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ALERT: U.S. Boxed Warning
The FDA-approved labeling includes a boxed warning. See Warnings/Precautions section for a concise summary of this information. For verbatim wording of the boxed warning, consult the product labeling or www.fda.gov.
Pronunciation
(vin KRIS teen)
Generic Available (U.S.)
Yes
Index Terms
U.S. Brand Names
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Treatment of acute lymphocytic leukemia (ALL), Hodgkin's lymphoma, non-Hodgkin's lymphomas, Wilms' tumor, neuroblastoma, rhabdomyosarcoma
Use: Unlabeled/Investigational
Treatment of multiple myeloma, chronic lymphocytic leukemia (CLL), brain tumors, small cell lung cancer, ovarian germ cell tumors
Pregnancy Risk Factor
D
Pregnancy Considerations
Animal studies have demonstrated teratogenicity and fetal loss. There are no adequate and well-controlled studies in pregnant women. May cause fetal harm if administered during pregnancy. Women of childbearing potential should avoid becoming pregnant during treatment.
Lactation
Excretion in breast milk unknown/not recommended
Breast-Feeding Considerations
Due to the potential for serious adverse reactions in the nursing infant, breast-feeding is not recommended.
Contraindications
Patients with demyelinating form of Charcot-Marie-Tooth syndrome
Warnings/Precautions
Boxed warnings:
• Not for intrathecal administration: See “Other warnings/precautions” below.
• Vesicant: See “Other warnings/precautions” below.
Special handling:
• Hazardous agent: Use appropriate precautions for handling and disposal; avoid eye contamination.
Concerns related to adverse effects:
• Constipation: Constipation, paralytic ileus, intestinal necrosis and/or perforation may occur; constipation may present as upper colon impaction with an empty rectum (may require flat film of abdomen for diagnosis); generally responds to high enemas and laxatives. All patients should be on a prophylactic bowel management regimen.
• Neurotoxicity: Alterations in mental status such as depression, confusion, or insomnia may occur; neurologic effects are dose-limiting (may require dosage reduction) and may be additive with those of other neurotoxic agents and spinal cord irradiation. Use with caution in patients with pre-existing neuromuscular disease and/or with concomitant neurotoxic agents.
• Respiratory effects: Acute shortness of breath and severe bronchospasm have been reported with vinca alkaloids, usually when used in combination with mitomycin-C. Onset may be several minutes to hours after vincristine administration and up to 2 weeks after mitomycin-C. Progressive dyspnea may occur. Permanently discontinue vincristine in this situation.
• Uric acid nephropathy: Acute uric acid nephropathy has been reported with vincristine.
Disease-related concerns:
• Hepatic impairment: Use with caution in patients with hepatic impairment; dosage modification required. May be associated with hepatic veno-occlusive disease (VOD), increased risk in children <3 years of age; use with caution in hepatobiliary dysfunction. Monitor for signs or symptoms of hepatic VOD, including bilirubin >1.4 mg/dL, unexplained weight gain, ascites, hepatomegaly, or unexplained right upper quadrant pain (Arndt, 2004).
Concurrent drug therapy issues:
• High potential for interactions: Use with caution in patients receiving concurrent therapy which alters CYP3A4 activity; may require therapy alterations.
Special populations:
• Elderly: Use with caution in the elderly.
Other warnings/precautions:
• Not for intrathecal administration: [U.S. Boxed Warning]: For I.V. administration only; intrathecal administration has uniformly caused severe neurologic damage and/or death; vincristine should never be administered by this route. Vincristine should NOT be prepared during the preparation of any intrathecal medications. After preparation, store vincristine in a location away from the separate storage location recommended for intrathecal medications. Vincristine should NOT be delivered to the patient at the same time with any medications intended for central nervous system administration.
• Vesicant: [U.S. Boxed Warning]: Vincristine is a vesicant; avoid extravasation. (Individuals administering should be experienced in vincristine administration.) Check for proper needle placement; if extravasation occurs, discontinue vincristine infusion and initiate appropriate extravasation management.
Adverse Reactions
Frequency not defined.
