are set by body size, kidney function and the running total already given, lymphoma patients receive small test doses first because about 1% react with fever, low blood pressure and wheezing, and the drug is given with chest imaging and lung monitoring. The figures below come from the label and from trials in people with cancer.
Mechanism of Action
Bleomycin damages DNA in dividing cells; the label notes its exact mechanism is not fully known.
DNA strand breaks
Inhibits DNA synthesis and causes single and some double-strand DNA breaks, with arrest in G2 and mitosis (label, Mechanism of Action).
Why the lung
Inactivated by bleomycin hydrolase, an enzyme scarce in skin and lung, its two main toxicity targets (label, Metabolism); lung injury begins with endothelial damage (PMID 11502668).
Kidney clearance
About 65% of an intravenous dose leaves in urine within 24 hours, so drugs that harm the kidneys, such as cisplatin, can raise its levels (label).
Published Research
The studies behind bleomycin, read from their PubMed abstracts. Most are trials of combination chemotherapy in which bleomycin is one of several drugs.
Leaving bleomycin out costs lives
In 218 men with good-prognosis germ cell cancer given cisplatin and vinblastine with or without bleomycin 30 mg intramuscularly each week, the bleomycin arm had more blood, kidney and lung toxicity, but deaths from cancer were 5% against 15% without it, partly offset by more toxic deaths.
BEP against VIP in advanced germ cell tumours
In 286 evaluable men followed for 7.3 years, four cycles of bleomycin, etoposide and cisplatin (BEP) gave overall survival similar to the ifosfamide regimen VIP (67% against 69%), with less blood toxicity; the authors kept BEP as standard and suggested VIP for men with lung disease.
Pleural effusion: bleomycin against tetracycline
In 85 patients with malignant pleural effusion, 60 units of bleomycin into the pleural space cut recurrence within 30 days to 36% against 67% with tetracycline, and to 30% against 53% at 90 days; toxicity and survival were similar.
Pleural effusion: talc did as well
In 71 bedside pleurodesis procedures, talc slurry and 60 units of bleomycin had the same success rate and no major complications; talc cost less, so the authors called it the agent of choice.
Injections for vascular malformations
A meta-analysis of 27 studies (1,325 patients) found good to excellent shrinkage in 84% of lymphatic and 87% of venous malformations after intralesional bleomycin, fewer adverse events than other sclerosants, and no case of lung fibrosis; the studies were of low quality.
Keloid and hypertrophic scars
Pooling three randomised and two controlled trials, intralesional bleomycin improved scars more than triamcinolone injections, 5-fluorouracil, or triamcinolone with cryotherapy; the authors asked for larger randomised trials.
Electrochemotherapy of skin tumours
Across 55 studies and 3,729 patients, intravenous bleomycin combined with electric pulses to the tumour gave a mean objective response rate of 81.5%, and studies using reduced doses reported similar responses (85.5%).
Lung toxicity and filgrastim
In a case-control study of 88 patients given BEP or ABVD, 14.7% developed lung toxicity and two died of it; adding the white-cell booster filgrastim did not significantly raise the risk, and women appeared more affected than men, a difference that was not significant.
Hodgkin lymphoma: who gets lung toxicity
Of 253 patients given ABVD, 11% developed bleomycin lung toxicity; age 45 or older and use of granulocyte colony-stimulating factor predicted it. Neither the toxicity nor stopping bleomycin changed five-year survival.
Testicular cancer in Ontario
Among 394 men given bleomycin-based chemotherapy, 23% saw a doctor for breathing symptoms within two years, rising to 40% after 10 to 12 doses against 14% after 1 to 6; only 17% had lung function tested before treatment.
Lungs of childhood cancer survivors
In 143 survivors tested a median 2.3 years after treatment, spirometry was abnormal in 41%, mostly mild and obstructive, and only 5 of those 58 had symptoms; survivors who had relapsed were about five times as likely to have abnormal results.
Germ cell tumours in South India
Of 41 patients on BEP, 27% developed bleomycin lung toxicity, during or after treatment; a cumulative dose of 240 mg or more carried 3.8 times the risk, and three-year survival was 82% with toxicity against 93% without.
