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Oncovin

Generic Name: Vincristine Sulfate
Class: Antineoplastic Agents
VA Class: AN900
CAS Number: 2068-78-2

Warning(s)

  • Administration Warnings
  • For IV use only.131

  • Fatal if given intrathecally.131 (See Intrathecal Administration under Cautions.)

  • Extremely important to properly place IV needle or catheter before any vincristine is injected.131

  • Leakage into surrounding tissues may cause considerable irritation.131

  • Discontinue immediately if leakage occurs; administer remainder of the dose through another vein.131

  • Local treatment of leakage area (e.g., with hyaluronidase injection, application of moderate heat) may help disperse vincristine and minimize discomfort and possibility of cellulitis.131

  • Limit to Qualified Personnel
  • For administration only by individuals experienced in the administration of vincristine.131

Introduction

Antineoplastic agent; vinca alkaloid.a 135 140

Uses for Oncovin

As a component of many chemotherapeutic regimens because of its relative lack of hematologic toxicity.a 136

Acute Lymphocytic Leukemia

Component of combination chemotherapeutic regimens for the induction of remissions of childhood or adult acute lymphocytic (lymphoblastic) leukemia (ALL).136 141 142 143 144 145

In non-high-risk childhood ALL, combination therapy with vincristine, an asparaginase preparation, and a corticosteroid (dexamethasone or prednisone) is used as an induction regimen.141 Intensive induction regimens with ≥4 drugs, including vincristine, an anthracycline (e.g., daunorubicin), an asparaginase preparation, and a corticosteroid, with or without cyclophosphamide, may improve event-free survival but cause greater toxicity.136 141 143 Some clinicians reserve 4- or 5-drug regimens for patients with high-risk childhood ALL;136 141 143 others elect to use such regimens for all patients with childhood ALL regardless of presenting features.141

In adults, induction regimens typically include vincristine, prednisone, and an anthracycline; some regimens also add other drugs (e.g., an asparaginase preparation, cyclophosphamide).142

Various drugs have been used for combination chemotherapy,136 141 142 143 144 145 and comparative efficacy of these regimens is continually being evaluated.141 142 143 144 145

Slideshow: Flashback: FDA Drug Approvals 2013

Acute Myeloid Leukemia

In various combination regimens for the treatment of acute myeloid (myelogenous, nonlymphocytic) leukemias (AML, ANLL),136 but the comparative efficacy of these combinations is continually being evaluated.a

Component of second-line regimens for induction in AML.136

Hodgkin’s Disease

Component of various chemotherapeutic regimens for Hodgkin’s disease;131 136 139 comparative efficacy of various regimens is continually being evaluated.137 138 139

Used in combination with bleomycin, etoposide, doxorubicin, cyclophosphamide, procarbazine and prednisone (increased-dose BEACOPP regimen) for advanced Hodgkin’s disease.136 139

Being investigated in combination with doxorubicin, bleomycin, vinblastine, mechlorethamine, etoposide, and prednisone (Stanford V regimen) for advanced Hodgkin’s disease.136 139

Non-Hodgkin’s Lymphoma

Component of combination chemotherapeutic regimens as first-line palliative therapy for non-Hodgkin’s lymphomas, including the diffuse histiocytic or lymphocytic type.131 136

Comparative efficacy of various regimens is continually being evaluated, and the best combination or sequence to achieve maximum response has not been established.a

Neuroblastoma

Component of various regimens as second-line palliative therapy for neuroblastoma.136

Rhabdomyosarcoma

Commonly used with dactinomycin, with or without cyclophosphamide, as an adjunct to surgery and/or radiation therapy.a 136

Wilms’ Tumor

In children with Wilms’ tumor, generally used with dactinomycin (with or without doxorubicin or cyclophosphamide),136 but the best combination or sequential therapy to achieve maximum response and duration of survival has not been established and comparative efficacy is continually being evaluated.a

Combination chemotherapy is superior to single-drug therapy as an adjunct to surgery and/or radiation therapy in prolonging relapse-free survival and overall survival.a

Brain Tumors

Palliative treatment of various primary brain tumors.136

Various first- and second-line regimens that typically include vincristine and lomustine with another antineoplastic agent, such as procarbazine or cisplatin, or a corticosteroid (prednisone) have been used in the treatment of astrocytic tumors (e.g., glioblastoma multiforme and anaplastic astrocytoma),136 150 151 medulloblastoma,136 152 153 and oligodendroglioma.136 154

AIDS-related Kaposi’s Sarcoma

Used alone120 121 146 149 or in combination chemotherapy for the palliative treatment of AIDS-related Kaposi’s sarcoma.136 146 147 148 149 181

Small Cell Lung Cancer

In combination with cyclophosphamide and doxorubicin (CAV) for the treatment of extensive-stage small cell lung cancer.136 187

Survival outcomes are similar with CAV or cisplatin/etoposide, and comparative efficacy is continually being evaluated.187

Current prognosis for small cell lung carcinoma is unsatisfactory regardless of stage; all patients are candidates for inclusion in clinical trials at the time of diagnosis.187

Other Uses

Used in combination chemotherapy for osteosarcoma (including Ewing's sarcoma), multiple myeloma, and choriocarcinoma.136

Used in combination with cyclophosphamide and prednisone (with or without doxorubicin) for chronic lymphocytic leukemia.136