Cardiovascular: Edema, hyper-/hypotension, MI, myocardial ischemia
Central nervous system: Ataxia, coma, cranial nerve dysfunction (auditory damage, extraocular muscle impairment, laryngeal muscle impairment, paralysis, paresis, vestibular damage, vocal cord paralysis), dizziness, fever, headache, neurotoxicity, neuropathic pain (common), seizure, vertigo
Dermatologic toxicity: Alopecia (common), rash
Endocrine & metabolic: Hyperuricemia, parotid pain, SIADH (rare)
Gastrointestinal: Abdominal cramps, abdominal pain, anorexia, constipation (common), diarrhea, intestinal necrosis, intestinal perforation, nausea, oral ulcers, paralytic ileus, vomiting, weight loss
Genitourinary: Bladder atony, dysuria, polyuria, urinary retention
Hematologic: Anemia (mild), leukopenia (mild), thrombocytopenia (mild), thrombotic thrombocytopenic purpura
Hepatic: Veno-occlusive liver disease (VOD)
Local: Phlebitis, tissue irritation/necrosis (if infiltrated)
Neuromuscular & skeletal: Back pain, bone pain, deep tendon reflex loss, difficulty walking, foot drop, gait changes, jaw pain, limb pain, motor difficulties, muscle wasting, myalgia, paralysis, paresthesia, peripheral neuropathy (common), sensorimotor dysfunction, sensory loss
Ocular: Cortical blindness (transient), nystagmus, optic atrophy with blindness
Otic: Deafness
Renal: Acute uric acid nephropathy, hemolytic uremic syndrome
Respiratory: Bronchospasm, dyspnea, pharyngeal pain
Miscellaneous: Allergic reactions (rare), anaphylaxis (rare), hypersensitivity (rare)
Metabolism/Transport Effects
Substrate of CYP3A4 (major), P-glycoprotein; Inhibits CYP3A4 (weak)
Drug Interactions
BCG: Immunosuppressants may diminish the therapeutic effect of BCG. Risk X: Avoid combination
Cardiac Glycosides: Antineoplastic Agents may decrease the absorption of Cardiac Glycosides. This may only affect digoxin tablets. Exceptions: Digitoxin. Risk C: Monitor therapy
Conivaptan: May increase the serum concentration of CYP3A4 Substrates. Management: Upon completion/discontinuation of conivaptan, allow at least 7 days before initiating therapy with drugs that are CYP3A4 substrates. Risk D: Consider therapy modification
CYP3A4 Inducers (Strong): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
CYP3A4 Inhibitors (Moderate): May decrease the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
CYP3A4 Inhibitors (Strong): May decrease the metabolism of CYP3A4 Substrates. Risk D: Consider therapy modification
Dasatinib: May increase the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapy
Deferasirox: May decrease the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapy
Denosumab: May enhance the adverse/toxic effect of Immunosuppressants. Specifically, the risk for serious infections may be increased. Risk C: Monitor therapy
Echinacea: May diminish the therapeutic effect of Immunosuppressants. Risk D: Consider therapy modification
Herbs (CYP3A4 Inducers): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
Itraconazole: May enhance the adverse/toxic effect of VinCRIStine. Itraconazole may increase the serum concentration of VinCRIStine. Risk D: Consider therapy modification
Leflunomide: Immunosuppressants may enhance the adverse/toxic effect of Leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Management: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Patients receiving both leflunomide and another immunosuppressant should be monitored for bone marrow suppression at least monthly. Risk D: Consider therapy modification
Lopinavir: May increase the serum concentration of VinCRIStine. Management: Monitor closely for signs and symptoms of vincristine toxicity; consider temporary interruption of lopinavir/ritonavir antiviral therapy if patients develop significant toxicity with concurrent use. Risk D: Consider therapy modification
Macrolide Antibiotics: May increase the serum concentration of Antineoplastic Agents (Vinca Alkaloids). Macrolides may also increase the distribution of Vinca Alkaloids into certain cells and/or tissues. Management: Consider an alternative to using a macrolide antibiotic when possible in order to avoid the potential for increased vinca alkaloid toxicity. Exceptions: Azithromycin; Azithromycin (Systemic). Risk D: Consider therapy modification
MAO Inhibitors: May enhance the orthostatic hypotensive effect of Orthostatic Hypotension Producing Agents. Risk C: Monitor therapy