How bleomycin injures the lung
This review describes bleomycin pneumonitis as endothelial damage driven by cytokines and free radicals that can progress to fibrosis. Lung volumes detect it best, no treatment is proven though corticosteroids are widely used, and survivors usually recover completely.
The bleomycin lung-fibrosis model in animals
A systematic review of 240 rodent studies found that almost all tested drugs before fibrosis was established (222 preventive against 13 therapeutic), none had reached clinical use for idiopathic pulmonary fibrosis, and the model partly reverses on its own.
Kaposi sarcoma: the older regimen loses
In 241 people with AIDS-related Kaposi sarcoma, pegylated liposomal doxorubicin produced responses in 58.7% against 23.3% on bleomycin 15 IU/m² with vincristine every three weeks, and the bleomycin arm stopped early for side effects more often (26.7% against 10.7%).
Blood levels in older patients
In patients over 65 given an intravenous bolus of 15,000 IU/m² before electrochemotherapy, bleomycin left the blood slowly in a single phase, with a half-time of about 30 minutes; the authors suggested lower doses in the elderly.
Dosing Data
Bleomycin is dosed by weight or body surface area, by an oncology team, within a combination regimen. The label's schedules are below; they are not instructions for self-use.
Educational information, not medical advice. Each dose above is tagged with its source: an approved label, a published human study, animal data, or amounts reported by users. None is a recommendation for you. An unapproved compound has no established safe or effective human dose, and products sold for “research use only” are not made or tested for people. Talk to a doctor before acting on anything on this site, including before you start, stop or change any medicine or dose. Full medical disclaimer.
What a Buyer Needs to Know
What is sold, how it is mixed, stored and taken, and what is known about its safety, quality and legal status. Each part names its source. Where we have none, it says unknown.
What is sold
The approved product, as its label describes it:
- Bleomycin (bleomycin sulfate powder): Forms the label lists: vials.
Source: Bleomycin (bleomycin sulfate powder) label, section 16 (DailyMed version 3, effective April 17, 2026).
Mixing a vial: a worked example
Nothing to mix at home, and no syringe units to work out: Bleomycin is prepared and given by clinical staff, by a cancer team in hospital or an infusion clinic.
Its US label's boxed warning asks that it be given under a physician experienced with cancer drugs, where facilities to diagnose and treat complications are at hand.
Source: Bleomycin (bleomycin sulfate powder) label, boxed warning (DailyMed version 3, effective April 17, 2026).
Storage before and after mixing
Before mixing or first use: “Store refrigerated between 2° and 8°C (36° and 46°F).” “The sterile powder is stable under refrigeration and should not be used after the expiration date is reached.”
After mixing or first use: “Discard unused portion.”
Source: Bleomycin (bleomycin sulfate powder) label, sections 16 and 2 (DailyMed version 3, effective April 17, 2026).
How it is taken
As the approved label gives it: Intravenous, intramuscular or subcutaneous (Weekly or twice weekly; Label: squamous cell carcinoma, non-Hodgkin lymphoma, testicular carcinoma); Intravenous or intramuscular (Weekly or twice weekly, then maintenance; Label: Hodgkin lymphoma); Intrapleural injection (Single bolus; Label: malignant pleural effusion); As for the indication (As for the indication; Label: kidney impairment (creatinine clearance under 50 mL/min)).
Source: Manufacturer's recommended dosing (FDA label): the route and frequency of each row in Dosing Data below.
What to expect, and when
How long it stays in the body: a half-life of about 2 hours (intravenous bolus, normal kidney function). After about five half-lives almost none is left.
How long the doses were given: Label: squamous cell carcinoma, non-Hodgkin lymphoma, testicular carcinoma: Total doses over 400 units given with great caution; Label: Hodgkin lymphoma: Lymphoma patients get 2 units or less for the first 2 doses; Label: malignant pleural effusion: Once.
When effects appear: unknown; no source on this page gives a time to effect for Bleomycin. Results reported in the studies are under Published Research.
Source: half-life: Bleomycin for injection, USP, US prescribing information, Clinical Pharmacology (Meitheal Pharmaceuticals; DailyMed set 640602f9, version 3, effective April 17, 2026); Manufacturer's recommended dosing (FDA label), the duration of each row in Dosing Data below.