Used in combination with cisplatin and fluorouracil for hepatoblastoma.136

Used in combination with cyclophosphamide and dacarbazine for pheochromocytoma.136

Has been used for treatment of immune thrombocytopenic purpura.197 Used IV with some success for the treatment of thrombotic thrombocytopenic purpura,111 122 123 and the use of vincristine-loaded platelets has reportedly been useful in some cases for the management of autoimmune hemolytic anemia.112

Oncovin Dosage and Administration

General

  • Consult specialized references for procedures for proper handling and disposal of antineoplastics.131

  • Care must be taken to avoid contact with the eyes as severe irritation and possibly corneal ulceration (especially if administered under pressure) can result; if contact occurs, immediately wash eyes with copious amounts of water.131

  • Prophylactic regimen for constipation recommended for all patients receiving the drug.131

Administration

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer IV only by individuals experienced in the administration of the drug.131

Very irritating; must not administer IM, sub-Q, or intrathecally.131 Intrathecal administration almost always results in death.131 (See Boxed Warning.)

Management of patients mistakenly receiving intrathecal vincristine is a medical emergency.131 (See Intrathecal Administration under Cautions.)

Administer by IV injection, usually at weekly intervals.131 Inject appropriate quantity of solution either directly into a large central vein or into tubing of a running IV infusion of 0.9% sodium chloride or 5% dextrose injection.131

Has been administered as a slow IV infusion.105 108 114 115 116 117

Extravasation

Extremely important to ensure that needle or catheter is securely within vein to avoid extravasation.131

If leakage occurs, discontinue injection immediately and administer remainder of dose through another vein; local treatment of the area may minimize discomfort and the possibility of cellulitis.131 HID (See Boxed Warning and also Local Effects under Cautions.)

Dilution

Do not add extra fluid to vial prior to removal of dose or in an attempt to empty vial completely; withdraw solution into accurate dry syringe.131

It is recommended that vincristine doses be prepared as a diluted solution in a minibag or a 30-mL syringe to prevent inadvertent intrathecal administration of the drug.198 199 200

For adults, dilute the dose in 25 or 50 mL of 0.9% sodium chloride solution in a small-volume IV bag (i.e., minibag);198 199 alternatively, the dose may be diluted in 20 mL of 0.9% sodium chloride solution in a 30-mL syringe.199

For children, dilute the dose in a smaller volume of 0.9% sodium chloride solution in a small-volume IV bag.198

Rate of Administration

If prepared in a minibag or diluted in a 30 mL syringe, administer by IV injection over 5-10 minutes in adults; in children, administer at a slower rate.198

If administered undiluted, inject appropriate quantity of solution directly into a vein or into the tubing of a free-flowing infusion over a 1-minute period.131 HID

When diluted in a large volume of IV solution, has been administered as a slow IV infusion (e.g., over 4–8 hours);108 114 continuous 4- or 5-day IV infusions have also been used.105 115 116 117 Consult specialized references for specific information on slow IV infusion.a

To decrease pressure applied to the veins, experts recommend notusing an IV pump for vesicant drugs such as vincristine when administered by short infusion into a peripheral vein.201 202

Dispensing Precautions

When dispensing, must label syringe or container holding the individual dose with the statement: “Warning: Fatal if given intrathecally. For intravenous use only.”131 133

Enclose container or syringe holding the individual dose in an overwrap (e.g., plastic bag or similar wrap with typed label) bearing the statements: “Do not remove covering until moment of injection. Fatal if given intrathecally. For intravenous use only.”131 132 133 (See Intrathecal Administration under Cautions.)

Consider additional measures to prevent inadvertent intrathecal administration, including administering diluted vincristine solutions in minibags; preparing the medication at the time of administration; attaching a unique filter; dispensing separately from all other medications; dispensing directly to the individual who is administering the drug; conducting an independent check of the dose and route of administration for the drug both at the time of preparation and prior to administration; and administering vincristine in a separate room from rooms where intrathecal medications are administered.200

Dosage

Available as vincristine sulfate; dosage expressed in terms of the salt.131

Consult published protocols for the dosage of vincristine sulfate and other chemotherapeutic agents and the method and sequence of administration.a

Small daily doses are not recommended because they produce severe toxicity with no added therapeutic benefit.a

Pediatric Patients

General Dosage

In patients receiving asparaginase concomitantly, administer vincristine 12–24 hours before administration of asparaginase to minimize toxicity.131 (See Specific Drugs under Interactions.)

Do not administer while patient is receiving radiation therapy through ports that include the liver.131

IV

Children weighing ≤10 kg: Initially, 0.05 mg/kg at weekly intervals.131 a

Children weighing >10 kg: Usually, 1.5–2 mg/m2 at weekly intervals.131

Determine subsequent doses by clinical and hematologic response and patient tolerance to obtain optimum therapeutic results with minimum adverse effects.a

Dosage Modification for Toxicity and Contraindications for Continued Therapy
Neurologic Toxicity

Monitor carefully (e.g., history, physical examination) for neurologic toxicity.131 Dosage reduction may be necessary in preexisting neuromuscular disease or when other agents with neurotoxic potential are used.131 Some adverse neurologic effects (e.g., neuritic pain, constipation) may lessen or disappear when dosage is reduced.131

Hematologic Toxicity

Perform CBC before administration of each dose; consider withholding next dose in patients with leukopenia or infectious complications.131 Leukopenia may lessen or disappear when the dosage of vincristine is reduced.131

Pulmonary Toxicity

Discontinue vincristine therapy in patients who develop progressive dyspnea.131

Adults

General Dosage

In patients receiving asparaginase concomitantly, administer vincristine 12–24 hours before administration of asparaginase to minimize toxicity.131 (See Specific Drugs under Interactions.)

