Vincristine Side Effects
Some side effects of vincristine may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
For the Consumer
Applies to vincristine: intravenous powder for solution, intravenous solution
Along with their needed effects, medicines like vincristine can sometimes cause unwanted effects such as blood problems, nervous system problems, loss of hair, and other side effects. These and others are described below. Also, because of the way these medicines act on the body, there is a chance that they might cause other unwanted effects that may not occur until months or years after the medicine is used. Discuss these possible effects with your doctor.
Check with your doctor immediately if any of the following side effects occur while taking vincristine:Less common
- Pain or redness at place of injection
- Black, tarry stools
- blood in urine or stools
- cough or hoarseness
- fever or chills
- pinpoint red spots on skin
- unusual bleeding or bruising
Check with your doctor as soon as possible if any of the following side effects occur while taking vincristine:More common
- Blurred or double vision
- difficulty in walking
- drooping eyelids
- jaw pain
- joint pain
- lower back or side pain
- numbness or tingling in fingers and toes
- pain in fingers and toes
- pain in testicles
- stomach cramps
- swelling of feet or lower legs
- convulsions (seizures)
- decrease or increase in urination
- dizziness or lightheadedness when getting up from a lying or sitting position
- hallucinations (seeing, hearing, or feeling things that are not there)
- lack of sweating
- loss of appetite
- mental depression
- painful or difficult urination
- trouble in sleeping
- Sores in mouth and on lips
Some side effects of vincristine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:Less common
- loss of weight
- nausea and vomiting
- skin rash
Other side effects may occur that usually do not need medical attention. This medicine often causes a temporary loss of hair. After treatment with vincristine has ended, or sometimes even during treatment, normal hair growth should return.
For Healthcare Professionals
Applies to vincristine: compounding powder, intravenous solution
Prior to the use of vincristine, patients should be advised of the possibility of untoward symptoms. Adverse reactions associated with the use of the drug appear to be dose related.
In one study, 61% of the 23 patients treated for lymphoma developed neuropathy, while only 14% of the 37 patients with other malignant diseases developed these symptoms.
A long term study done of the effects of vincristine on the peripheral nervous system of 40 patients, concluded that with a cumulative dose of 12 mg over 18 to 24 weeks, signs and symptoms of vincristine neuropathy are reversible for the majority of patients and the prognosis is good.
There has been a case report of a patient with a familial variant of Charcot-Marie-Tooth syndrome. After receiving two 2 mg dosages, his weakness secondary to peripheral neuropathy rapidly progressed to complete paraplegia.
Acute acoustic nerve palsy has been reported.
Nervous system side effects frequently develop in a sequence. Initially, sensory impairment and paresthesia are most likely to be encountered. Patients may report numbness, pin prick or a tingling sensation. As treatment continues, neuritic pain followed by motor difficulties have been reported. Loss of deep-tendon reflexes, foot drop, wrist drop, slapping gait, ataxia, and paralysis have been reported with continued administration. Cranial nerve manifestations, including isolated paresis and/or paralysis of muscles controlled by cranial nerves, may occur in the absence of motor impairment elsewhere; extraocular and laryngeal muscles are those most commonly involved. Jaw pain, pharyngeal pain, parotid gland pain, bone pain, back pain, limb pain, and myalgias have been reported. Pain in these areas may be severe. Convulsions, frequently with hypertension have occasionally been reported. A case of acute fulminant encephalopathy with severe mental confusion and a focal seizure has been reported. Coma has been reported. The dose-limiting clinical toxicity is neurotoxicity.
Dermatologic side effects including alopecia (20% to 70%) and rash (infrequent) have been reported. Alopecia is the most common adverse reaction. It is usually reversible. Soft tissue damage has been reported when extravasation takes place.
Acute shortness of breath and severe bronchospasm occur most frequently when vincristine is used in combination with mitomycin. These adverse effects may require aggressive treatment, especially if there is preexisting pulmonary dysfunction. The onset of these reactions may occur minutes to hours after the administration of vincristine and up to 2 weeks following the dose of mitomycin.
Respiratory side effects including acute shortness of breath and severe bronchospasm have been reported following the administration of vinca alkaloids. Progressive dyspnea requiring chronic therapy has been reported.
Constipation may take the form of upper colon impaction and on physical examination, the rectum may be empty. Colicky abdominal pain coupled with an empty rectum may mislead the physician. A flat film of the abdomen is useful in demonstrating this condition. All cases have responded to high enemas and laxatives. Paralytic ileus may reverse itself with temporary discontinuance of the drug and symptomatic care.
Gastrointestinal side effects including constipation, abdominal cramps, anorexia, weight loss, nausea, vomiting, oral ulceration, diarrhea, paralytic ileus, intestinal necrosis, megacolon and/or perforation have been reported.
Hematologic side effects including anemia, leukopenia, thrombocytopenia, and central-nervous-system leukemia have been reported. Myelosuppression is generally mild. The drug does not appear to have any constant or significant effect on platelets or red blood cells.
Cardiovascular side effects including both hypertension and hypotension have been reported. In patients who have received mediastinal radiation prior to vincristine as a part of combination chemotherapy, coronary artery disease and myocardial infarction have been reported.
Ocular side effects including transient cortical blindness, diplopia, ptosis, photophobia and optic atrophy with blindness have been reported.
Endocrine side effects including pancreatitis and a syndrome attributable to inappropriate antidiuretic hormone have been reported rarely.
The syndrome is characterized by high urinary sodium excretion in the presence of hyponatremia. Renal or adrenal disease, hypotension, dehydration, azotemia, and clinical edema are absent. With fluid deprivation, improvement occurs in the hyponatremia and in the renal loss of sodium. Generally, treatment with vincristine can continue.
One study of 55 males who received chemotherapy as children, and at the time of the study were over 18, found a 5 fold increase in azoospermia when compared to patients that did not receive vincristine. The study concluded that vincristine may have a previously unrecognized important role in causing possibly irreversible azoospermia when administered in childhood or adolescence.
Genitourinary side effects including polyuria, dysuria, and urinary retention due to bladder atony have been reported. Amenorrhea and azoospermia have been reported in patients receiving combination chemotherapy (which also included an alkylating agent, procarbazine, and prednisone). Clinicians should counsel patients regarding reproductive risks if appropriate.
Oncologic side effects including second malignancies have been reported following the administration of vincristine in combination with chemotherapeutic drugs which are known carcinogens.
Studies in rats and mice have failed to clearly demonstrate evidence of carcinogenesis.
Hypersensitivity side effects including anaphylaxis, rash and edema have been reported rarely in patients receiving vincristine as part of a multidrug chemotherapeutic regimen. Fatal anaphylaxis following the administration of intravenous vincristine has been reported.
Hepatic side effects including a case of fatal hepatitis has been reported following therapy with irradiation and vincristine. A case of moderate transient liver function abnormalities has been confirmed by rechallenge with vincristine.
Other side effects including fever, headache, gynecomastia and visual hallucinations have been reported. Two cases have been reported where patients with recent surgical lesions received intravenous vincristine. In the first patient sloughing occurred at the incision site. In the second patient, the incisional margins became indurated, inflamed and necrotic.
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