Side effects, and when to stop or get help
From the Side Effects section: Lung toxicity: pneumonitis that can progress to fibrosis, in 11% to 27% of patients in the series above; Blood counts, kidney injury and hair loss in combination regimens; Mild, often symptomless lung-function changes years later in childhood survivors; Neuropathy and early stopping in the older Kaposi sarcoma regimen with vincristine. Full list and cautions ↓
Boxed warning on the label: Warning.
When to stop or get help: unknown; the label's warnings summary we read gives no rule for stopping Bleomycin. Treat a severe or unexpected reaction as a reason to stop and see a doctor.
Source: Bleomycin (bleomycin sulfate powder) label, boxed warning and section 5 (DailyMed version 3, effective April 17, 2026); the Side Effects section below (“From the studies above”).
Interactions
- nephrotoxic drugs, including cisplatin: bleomycin is cleared mainly by the kidneys; cumulative cisplatin cut bleomycin clearance in a report of two children, and fatal lung toxicity occurred in a patient with unrecognised cisplatin-induced kidney failure
Every peptide's record, with its source: the interaction matrix.
Source: Bleomycin for injection, USP, US prescribing information, Drug Interactions. DailyMed set 640602f9, version 3, effective April 17, 2026, read October 28, 2026.
Checking what you bought
Unknown: no published independent test of Bleomycin products is in our lab-results database yet, so how products sold under this name measure up is not known.
To read a certificate of analysis, paste it into the COA decoder. Trust & Verification explains what independent testing can and cannot show.
Legal status
US: FDA Approved (FDA-approved in 1973 as Blenoxane (NDA 050443, now discontinued) and marketed as generic bleomycin for injection, USP by several makers (Drugs@FDA, read October 28, 2026)). Sport: Not on the 2026 List.
Country by country ↓ · Regulatory tracker
Source: this entry's approval status and the WADA Prohibited List, as in Legal Status below.
Side Effects & Contraindications
Reported Side Effects
From the studies above.
Contraindications & Cautions
Boxed warning, contraindication and warnings from the bleomycin label (DailyMed set 640602f9, version 3, effective April 17, 2026).
Legal Status
Bleomycin is an approved prescription chemotherapy drug in the US, given in hospitals and clinics.
Frequently Asked Questions
?Is bleomycin a peptide I can buy?
It is a prescription chemotherapy drug with a glycopeptide structure, not a research peptide. It is given by oncology teams who track lung and kidney function and the total dose.
?What is bleomycin used for?
Its label covers squamous cell cancers of the head and neck, penis, cervix and vulva, Hodgkin and non-Hodgkin lymphoma, testicular cancer, and malignant pleural effusion. It is part of BEP for germ cell cancers and ABVD for Hodgkin lymphoma.
?Why is the lung toxicity such a concern?
About 10% of patients develop lung toxicity and about 1% die of fibrosis, per the label. Risk rises with age, total dose and kidney impairment, but it is unpredictable.
?Does dropping bleomycin make treatment safer?
It removes the lung risk but can cost cure. In good-prognosis germ cell cancer, removing it tripled deaths from cancer. In Hodgkin lymphoma, stopping it after lung toxicity did not change survival in one large series.
?Is it used outside cancer?
Doctors inject it into vascular malformations and keloid scars. Those uses are studied but are not on the US label.
?Why does it come up in lung fibrosis research?
Giving bleomycin to rodents is the most common animal model of pulmonary fibrosis. A review found that drugs that worked in this model have not translated into treatments for people.
References
- [fda-pi] Bleomycin for injection, USP, US prescribing information: description, indications, dosage, drug interactions and clinical pharmacology (Meitheal Pharmaceuticals; DailyMed set 640602f9, version 3, effective April 17, 2026; read October 28, 2026).
- [other] PubChem CID 5360373, Bleomycin: formula C55H84N17O21S3+, molecular weight 1415.6. Read October 28, 2026. https://pubchem.ncbi.nlm.nih.gov/compound/5360373
- [review] Sleijfer S. "Bleomycin-induced pneumonitis." Chest, 2001;120(2):617-24. PMID: 11502668.
- [pubmed] Moeller A, et al. "The bleomycin animal model: a useful tool to investigate treatment options for idiopathic pulmonary fibrosis?." Int J Biochem Cell Biol, 2008;40(3):362-82. PMID: 17936056.
