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Class: Vinca alkaloid
- Solution for Injection 1 mg/mL
Mode of action is unknown. In vitro, vincristine arrests mitotic division at metaphase. It reversibly binds to microtubule and spindle proteins in the S phase.
Very rapidly absorbed via IV (15 to 30 min).
More than 90% of drug is distributed from blood to tissue, where it remains tightly but not irreversibly. Penetration across the blood brain barrier is poor.
Triphasic serum decay following rapid IV injection.
Terminal t ½ is 85 h (19 to 155 h). Liver is the major excretory organ. 80% of the dose appears in the feces, 10% to 20% in the urine.
15 to 30 min.
Special PopulationsHepatic Function Impairment
A 50% reduction in dose is recommended for patients having a direct serum bilirubin more than 3 mg/dL.
Indications and UsageAdult/Pediatric
Acute lymphocytic leukemia, lymphomas, rhabdomyosarcoma, neuroblastoma, Wilms tumor.
Small-cell lung carcinoma, brain tumors, multiple myeloma, Kaposi sarcoma, chronic lymphocytic and myelocytic leukemias, autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura.
Patients with demyelinating form of Charcot-Marie-Tooth syndrome.
Dosage and AdministrationAcute Lymphocytic Leukemia, Lymphomas, Rhabdomyosarcoma, Neuroblastoma, Wilms Tumor
IV 1.4 mg/m 2 weekly (typical dose, 2 mg).Children weighing more than 10 kg (or body surface area at least 1 m 2 )
IV 1.4 to 2 mg/m 2 weekly for 3 to 8 wk. Do not exceed a max of 2 mg/dose.Children weighing up to 10 kg (or body surface area less than 1 m 2 )
IV 0.05 mg/kg weekly initially. Titrate dose as tolerated, up to a max of 2 mg/dose. Continue therapy for 3 to 8 wk.Adjustment in Hepatic Insufficiency
IV A 50% reduction in dose is recommended for patients having a direct serum bilirubin value more than 3 mg/dL.Neuroblastoma, Combination Therapy
Children weighing more than 10 kg (or body surface area at least 1 m 2 )
IV Vincristine 1 mg/m 2 /day by continuous infusion over 24 h for 3 days (total dose of 3 mg/m 2 over a 3-day period).
- Do not dilute vincristine for routine IV use. For continuous IV infusion, vincristine may be diluted with 0.9% Sodium Chloride or 5% Dextrose.
- Administer by IV injection or continuous IV infusion.
- Do not filter.
- Give over a 1-min period by IV push injection or IV side arm into a running infusion.
- Continuous infusions can only be administered through a central venous catheter resting in the vena cava. A peripherally-inserted central catheter, or PICC line, may also be appropriate.
Refrigerate. Protect from light.
Drug InteractionsCYP-450 inhibitors
Vincristine elimination may be reduced by CYP-450 enzyme inhibitors.Digoxin
May decrease digoxin plasma concentration.Itraconazole
Vincristine neurotoxicity has occurred during coadministration.L-asparaginase
Vincristine clearance may decrease when L-asparaginase is given prior to vincristine. Give vincristine 12 to 24 hr prior to L-asparaginase.Mitomycin
Acute shortness of breath and severe bronchospasm have occurred following concomitant or previous use of mitomycin.Phenytoin
May reduce phenytoin plasma concentration.Quinolone antibiotics
Vincristine may decrease oral absorption of quinolone antibiotics.
Laboratory Test Interactions
None well documented.
Hypertension; hypotension; MI.
Autonomic and peripheral neuropathy; headache.
Mucositis; abdominal cramps; diarrhea; anorexia; intestinal necrosis or perforation; constipation that can lead to upper colon impaction; paralytic ileus; weight loss.
Amenorrhea; polyuria; dysuria; urinary retention because of bladder atony; azoospermia.
Bone marrow suppression; nadir less than 7 days.
Acute bone or jaw pain.
Acute shortness of breath; severe bronchospasm.
Optic atrophy with blindness; transient cortical blindness; ptosis; diplopia; photophobia.
WarningsIV use only
Intrathecal use of other vinca alkaloids has been fatal. Label syringe “Warning - For IV Use Only; fatal if given intrathecally.”Granulocytopenia
May be severe and predispose to infection. Do not administer to patients with granulocyte counts less than 1,000 cells/mm 3 .Avoid extravasation
Proper placement of needle/catheter prior to administration. Local irritation or phlebitis may occur. Refer to your institution specific protocol.
Category D . Can cause fetal harm when administered to pregnant women.
Hypersensitivity temporally related to vincristine therapy has occurred.
Dosage adjustment (pediatric)
Follow dosage adjustment guidelines recommended for adults.
CNS leukemia has occurred. Additional agents may be required.
Acute shortness of breath and severe bronchospasm have occurred, most frequently when the drug was used with mitomycin-C.
Side effects are dose-related. Expect exaggerated side effects.
- Advise patient, family, or caregiver that medication will be prepared and administered by health care provider in a health care setting.
- Advise patient, family, or caregiver that medication may be used in combination with other agents to achieve max benefit possible.
- Review dosing schedule with patient, family, or caregiver.
- Advise patient, family, or caregiver that medication may cause hair loss but that it is reversible when therapy is stopped.
- Advise patient, family, or caregiver to immediately report any of the following to health care provider: rash; shortness of breath or difficulty breathing; abnormal skin sensations; stumbling; muscle wasting; fever, chills, or other signs of infection; redness or swelling at injection site.
- Advise patient, family, or caregiver to report any of the following to health care provider: persistent nausea, vomiting, constipation, diarrhea, or appetite loss; persistent or worsening general body weakness.
- Caution women of childbearing potential to avoid becoming pregnant during therapy.
Copyright © 2009 Wolters Kluwer Health.