Cardiac tamponade is an emergency situation that warrants immediate evacuation of the pericardial fluid. Since the fluid tends to recur only by pericardiocentesis, various agents have been instilled into the pericardium to promote adhesion and obliteration of the cavity. Comparative studies of sclerosing agents for the management of malignant pericardial effusion include that comparing the Bleomycin group and non-administered group (JCOG) and another comparing bleomycin and doxycycline in 1996. Both studies recommended Bleomycin to control malignant pericardial effusion. Although instillation of drugs into the pericardium are reportedly safe, paracentesis or tube pericardiostomy are sometimes associated with an incidence of complications, some of which are fatal. These complications are assumed to occur in about 3% of the cases, even if an experienced physician proceeds using an echo guide. Though bleomycin is the recommended drug for the initial sclerosing agent in malignant pericardial effusion, physicians should consider the status and the prognosis of each case in the treatment of malignant pericardial effusion.