- [fda] US FDA, Drugs@FDA (openFDA): BLENOXANE (bleomycin sulfate), NDA 050443, Bristol Myers Squibb; original approval July 31, 1973; marketing status Discontinued. Read October 28, 2026.
- [fda] US FDA, Drugs@FDA (openFDA): bleomycin sulfate for injection, ANDA 205030, Meitheal; original approval April 20, 2018; marketing status Prescription. Read October 28, 2026.
- [clinical-trial] Levi JA, et al. "The importance of bleomycin in combination chemotherapy for good-prognosis germ cell carcinoma. Australasian Germ Cell Trial Group." J Clin Oncol, 1993;11(7):1300-5. PMID: 7686216.
- [clinical-trial] Hinton S, et al. "Cisplatin, etoposide and either bleomycin or ifosfamide in the treatment of disseminated germ cell tumors: final analysis of an intergroup trial." Cancer, 2003;97(8):1869-75. PMID: 12673712.
- [clinical-trial] Ruckdeschel JC, et al. "Intrapleural therapy for malignant pleural effusions. A randomized comparison of bleomycin and tetracycline." Chest, 1991;100(6):1528-35. PMID: 1720370.
- [clinical-trial] Haddad FJ, et al. "Pleurodesis in patients with malignant pleural effusions: talc slurry or bleomycin? Results of a prospective randomized trial." World J Surg, 2004;28(8):749-53; discussion 753-4. PMID: 15457352.
- [review] Horbach SER, et al. "Intralesional Bleomycin Injections for Vascular Malformations: A Systematic Review and Meta-Analysis." Plast Reconstr Surg, 2016;137(1):244-256. PMID: 26710030.
- [review] Kim WI, et al. "The efficacy of bleomycin for treating keloid and hypertrophic scar: A systematic review and meta-analysis." J Cosmet Dermatol, 2020;19(12):3357-3366. PMID: 32243056.
- [review] Bastrup FA, et al. "Electrochemotherapy with intravenous bleomycin for patients with cutaneous malignancies, across tumour histology: a systematic review." Acta Oncol, 2022;61(9):1093-1104. PMID: 36036195.
- [pubmed] Laprise-Lachance M, et al. "Risk of pulmonary toxicity of bleomycin and filgrastim." J Oncol Pharm Pract, 2019;25(7):1638-1644. PMID: 30319063.
- [pubmed] Sun HL, et al. "Bleomycin pulmonary toxicity does not adversely affect the outcome of patients with Hodgkin lymphoma." Leuk Lymphoma, 2017;58(11):2607-2614. PMID: 28504035.
- [pubmed] Raphael MJ, et al. "A population-based study of pulmonary monitoring and toxicity for patients with testicular cancer treated with bleomycin." Curr Oncol, 2020;27(6):291-298. PMID: 33380860.
- [pubmed] Zorzi AP, et al. "Bleomycin-associated Lung Toxicity in Childhood Cancer Survivors." J Pediatr Hematol Oncol, 2015;37(8):e447-52. PMID: 26422284.
- [pubmed] Thakkar DN, et al. "Frequency and risk factors of bleomycin-induced pulmonary toxicity in South Indian patients with germ-cell tumors." J Cancer Res Ther, 2021;17(2):443-449. PMID: 34121690.
- [clinical-trial] Stewart S, et al. "Randomized comparative trial of pegylated liposomal doxorubicin versus bleomycin and vincristine in the treatment of AIDS-related Kaposi's sarcoma. International Pegylated Liposomal Doxorubicin Study Group." J Clin Oncol, 1998;16(2):683-91. PMID: 9469358.
- [pubmed] Groselj A, et al. "Bleomycin pharmacokinetics of bolus bleomycin dose in elderly cancer patients treated with electrochemotherapy." Cancer Chemother Pharmacol, 2016;77(5):939-47. PMID: 26992379.
Sources & Citations
Studies were read from their PubMed abstracts; the label from DailyMed (Meitheal, set 640602f9, version 3, effective April 17, 2026), read October 28, 2026; approval records from Drugs@FDA.
Medical Disclaimer: This content is for educational and informational purposes only. It is not medical advice, and nothing here is an instruction to obtain or use any compound. Talk to a licensed clinician about your own situation.