Do not administer while patient is receiving radiation therapy through ports that include the liver.131

IV

Usually, 1.4 mg/m2 at weekly intervals.131

Determine subsequent doses by clinical and hematologic response and patient tolerance to obtain optimum therapeutic results with minimum adverse effects.a

Dosage Modification for Toxicity and Contraindications for Continued Therapy
Neurologic Toxicity

Monitor carefully (e.g., history, physical examination) for neurologic toxicity.131 Dosage reduction may be necessary in preexisting neuromuscular disease or when other agents with neurotoxic potential are used.131 Some adverse neurologic effects (e.g., neuritic pain, constipation) may lessen or disappear when dosage is reduced.131

Hematologic Toxicity

Perform CBC before administration of each dose; consider withholding next dose in patients with leukopenia or infectious complications.131 Leukopenia may lessen or disappear when the dosage of vincristine is reduced.131

Pulmonary Toxicity

Discontinue vincristine therapy in patients who develop progressive dyspnea.131

Prescribing Limits

Adults

IV

Maximum 2-mg dose recommended by some clinicians.a

Special Populations

Hepatic Impairment

IV

In patients with a direct serum bilirubin concentration >3 mg/dL or other evidence of significant hepatic impairment, a 50% dose reduction recommended.131

Cautions for Oncovin

Contraindications

  • Demyelinating form of Charcot-Marie-Tooth syndrome.131

Warnings/Precautions

Warnings

Intrathecal Administration

Fatal if administered intrathecally; management of patients mistakenly receiving intrathecal vincristine is a medical emergency.131

Prognosis to date generally has been poor despite immediate efforts to remove spinal fluid and flush with lactated Ringer’s injection and other solutions, with such efforts failing to prevent ascending paralysis and death in almost all cases.131

In one adult patient, progression of paralysis was stopped when treatment was initiated immediately after inadvertent intrathecal injection of vincristine.131

Treatment consisted of immediate removal of as much CSF as safely possible via lumbar access, followed by flushing of the subarachnoid space with lactated Ringer’s solution infused continuously at a rate of 150 mL/hour through a catheter in a cerebral lateral ventricle and removal of fluid through a lumbar access.131

As soon as available, fresh frozen plasma (25 mL) diluted in 1 L of lactated Ringer’s solution was infused through the cerebral ventricular catheter at a rate of 75 mL/hour with removal of fluid through the lumbar access.131 The rate of infusion was adjusted to maintain a CSF protein concentration of 150 mg/dL.131 Glutamic acid was administered in a dose of 10 g given IV over 24 hours, followed by 500 mg orally 3 times daily for 1 month or until stabilization of neurologic status.131 134 The role of glutamic acid in this treatment is uncertain.131

Fetal/Neonatal Morbidity and Mortality

May cause fetal harm; teratogenicity and embryolethality demonstrated in animals.131 Avoid pregnancy during therapy.131 If used during pregnancy or patient becomes pregnant, apprise of potential fetal hazard.131

Radiation Therapy

Do not administer while patient is receiving radiation therapy through ports that include the liver.131

Sensitivity Reactions

Allergic reactions126 129 131 (i.e., anaphylaxis,126 131 rash,131 edema131 ) temporally related to vincristine therapy reported in patients receiving the drug as part of combination chemotherapy regimens.126 129 131

Major Toxicities

Neurotoxicity

Major and dose-limiting adverse effect; severity may vary greatly among patients.a

Adverse neuromuscular effects often occur in a sequence with early development of sensory impairment and paresthesia followed by neuritic pain and motor difficulties as therapy is continued.131

Most frequent manifestation is peripheral (mixed sensorimotor) neuropathy; occurs in nearly every patient.a

Earliest and most consistent peripheral neuropathy indication is asymptomatic depression of the Achilles reflex; loss of other deep tendon reflexes occurs in most patients after ≥3 weekly doses and peripheral paresthesias, especially numbness, pain, and tingling, are common.a

Wrist drop, foot drop, cranial nerve palsy, atrophy, cramps, ataxia, slapping gait, and difficulty in walking or inability to walk may occur if prolonged or high-dose therapy is given.a

Cranial nerve palsies may account for headaches and jaw pain; jaw pain usually occurs within 24 hours after the first and/or second dose of vincristine and rarely recurs.a Pain in other areas (e.g., pharyngeal, parotid gland, bone, back, limb) and myalgia have been reported and may be severe.131

Cranial nerve palsies and muscular weakness involving the larynx may produce hoarseness and vocal cord paresis, including potentially life-threatening bilateral vocal cord paralysis; those involving extrinsic eye muscles may cause ptosis, double vision, and optic and extraocular neuropathy.a Optic atrophy with blindness or transient cortical blindness has been reported.131

Peripheral neuritis (both mononeuritis and polyneuritis) and neuralgia also occur frequently.a

Autonomic toxicity (e.g., severe constipation or obstipation and abdominal cramps) may occur; a adynamic ileus occurs frequently, especially in young children.a Constipation may take the form of upper-colon impaction; a flat abdominal film may be used to facilitate diagnosis so the physician is not misled by presentation of colicky abdominal pain coupled with an empty rectum.131 May treat constipation with high enemas and laxatives;131 a routine prevention regimen (e.g., laxatives, enemas) usually is recommended.131 Constipation usually persists <7 days with once weekly dose administration;131 in children, abdominal cramps and adynamic ileus usually also disappear in ≤1 week.a