MitoMYcin: Antineoplastic Agents (Vinca Alkaloids) may enhance the adverse/toxic effect of MitoMYcin. Specifically, the risk of pulmonary toxicity may be increased. Risk C: Monitor therapy
Natalizumab: Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased. Risk X: Avoid combination
NIFEdipine: May decrease the excretion of VinCRIStine. Risk C: Monitor therapy
P-Glycoprotein Inducers: May decrease the serum concentration of P-Glycoprotein Substrates. P-glycoprotein inducers may also further limit the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Risk C: Monitor therapy
P-Glycoprotein Inhibitors: May increase the serum concentration of P-Glycoprotein Substrates. P-glycoprotein inhibitors may also enhance the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Risk C: Monitor therapy
Pimecrolimus: May enhance the adverse/toxic effect of Immunosuppressants. Risk X: Avoid combination
Posaconazole: May enhance the adverse/toxic effect of Antineoplastic Agents (Vinca Alkaloids). Posaconazole may increase the serum concentration of Antineoplastic Agents (Vinca Alkaloids). Management: Consider vinca alkaloid dose adjustment. Specific dose adjustment guidelines are not currently available. Monitor response to vinca alkaloid therapy, including development of vinca alkaloid toxicities (e.g., gastrointestinal toxicity, neurotoxicity). Risk D: Consider therapy modification
Ritonavir: May increase the serum concentration of VinCRIStine. Management: Monitor closely for signs and symptoms of vincristine toxicity; consider temporary interruption of ritonavir antiviral therapy if patients develop significant toxicity with concurrent use. Risk D: Consider therapy modification
Roflumilast: May enhance the immunosuppressive effect of Immunosuppressants. Risk X: Avoid combination
Sipuleucel-T: Immunosuppressants may diminish the therapeutic effect of Sipuleucel-T. Risk C: Monitor therapy
Tacrolimus (Topical): May enhance the adverse/toxic effect of Immunosuppressants. Risk X: Avoid combination
Teniposide: May enhance the neurotoxic effect of VinCRIStine. Risk C: Monitor therapy
Tocilizumab: May decrease the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapy
Trastuzumab: May enhance the neutropenic effect of Immunosuppressants. Risk C: Monitor therapy
Vaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Risk C: Monitor therapy
Vaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of Vaccines (Live). Vaccinial infections may develop. Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live organism vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants. Risk X: Avoid combination
Vitamin K Antagonists (eg, warfarin): Antineoplastic Agents may enhance the anticoagulant effect of Vitamin K Antagonists. Antineoplastic Agents may diminish the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy
Voriconazole: May enhance the adverse/toxic effect of Antineoplastic Agents (Vinca Alkaloids). Voriconazole may increase the serum concentration of Antineoplastic Agents (Vinca Alkaloids). Risk D: Consider therapy modification
Ethanol/Nutrition/Herb Interactions
Herb/Nutraceutical: St John's wort may decrease vincristine levels.
Storage
Store intact vials under refrigeration. May be stable for up to 30 days at room temperature. Protect from light.
I.V. solution: Diluted in 25-50 mL NS or D5W, stable for 7 days under refrigeration, or 2 days at room temperature. In ambulatory pumps, solution is stable for 7 days at room temperature. After preparation, store vincristine in a location away from the separate storage location recommended for intrathecal medications.
Reconstitution
Use appropriate precautions for handling and disposal. Solutions for I.V. infusion may be mixed in NS or D5W. Note: In order to prevent inadvertent intrathecal administration the World Health Organization (WHO) and the Institute for Safe Medical Practices (ISMP) recommend dispensing vincristine in a minibag (rather than a syringe). Vincristine should NOT be prepared during the preparation of any intrathecal medications. If dispensing vincristine in a syringe, it must be packaged in the manufacturer-provided overwrap which bears the statement "Do not remove covering until the moment of injection. For intravenous use only. Fatal if given intrathecally.”
Compatibility
Stable in D5W, LR, NS.
