Vincristine

Indications
 Intravenous
Acute lymphoblastic leukaemia, AIDS-related Kaposi's sarcoma, Hodgkin's disease, Neuroblastoma, Small cell lung cancer, Wilm's tumour, Brain tumours, Non-Hodgkin's lymphoma, Acute myeloid leukaemia
Adult: Usual recommended dosage: 1.4-1.5 mg/m2 once wkly. Max: 2 mg wkly. Subsequent doses may be modified based on clinical and haematological responses and tolerance of the patient. May be used in combination with other drugs. Prescribers should consult published protocols for the dosage, method and sequence of admin.
Child: Usual recommended dosage: 1.5-2 mg/m2 once wkly; for patients ≤10 kg: Initiate at 0.05 mg/kg once wkly. Subsequent doses may be modified based on clinical and haematological responses and tolerance of the patient. May be used in combination with other drugs. Prescribers should consult published protocols for the dosage, method and sequence of admin.
Hepatic impairment: Dose adjustment may be needed. Serum bilirubin >3 mg/100ml: Reduce dose by 50%.

Special Populations: Reduce dose to 50% in patients with moderately severe hepatic impairment.

Incompatibility: Any solution that may change pH of the solution beyond 3.5-5.5.
Contraindications
 Patients with demyelinating form of Charcot-Marie-Tooth syndrome. Pregnancy and lactation. Intrathecal admin (may be fatal). Patients receiving radiation therapy through ports which include liver.
Warnings / Precautions
 Elderly. Preexisting pulmonary dysfunction or neuromuscular disease; leucopenia or a complicating infection; impaired liver function; obstructive jaundice. Routine prophylactic laxative needed to ensure regular bowel movement. Discontinue immediately if extravasation occurs, and inj any remaining drug into another vein, followed by local Inj of hyaluronidase and topical heat application to the affected area to aid in drug removal and reduce discomfort. Discontinue in patients who develop progressive dyspnea. CBC to be checked before each dose admin. Frequent monitoring of uric acid during first 3-4 wk of treatment and watch out for uric acid nephropathy.
Adverse Reactions
 Dose limiting neurotoxicity (e.g. motor function impairment, gait abnormalities), hyperuricaemia, bronchospasm, azospermia, amenorrhoea, alopoecia, leucopenia, urinary dysfunction, abdominal cramps, vomiting, diarrhoea, severe constipation, paralytic ileus, convulsions, hypertension, orthostatic hypotension, ptosis, hoarseness, optic neuropathies, hallucinations, blindness, neurological deafness, difficulty in walking, syndrome of inappropriate ADH secretion.
Potentially Fatal: Myelosuppression.
Overdose Reactions
 Symptoms: mainly extensions of its common adverse effects. Management: Treatment is supportive and includes prevention of side effects from syndrome of inappropriate antidiuretic hormone secretion (SIADH) (e.g. fluid restriction and admin of loop diuretic); admin of anticonvulsants and use of enemas (to prevent ileus). Closely monitor the CV system and determine the blood counts daily to guide transfusion requirements. Folinic acid 100 mg admin IV every 3 hr for 24 hr and then every 6 hr for at least 48 h may be admin. Haemodialysis unlikely to be useful.
Drug Interactions
 Decreased digoxin (tablets) and verapamil absorption with antineoplastic regimens. Increased etoposide serum levels with vincristine. Increased toxicity when ganciclovir given with, immediately before or after vincristine. Reduced vincristine metabolism with miconazole. Increased neurotoxicity with isoniazid, itraconazole, voriconazole, posaconazole and nifedipine. Decreased immune response when used concurrently with vaccines. Increased myelotoxicity with zidovudine. Increased risk of thromboembolic complications with tamoxifen. Increased risk of ototoxicity with ototoxic drugs (e.g. platinum-containing antineoplastic agents). Possible risk of earlier onset and/or increased severity of adverse effects with macrolides. Possible increase in vincristine levels with aprepitant. Possible decrease in antiepileptic levels with vincristine, monitor serum antiepileptic levels and effectiveness of chemotherapy.
Potentially Fatal: Increased risk of bronchospasm with mitomycin C. Reduced vincristine clearance and increased toxicity with asparaginase, minimise toxicity by giving vincristine 12-24 hr before L-asparaginase admin.
See Below for More vincristine sulfate Drug Interactions
Mechanism of Actions
 Vincristine arrests cell division at the metaphase stage by inhibiting microtubule formation in the mitotic spindle.
Absorption: Poorly absorbed from the GI tract.
Distribution: Does not cross the blood-brain barrier in significant amounts. Protein-binding: Extensive.
Metabolism: Metabolised in liver.
Excretion: Excreted mainly via bile into faeces (as unchanged drug and metabolites, 70-80%), urine; 85 hrs (elimination half-life).
Storage Conditions
 Intravenous: Store at 2-8°C. Protect from light.
ATC Classification
 L01CA02 - vincristine ; Belongs to the class of plant alkaloids and other natural products, vinca alkaloids and analogues. Used in the treatment of cancer.
Storage
 Intravenous: Store at 2-8°C. Protect from light.
Available As
  • Vincristine 1 mg

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