Urinary tract disturbances (e.g., bladder atony, incontinence, urinary retention, nocturia, oliguria, dysuria, polyuria) have also been reported.a Whenever possible, discontinue other drugs causing urinary retention during the first few days after administration of vincristine, particularly in geriatric patients.131

Other autonomic effects include orthostatic hypotension, abnormal Valsalva response, defective sweating, and myoclonic jerks.a

CNS effects (e.g., altered consciousness, depression, agitation, insomnia, hallucinations, seizures [often with hypertension], progressive encephalopathy, respiratory difficulties, coma) have occurred.a Seizures followed by coma have been reported in several pediatric patients.131

Neurotoxic effects may be additive with those of other neurotoxic agents and spinal cord irradiation.a Use with caution and monitor dosage and toxicity in patients receiving other neurotoxic drugs or in those with preexisting neuromuscular disease.a

General Precautions

Highly toxic drug with a low therapeutic index; therapeutic response is not likely to occur without some evidence of toxicity.a Administer only under constant supervision of clinicians experienced in therapy with cytotoxic agents.a

Hyperuricemia

Hyperuricemia may result from extensive purine catabolism accompanying rapid cellular destruction in some patients receiving vincristine, especially those with non-Hodgkin’s lymphomas or leukemia.a In some patients, uric acid nephropathy may result.131 Monitor serum uric acid concentrations frequently during first 3–4 weeks of therapy; take appropriate measures to prevent hyperuricemia related to rapid leukemic cell lysis.131 Minimize hyperuricemic effects by adequate hydration, alkalinization of the urine, and/or administration of allopurinol.a

Hematologic Effects

Anemia, leukopenia, and thrombocytopenia have been reported.131 Use caution in presence of leukopenia or complicating infection.131

Hematologic toxicity produced by vincristine is less than that produced by most other antineoplastic agents.a

Manufacturers recommend that CBC be performed before each dose.131

Thrombocytopenia (if present when therapy is initiated) may improve before appearance of bone marrow remission.a

CNS Leukemia

If CNS leukemia is diagnosed, additional chemotherapy agents may be required; vincristine does not cross blood-brain barrier in adequate amounts.131

Respiratory Effects

Acute shortness of breath and bronchospasm, which can be severe or life threatening, have occurred; reported most frequently when mitomycin was administered concomitantly.131

Such reactions may occur a few minutes to several hours after administration of a vinca alkaloid, or up to 2 weeks after mitomycin dose.131

Progressive dyspnea, which may require chronic therapy, can occur in patients receiving vincristine; do not readminister to these patients.131

Cardiovascular Effects

Hypertension and hypotension reported.131 CAD131 and MI124 127 128 130 131 have occurred in patients receiving vincristine in combination with other antineoplastic agents but causal relationship not established;131 some patients who developed MI had previously received radiation to the mediastinal area, but MI also reported in patients with no history of radiation to mediastinal area or risk factors for CAD.124 128 130

Local Effects

Tissue irritant; may cause phlebitis and necrosis.a Extravasation can result in pain and cellulitis.a

Manufacturers state that local injection of hyaluronidase and application of moderate heat may decrease local reactions resulting from extravasation;131 however, some clinicians prefer to treat extravasation with cold compresses, dilution with 0.9% sodium chloride injection or infiltration of sodium bicarbonate (5 mL of 8.4% injection), and/or local injection of hydrocortisone.a

Otic Effects

Eighth cranial nerve damage, which may be evident as vestibular manifestations (e.g., dizziness, nystagmus, vertigo) and by auditory manifestations (e.g., varying degrees of hearing impairment including partial or total deafness) that may be temporary or permanent, reported in patients receiving vinca alkaloids.131

Use vincristine concomitantly with other potentially ototoxic drugs (e.g., platinum-containing antineoplastic agents) with extreme caution.131 (See Specific Drugs under Interactions.)

Dermatologic Effects

Vincristine-induced alopecia is common; reversible with discontinuance and in some cases, hair may regrow during maintenance therapy.131

Specific Populations

Pregnancy

Category D.131 (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

Lactation

Not known whether vincristine or its metabolites are distributed into milk. Discontinue nursing or the drug.131

Hepatic Impairment

Use with caution and reduce dosage in patients with obstructive jaundice or other substantial hepatic impairment.a (See Hepatic Impairment under Dosage and Administration)

Common Adverse Effects

Asymptomatic depression of the Achilles reflex, loss of deep tendon reflexes, peripheral paresthesias (numbness, pain, and tingling), hair loss, leukopenia, neuritic pain, constipation, sensory loss, wrist drop, foot drop, cranial nerve palsy, atrophy, cramps, ataxia, difficulty walking, inability to walk, slapping gait, muscle wasting, cranial nerve palsies, headache, jaw pain.131

Interactions for Oncovin

Metabolized by CYP microsomal enzymes, including CYP3A.131

Drugs Affecting Hepatic Microsomal Enzymes

Inhibitors of CYP3A: Potential pharmacokinetic interaction (inhibition of vincristine metabolism); use concomitantly with caution.131