Y-site administration: Compatible: Allopurinol, amifostine, amphotericin B cholesteryl sulfate complex, anidulafungin, aztreonam, bleomycin, cisplatin, cladribine, cyclophosphamide, doxorubicin HCl, doxorubicin liposome, droperidol, etoposide phosphate, filgrastim, fludarabine, fluorouracil, gemcitabine, granisetron, heparin, leucovorin calcium, linezolid, melphalan, methotrexate, metoclopramide, mitomycin, ondansetron, oxaliplatin, paclitaxel, pemetrexed, piperacillin/tazobactam, sargramostim, teniposide, thiotepa, topotecan, vinblastine, vinorelbine. Incompatible: Cefepime, furosemide, idarubicin, sodium bicarbonate.
Mechanism of Action
Binds to tubulin and inhibits microtubule formation, therefore, arresting the cell at metaphase by disrupting the formation of the mitotic spindle; it is specific for the M and S phases. Vincristine may also interfere with nucleic acid and protein synthesis by blocking glutamic acid utilization.
Pharmacodynamics/Kinetics
Distribution: Rapidly removed from bloodstream and tightly bound to tissues; penetrates blood-brain barrier poorly
Metabolism: Extensively hepatic, via CYP3A4
Half-life elimination: Terminal: 85 hours (range: 19-155 hours)
Excretion: Feces (~80%); urine (10% to 20%; <1% as unchanged drug)
Dosage
Note: Doses may be capped at a maximum of 2 mg/dose; refer to individual protocol.
Doses in the manufacturer's FDA-approved labeling: I.V.:
Children ≤10 kg: 0.05 mg/kg/dose once weekly
Children >10 kg: 1.5-2 mg/m2/dose; frequency may vary based on protocol
Adults: 1.4 mg/m2/dose; frequency may vary based on protocol
Additional dosing in combination therapy; indication-specific and/or unlabeled dosing: I.V.:
Children:
ALL: Induction phase: 1.5 mg/m2/dose days 0, 7, 14, and 21; Consolidation phase: 1.5 mg/m2/dose days 0, 28, and 56; Delayed intensification phase: 1.5 mg/m2/dose days 0, 7, and 14; Maintenance phase: 1.5 mg/m2/dose days 0, 28, and 56 (Bostrom, 2003) or Induction phase: 1.5 mg/m2/dose days 0, 7, 14, and 21; Consolidation phase: 1.5 mg/m2/dose days 0, 28, and 56; Interim maintenance phases: 1.5 mg/m2/dose days 0 and 28; Delayed intensification phase: 1.5 mg/m2/dose days 0, 7, and 14; Maintenance phase: 1.5 mg/m2/dose every 4 weeks (Avramis, 2002)
Ewing's sarcoma: 2 mg/m2/dose (maximum dose: 2 mg) on day 1 of a 21-day cycle, administer either every cycle or during odd-numbered cycles (Grier, 2003) or 0.67 mg/m2/day continuous infusion days 1, 2, and 3 (total 2 mg/m2/cycle; maximum dose/cycle: 2 mg) during cycles 1, 2, 3, and 6 (Kolb, 2003)
Hodgkin's lymphoma: BEACOPP regimen: 2 mg/m2/dose (maximum dose: 2 mg) on day 7 of a 21-day treatment cycle (Kelly, 2002)
Rhabdomyosarcoma:
VA regimen: 1.5 mg/m2/dose (maximum dose: 2 mg) weeks 1-8, weeks 13-20, and weeks 25-32 (Crist, 2001)
VAC regimen: 1.5 mg/m2/dose (maximum dose: 2 mg) weeks 0-12, week 16, weeks 20-25; Continuation therapy: Weeks 29-34, and weeks 38-43 (Crist, 2001)