Specific Drugs

Drug

Interaction

Comments

Asparaginase

Possible reduction in hepatic clearance of vincristine131

When used concomitantly, administer vincristine 12–24 hours before administration of asparaginase to minimize toxicity; do not administer asparaginase before vincristine administration131

Itraconazole

Earlier onset and/or increased severity of neuromuscular adverse effects reported with concomitant use, probably related to inhibition of vincristine metabolism131

Use concomitantly with caution131

Mitomycin

Potential increased risk of serious adverse respiratory effects with concomitant use, particularly in preexisting pulmonary dysfunction131

Reactions may occur up to 2 weeks after mitomycin dose131 (see Respiratory Effects under Cautions)

Ototoxic drugs (e.g., platinum-containing antineoplastic agents)

Potential additive ototoxic effect131

Varying degrees of permanent or temporary hearing impairment associated with eighth cranial nerve damage reported in patients receiving vinca alkaloids; use concomitantly with other potentially ototoxic drugs with extreme caution131

Phenytoin

Decreased serum concentrations of phenytoin and increased seizure activity reported with combination chemotherapy regimens that included vincristine, possibly as a result of decreased absorption and/or increased metabolism of phenytoin131

Contribution of vincristine to interaction is uncertain131

Monitor serum phenytoin concentrations and adjust dosage as necessary131

Oncovin Pharmacokinetics

Distribution

Extent

Distribution of vincristine and its metabolites not fully characterized; following IV administration, the drug is rapidly and widely distributed.100 101 102 103 104

Following rapid IV injection, rapidly and extensively distributed into bile.103

Following rapid IV injection, vincristine and its metabolites (and/or decomposition products) cross the blood-brain barrier poorly, generally do not appear in the CSF in cytotoxic concentrations.102

Not known whether vincristine and its metabolites are distributed into milk.a

Elimination

Metabolism

Not clearly determined; apparently extensively metabolized, probably in the liver by CYP microsomal enzymes, including CYP3A,131 but extent of metabolism is not clear because vincristine also apparently undergoes decomposition in vivo.100 103

Elimination Route

Vincristine and its metabolites (and/or decomposition products) are excreted principally in feces via biliary elimination (30% within 24 hours and 70% within 72 hours) and to lesser extent in urine (about 10% within 24 hours).100 103 104

Half-life

19–155 hours.131

Special Populations

In patients with hepatic impairment, metabolism of vincristine may be decreased.102 103 131 Only small amounts of vincristine are removed by hemodialysis.131

Stability

Storage

Parenteral

Injection

2–8°C;131 protect from light.a

Doses of 0.5, 1, 2, or 3 mg of vincristine sulfate diluted in 25 or 50 mL of 0.9% sodium chloride injection in small-volume IV bags (i.e., minibags) or in 20 mL of 0.9% sodium chloride injection in a 30-mL syringe remained stable when stored for 7 days at 4°C followed by 2 days at 23°C.199

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Manufacturers state that injection should not be diluted in solutions that alter pH outside range of 3.5–5.5 and do not recommend mixing with solutions other than 0.9% sodium chloride injection or 5% dextrose injection.131

Solution CompatibilityHID

Compatible

Dextrose 5% in water

Ringer’s injection, lactated

Sodium chloride 0.9%

Drug Compatibility
Admixture CompatibilityHID

Compatible

Bleomycin sulfate

Cytarabine

Doxorubicin HCl

Doxorubicin HCl with etoposide phosphate

Doxorubicin HCl with ondansetron HCl

Fluorouracil

Methotrexate sodium

Variable

Doxorubicin HCl with etoposide

Y-Site CompatibilityHID

Compatible

Allopurinol sodium

Amifostine

Amphotericin B cholesteryl sulfate complex

Anidulafungin

Aztreonam

Bleomycin sulfate

Caspofungin acetate

Cisplatin

Cladribine

Cyclophosphamide

Doxorubicin HCl

Doxorubicin HCl liposome injection

Droperidol

Etoposide phosphate

Filgrastim

Fludarabine phosphate

Fluorouracil

Gemcitabine HCl

Granisetron HCl

Heparin sodium

Leucovorin calcium

Linezolid

Melphalan HCl

Methotrexate sodium

Metoclopramide HCl

Mitomycin

Ondansetron HCl

Oxaliplatin

Paclitaxel

Pemetrexed disodium

Piperacillin sodium–tazobactam sodium

Sargramostim

Teniposide

Thiotepa

Topotecan HCl

Vinblastine sulfate

Vinorelbine tartrate

Incompatible

Furosemide

Idarubicin HCl

Sodium bicarbonate

Actions

  • Mechanism of action not fully elucidated; vincristine and other vinca alkaloids exert cytotoxic effects by binding to tubulin, the protein subunit of the microtubules that form the mitotic spindle.135 140

  • Formation of vincristine-tubulin complexes prevents polymerization of the tubulin subunits into microtubules, induces depolymerization of microtubules resulting in inhibition of microtubule assembly and cellular metaphase arrest.135

  • In high concentrations, also exerts complex effects on nucleic acid and protein synthesis.a

  • Exerts some immunosuppressive activity.a

Advice to Patients

  • Importance of advising patients and/or their parents or guardians of adverse effects and associated manifestations.a

  • Risk of hair loss; reversible when the drug is discontinued.a Regrowth of hair may occur even when vincristine is continued in therapeutic doses.a

  • Importance of avoiding contact of vincristine with eyes;131 importance of informing clinician if eye irritation continues after washing affected eye(s) following contact.a

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.a

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.a

  • Importance of informing patients of other important precautionary information.a (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Vincristine Sulfate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection, for IV use only

1 mg/mL (1 and 2 mg)*

Vincristine Sulfate Injection

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions September 17, 2013. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

100. Bender RA, Castle MC, Margileth DA et al. The pharmacokinetics of [3H]-vincristine in man. Clin Pharmacol Ther. 1977; 22:430-8. [IDIS 95802] [PubMed 902455]

101. Jackson DV Jr, Sethi VS, Spurr CL et al. Pharmcokinetics of vincristine infusion. Cancer Treat Rep. 1981; 65:1043-8. [IDIS 141657] [PubMed 7296550]

102. Jackson DV Jr, Sethi VS, Spurr CL et al. Pharmacokinetics of vincristine in the cerebrospinal fluid of humans. Cancer Res. 1981; 41:1466-8. [IDIS 176921] [PubMed 6260340]

103. Jackson DV Jr, Castle MC, Bender RA. Biliary excretion of vincristine. Clin Pharmacol Ther. 1978; 24:101-7. [PubMed 657711]

104. Owellen RJ, Root MA, Hains FO. Pharmacokinetics of vindesine and vincristine in humans. Cancer Res. 1977; 37:2603-7. [PubMed 872088]

105. Barlogie B, Smith L, Alexanian R. Effective treatment of advanced multiple myeloma refractory to alkylating agents. N Engl J Med. 1984; 310:1353-6. [IDIS 185486] [PubMed 6546971]

106. Ahn YS, Harrington WJ, Seelman RC et al. Vincristine therapy of idiopathic and secondary thrombocytopenias. N Engl J Med. 1974; 291:376-80. [IDIS 43910] [PubMed 4847353]

107. Ries CA. Vincristine for treatment of refractory autoimmune thrombocytopenia. N Engl J Med. 1976; 295:1136. [PubMed 980011]

108. Ahn YS, Harrington WJ, Mylvaganam R et al. Slow infusion of vinca alkaloids in the treatment of idiopathic thrombocytopenic purpura. Ann Intern Med. 1984; 100:192-6. [IDIS 181312] [PubMed 6537881]

109. Nenci GG, Agnelli G, De Cunto M et al. Infusion of vincristine-loaded platelets in acute ITP refractory to steroids: an alternative to splenectomy. Acta Haematol. 1981; 66:117-21. [PubMed 6794311]

110. Rosse WF. Whatever happened to vinca-loaded platelets? N Engl J Med. 1984; 310:1051-2. Editorial.

111. Gutterman LA, Stevenson TD. Treatment of thrombotic thrombocytopenic purpura with vincristine. JAMA. 1982; 247:1433-6. [IDIS 146911] [PubMed 7199096]

112. Ahn YS, Harrington WJ, Byrnes JJ et al. Treatment of autoimmune hemolytic anemia with vinca-loaded platelets. JAMA. 1983; 249:2189-94. [PubMed 6834615]

113. Rogers GM, Ries CA. Long-term effectiveness of vincristine in the therapy of refractory autoimmune thrombocytopenia. N Engl J Med. 1980; 303:585. [IDIS 124966] [PubMed 7402227]

114. Manoharan A. Slow infusion of vinca alkaloids in idiopathic thrombocytopenic purpura. Ann Intern Med. 1984; 100:921. [IDIS 186257] [PubMed 6539090]

115. Weber W, Nagel GA, Nagel-Studer E et al. Vincristine infusion: a phase I study. Cancer Chemother Pharmacol. 1979; 3:49-55. [PubMed 317027]

116. Jackson DV Jr, Sethi VS, Spurr CL et al. Intravenous vincristine infusion: phase I trial. Cancer. 1981; 48:2559-64. [IDIS 142478] [PubMed 7306914]

117. Jackson DV Jr, Paschold EH, Spurr CL et al. Treatment of advanced non-Hodgkin’s lymphoma with vincristine infusion. Cancer. 1984; 53:2601-6. [IDIS 186198] [PubMed 6722721]

118. Dyke RW. Acute bronchospasm after a vinca alkaloid in patients previously treated with mitomycin. N Engl J Med. 1984; 310:389. [IDIS 181096] [PubMed 6690968]

119. Alexanian R, Barlogie B, Dixon D. High-dose glucocorticoid treatment of resistant myeloma. Ann Intern Med. 1986; 105:8-11. [IDIS 217835] [PubMed 3717812]

120. Rieber E, Mittelman A, Wormser GP et al. Vincristine and Kaposi’s sarcoma in the acquired immunodeficiency syndrome. Ann Intern Med. 1984; 101:876. [IDIS 194144] [PubMed 6497201]

121. Mintzer DM, Real FX, Jovino L et al. Treatment of Kaposi’s sarcoma and thrombocytopenia with vincristine in patients with the acquired immunodeficiency syndrome. Ann Intern Med. 1985; 102:200-2. [IDIS 195778] [PubMed 2981498]

122. Sennett ML, Conrad ME. Treatment of thrombotic thrombocytopenic purpura: plasmapheresis, plasma transfusion, and vincristine. Arch Intern Med. 1986; 146:266-7. [IDIS 211730] [PubMed 3947187]

123. Schreeder MT, Prchal JT. Successful treatment of thrombotic thrombocytopenic purpura by vincristine. Am J Hematol. 1983; 14:75-8. [PubMed 6682286]