Wilms' tumor:
Children <1 year: 0.75 mg/m2/dose weekly for 10-11 weeks, then every 3 weeks for 15 additional weeks (total 25-26 weeks) (Pritchard, 1995)
Children ≥1 year: 1.5 mg/m2/dose weekly for 10-11 weeks, then every 3 weeks for 15 additional weeks (total 25-26 weeks) (Pritchard, 1995)
or
Children ≤30 kg: 0.05 mg/kg/dose (maximum dose: 2 mg) weeks 1, 2, 4, 5, 6, 7, 8, 10, and 11, followed by 0.067 mg/kg/dose (maximum dose: 2 mg) weeks 12, 13, 18, and 24 (Green, 2007)
Children >30 kg: 1.5 mg/m2/dose (maximum dose: 2 mg) weeks 1, 2, 4, 5, 6, 7, 8, 10, and 11, followed by 2 mg/m2/dose (maximum dose: 2 mg) weeks 12, 13, 18, and 24 (Green, 2007)
Adults:
ALL:
Hyper-CVAD regimen: 2 mg/dose days 4 and 11 during odd-numbered cycles (cycles 1, 3, 5, 7) of an 8-cycle phase, followed by maintenance treatment (if needed) of 2 mg monthly for 2 years (Kantarjian, 2004)
Larson (CALBG 8811) regimen: Induction phase: 2 mg/dose days 1, 8, 15, and 22 (4-week treatment cycle); Early intensification phase: 2 mg/dose days 15, and 22 (4-week treatment cycle, repeat once); Late intensification phase: 2 mg/dose days 1, 8, 15 (8-week treatment cycle); Maintenance phase: 2 mg/dose day 1 every 4 weeks until 24 months from diagnosis (Larson, 1995)
Brain tumors: PCV regimen: 1.4 mg/m2/dose (maximum dose: 2 mg) on days 8 and 29 of a 6-week treatment cycle for a total of 6 cycles (van de Bent, 2006) or 1.4 mg/m2/dose (no maximum dose) on days 8 and 29 of a 6-week treatment cycle for up to 4 cycles (Cairncross, 2006)
Hodgkin's lymphoma:
BEACOPP regimen: 1.4 mg/m2/dose (maximum dose: 2 mg) on day 8 of a 21-day treatment cycle (Diehl, 2003)
Stanford-V regimen: 1.4 mg/m2/dose (maximum dose: 2 mg) in weeks 2, 4, 6, 8, 10, and 12 (Horning, 2000; Horning, 2002)
Non-Hodgkin's lymphoma:
CHOP regimen: 1.4 mg/m2/dose (maximum dose: 2 mg) on day 1 of a 21-day treatment cycle for 8 cycles (Coiffier, 2002)
CVP regimen: 1.4 mg/m2/dose (maximum dose: 2 mg) on day 1 of a 21-day treatment cycle for 8 cycles (Marcus, 2005)
EPOCH regimen: 0.4 mg/m2/day continuous infusion for 4 days (over 96 hours) (total 1.6 mg/m2/cycle; dose not usually capped) of a 21-day treatment cycle (Wilson, 2002)
Multiple myeloma (unlabeled use):
DVD regimen: 1.4 mg/m2/dose (maximum dose: 2 mg) on day 1 of a 28-day treatment cycle (Rifkin, 2006)
VAD regimen: 0.4 mg/day continuous infusion for 4 days (over 96 hours) (total 1.6 mg/cycle) of a 28-day treatment cycle (Rifkin, 2006)
Ovarian cancer (unlabeled use): VAC regimen: 1.5 mg/m2/dose (maximum dose: 2 mg) weekly for 8-12 weeks (Slayton, 1985)
Small cell lung cancer (unlabeled use): CAV regimen: 1.4 mg/m2/dose day 1 of a 21-day treatment cycle (Hong, 1989) or 2 mg/dose on day 1 of a 21-day treatment cycle (von Pawel, 1999)
Dosing adjustment in renal impairment: No adjustment is necessary in patients with renal impairment.