124. Federman DG, Henry G. Chemotherapy-induced myocardial necrosis in a patient with chronic lymphocytic leukemia. Respir Med. 1997; 91:565-7. [PubMed 9415359]

125. Nelson RL. The comparative clinical pharmacology and pharmacokinetics of vindesine, vincristine, and vinblastine in human patients with cancer. Med Pediatr Oncol. 1982; 10:115-27. [PubMed 7070351]

126. Bhardwaj B, Kalra SK, Gupta G. Fatal anaphylaxis following intravenous vincristine. Indian Pediatr. 1986; 23:961. [PubMed 3793225]

127. Voelker W. Schuler U, Ehninger G et al. Anterior wall infarct in an 18-year-old patient with Hodgkin’s disease: possible relation between mediastinal irradiation, accelerated arteriosclerosis and vincristine chemotherapy. (German; with English abstract.) Dtsch Med Wochenschr. 1987; 112:1216-9.

128. Barra M, Brignole M, Sartore B et al. Myocardial infarction induced by vincristine in patients with Hodgkin’s lymphoma: description of 2 cases and review of the literature. (Italian; with English abstract.) G Ital Cardiol. 1985; 15:107-11.

129. Gassel WD, Gropp C, Havemann K. Acute allergic reaction due to vincristine sulfate: a case report. Oncology. 1984; 41:403-5. [PubMed 6548802]

130. Allal J, Becq-Giraudon B, Pouget-Abadie JF et al. 2 new cases of myocardial infarction after injection of vincristine. (French; with English abstract.) Ann Cardiol Angeiol (Paris). 1984; 33:469-70.

131. Mayne. Vincristine sulfate injection prescribing information. Paramus, NJ; 2004 Jan.

132. The United States Pharmacopeia, 22nd rev, and The national formulary, 17th ed. Rockville, MD: The United States Pharmacopeial Convention, Inc; 1991(Suppl 4):2506.

133. United States Pharmacopeial Convention Drug Product Problem Reporting Program. Vincristine sulfate monographs revised—dispensing pharmacy practice is affected. USP Drug Product Quality Review. No. 19. Rockville, MD; 1991 Jun.

134. Dyke RW. Treatment of inadvertent intrathecal injection of vincristine. N Engl J Med. 1989, 321:1270-1. Letter.

135. Zhou XJ, Rahmani R. Preclinical and clinical pharmacology of vinca alkaloids. Drugs. 1992; 44(Suppl 4):1-16. [PubMed 1283846]

136. Anon. Drugs of choice for cancer. Treat Guidel Med Lett. 2003; 1:41-52. [PubMed 15529105]

137. Urba WJ, Longo DL. Hodgkin’s disease. N Engl J Med. 1992; 326:678-687. [IDIS 292239] [PubMed 1736106]

138. DeVita VT Jr, Hubbard SM. Hodgkin’s disease. N Engl J Med. 1993; 328:560-5. [IDIS 309839] [PubMed 8426624]

139. Adult Hodgkin’s lymphoma. From: PDQ. Physician data query (database). Bethesda, MD: National Cancer Institute; 2007 May 3.

140. Rowinsky EK, Donehower RC. The clinical pharmacology and use of antimicrotubule agents in cancer chemotherapeutics. Pharmacol Ther. 1991; 52:35-84. [PubMed 1687171]

141. Childhood acute lymphoblastic leukemia. From: PDQ. Physician data query (database). Bethesda, MD: National Cancer Institute; 2012 May 18.

142. Adult acute lymphoblastic leukemia. From: PDQ. Physician data query (database). Bethesda, MD: National Cancer Institute; 2012 May 10.

143. Margolin JF, Rabin KR, Poplack DG. Leukemias and lymphomas of childhood. In: DeVita VT Jr, Lawrence TS, Rosenberg SA et al, eds. DeVita, Hellman, and Rosenberg's cancer: principles and practice of oncology. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2011.

144. Preti A, Kantarjian HM. Management of adult acute lymphocytic leukemia: present issues and key challenges. J Clin Oncol. 1994; 12:1312-22. [IDIS 331854] [PubMed 8201394]

145. Kebriaei P, Champlin R, De Lima M et al. Management of acute leukemias. In: DeVita VT Jr, Lawrence TS, Rosenberg SA et al, eds. DeVita, Hellman, and Rosenberg's cancer: principles and practice of oncology. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2011.

146. Kaposi’s sarcoma. From: PDQ. Physician data query (database). Bethesda, MD: National Cancer Institute; 2006 Dec 13.

147. Gelmann EP, Longo D, Lane HC et al. Combination chemotherapy of disseminated Kaposi’s sarcoma in patients with the acquired immune deficiency syndrome. Am J Med. 1987; 82:456-62. [IDIS 226739] [PubMed 2435150]

148. Gill PS, Rarick M, McCutchan JA et al. Systemic treatment of AIDS-related Kaposi’s sarcoma: results of a randomized trial. Am J Med. 1991; 90:427-33. [IDIS 280110] [PubMed 1707230]

149. Northfelt DW. Treatment of Kaposi’s sarcoma: current guidelines and future perspectives. Drugs. 1994; 48:569-82. [PubMed 7528130]

150. Levin VA, Silver P, Hannigan J et al. Superiority of post-radiotherapy adjuvant chemotherapy with CCNU, procarbazine, and vincristine (PCV) over BCNU for anaplastic gliomas: NCOG 6G61 final report. Int J Radiat Oncol Biol Phys. 1990; 18:321-4. [PubMed 2154418]

151. Sposto R, Ertel IJ, Jenkin RD et al. The effectiveness of chemotherapy for treatment of high grade astrocytoma in children: results of a randomized trial. A report from the Childrens Cancer Study Group. J Neurooncol. 1989; 7:165-77. [PubMed 2550594]

152. Packer RJ, Sutton LN, Elterman R et al. Outcome for children with medulloblastoma treated with radiation and cisplatin, CCNU, and vincristine chemotherapy. J Neurosurg. 1994; 81:690-8. [PubMed 7931615]

153. Evans AE, Jenkin RD, Sposto R et al. The treatment of medulloblastoma. Results of a prospective randomized trial of radiation therapy with and without CCNU, vincristine, and prednisone. J Neurosurg. 1990; 72:572-82. [PubMed 2319316]

154. Cairncross G, Macdonald D, Ludwin S et al. Chemotherapy for anaplastic oligodendroglioma. National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 1994; 12:2013-21. [IDIS 337224] [PubMed 7931469]

181. Kaplan L, Abrams D, Volberding P. Treatment of Kaposi’s sarcoma in acquired immunodeficiency syndrome with an alternating vincristine-vinblastine regimen. Cancer Treat Rep. 1986; 70:1121-2. [IDIS 222400] [PubMed 3742492]

184. Gill PS, Wernz J, Scadden DT et al. Randomized phase III trial of liposomal daunorubicin versus doxorubicin, bleomycin, and vincristine in AIDS-related Kaposi’s sarcoma. J Clin Oncol. 1996; 14:2353-64. [IDIS 371434] [PubMed 8708728]

186. Shields PG, Dawkins F, Holmlund J et al. Low-dose multidrug chemotherapy plus pneumocystis carinii pneumonia prophylaxis for HIV-related Kaposi’s sarcoma. J Acquir Immune Defic Syndr. 1990; 3:695-700. [PubMed 1693677]

187. Small cell lung cancer. From: PDQ. Physician data query (database). Bethesda, MD: National Cancer Institute; 2007 May 3.

190. Northfelt DW, Dezube BJ, Thommes JA et al. Pegylated-liposomal doxorubicin versus doxorubicin, bleomycin, and vincristine in the treatment of AIDS-related Kaposi’s sarcoma: results of a randomized phase III clinical trial. J Clin Oncol. 1998; 16:2445-51. [IDIS 410501] [PubMed 9667262]

191. Stewart S, Jablonowski H, Goebel FD et al. Randomized comparative trial of pegylated liposomal doxorubicin versus bleomycin and vincristine in the treatment of AIDS-related Kaposi’s sarcoma. J Clin Oncol. 1998; 16:683-91. [IDIS 401192] [PubMed 9469358]

192. Food and Drug Administration. Labeling and prescription drug advertising; content and format for labeling for human prescription drugs. 21 CFR Parts 201 and 202. Final Rule. [Docket No. 75N-0066] Fed Regist. 1979; 44:37434-67.

193. Department of Health and Human Services, Food and Drug Administration. Subpart B—Labeling requirements for prescription drugs and/or insulin. (21 CFR Ch. 1 (4-1-87 Ed.)). 1987:18-24.

194. Sicor. Vincasar PFS (vincristine sulfate injection) prescribing information. Irvine, CA; 2003 Jul.

195. Food and Drug Administration. MedWatch—Safety-related drug labeling changes: Vfend (voriconazole) [Dec 2003]. From FDA web site .

196. Food and Drug Administration. MedWatch—Safety-related drug labeling changes: Emend (aprepitant) [May 2003]. From FDA web site .

197. Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med. 2002; 346:995-1008. [IDIS 478287] [PubMed 11919310]

198. Stefanou A, Dooley M. Simple method to eliminate the risk of inadvertent intrathecal vincristine administration. J Clin Oncol. 2003; 21:2044. [PubMed 12743160]

199. Trissel AL, Zhang Y, Cohen MR. The stability of diluted vincristine sulfate used as a deterrent to inadvertent intrathecal injection. Hosp Pharm. 2001; 36:740-5.

200. Joint Commission on Accreditation of Healthcare Organizations. Preventing vincristine administration errors. Sentinel Event Alert. 2005 Jul 14; (34):1-3.

201. Oncology Nursing Society (ONS). Chemotherapy and biotherapy guidelines and recommendations for practice. 2nd ed. Pittsburgh, PA: Oncology Nursing Society (ONS); 2005. Brief summary from the National Guideline Clearinghouse website (). Accessed 2007 Nov 16. (IDIS ) (PubMed )

202. Oncology Nursing Society (ONS). ONS Frequently Asked Questions: Chemotherapy FAQ; Does ONS have recommendations regarding the administration of vincristine by minibag or IV push? From the ONS website (). Accessed 2007 Nov 14.

203. Pui CH, Evans WE. Treatment of acute lymphoblastic leukemia. N Engl J Med. 2006; 354:166-78. [PubMed 16407512]

a. AHFS drug information 2008. McEvoy GK, ed. Vincristine sulfate. Bethesda, MD: American Society of Health-System Pharmacists; 2008:1264-8.

HID. Trissel LA. Handbook on injectable drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013:1140-5.

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