Dosing adjustment in hepatic impairment:
The FDA-approved labeling recommends the following guidelines: Serum bilirubin >3 mg/dL: Administer 50% of normal dose
The following guidelines have been used by some clinicians:
Serum bilirubin 1.5-3 mg/dL or AST 60-180 units: Administer 50% of dose
Serum bilirubin 3-5 mg/dL: Administer 25% of dose
Serum bilirubin >5 mg/dL or AST >180 units: Avoid use
Floyd, 2006: Serum bilirubin 1.5-3 mg/dL or transaminases 2-3 times ULN or alkaline phosphatase increased: Administer 50% of dose
Dosage: Combination Regimens
Brain tumors:
8 in 1 (Brain Tumors)
COPE
MOPP (Medulloblastoma)
PCV (Brain Tumor Regimen)
POC
Gestational trophoblastic tumor:
CHAMOCA (Modified Bagshawe Regimen)
CHAMOMA (Bagshawe Regimen)
EMA/CO
Leukemia, acute lymphocytic:
DVP
Hyper-CVAD + Imatinib
Hyper-CVAD (Leukemia, Acute Lymphocytic)
Larson Regimen (ALL)
Linker Protocol (ALL)
MTX/6-MP/VP (Maintenance)
POMP
PVA (POG 8602)
PVDA
VAD/CVAD
Leukemia, chronic lymphocytic: CVP (Leukemia)
Lung cancer (small cell): CAVE
Lymphoma, Hodgkin's disease:
BEACOPP-14 (Hodgkin's Lymphoma)
BEACOPP Escalated (Hodgkin's Lymphoma)
BEACOPP Standard (Hodgkin's Lymphoma)
MOPP/ABVD
MOPP/ABV Hybrid
MOPP (Lymphoma, Hodgkin's Disease)
OPA
OPPA
Stanford V Regimen
Lymphoma, non-Hodgkin's:
CHOP
CNOP
CODOX-M
CODOX-M/IVAC
COMLA
COP-BLAM
COPP
CVP (Lymphoma, non-Hodgkin's)
EPOCH Dose-Adjusted (AIDS-Related Lymphoma)
EPOCH Dose-Adjusted (NHL)
EPOCH (Dose-Adjusted)-Rituximab (NHL)
EPOCH (NHL)
EPOCH-Rituximab (NHL)
Hyper-CVAD (Lymphoma, non-Hodgkin's)
MACOP-B
m-BACOD
Pro-MACE-CytaBOM
Rituximab-CHOP (NHL)
R-CVP
Lymphoma, non-Hodgkin's (Burkitt's): CODOX-M/IVAC
Lymphoma, non-Hodgkin's (Mantle cell): Hyper-CVAD + Rituximab
Melanoma:
BOLD
BOLD + Interferon
BOLD (Melanoma)
Multiple myeloma:
Doxorubicin (Liposomal)-Vincristine-Dexamethasone
Hyper-CVAD (Multiple Myeloma)
VAD
VBMCP (Multiple Myeloma)
VCAP
Neuroblastoma:
CAV-P/VP
CE-CAdO
HIPE-IVAD
N4SE Protocol
N6 Protocol
Regimen A1
Ovarian cancer: Vincristine-Dactinomycin-Cyclophosphamide (Ovarian Cancer)
Retinoblastoma:
8 in 1 (Retinoblastoma)
CO
CV
VAC (Retinoblastoma)
Rhabdomyosarcoma:
CEV
VAC Pulse
VAC (Rhabdomyosarcoma)
Sarcoma:
CYVADIC
VAC Alternating With IE (Ewing's Sarcoma)
Wilms' tumor:
AAV (DD)
AVD
AV (EE)
AV (K)
AV (L)
AV (Wilms' Tumor)
EE
EE-4A
VDA-C (Wilms' Tumor)
Administration: I.V.
Vesicant; avoid extravasation. For I.V. administration only. FATAL IF GIVEN INTRATHECALLY. Vincristine should NOT be delivered to the patient at the same time with any medications intended for central nervous system administration.
Usually administered as short 5-10 minute infusion (preferred); may also be administered as a slow (1 minute) push or by a 24-hour continuous infusions (depending on the protocol)
Administration: I.V. Detail
pH: 3.5-5.5
Monitoring Parameters
Serum electrolytes (sodium), hepatic function tests, neurologic examination, CBC, serum uric acid; monitor infusion site
Patient Education
This medication can only be administered by infusion; report immediately any redness, swelling, burning, or pain at infusion site. Maintain adequate nutrition and hydration, unless instructed to restrict fluid intake. You will be more susceptible to infection. May cause postural hypotension, hair loss (will grow back after therapy), nausea or vomiting (request antiemetic if persistent), photosensitivity, feelings of extreme weakness or lethargy, or mouth sores. Report persistent gastrointestinal changes (eg, constipation, abdominal cramps, bloating); numbness, tingling, or pain in legs, fingers, or toes; signs of infection (eg, fever, chills, sore throat, burning urination, fatigue); unusual bleeding (eg, tarry stools, easy bruising, blood in stool, urine, or mouth); unresolved mouth sores; skin rash or itching; or respiratory difficulty.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Oral ulceration, metallic taste, orthostatic hypotension or hypertension.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May cause sedation, confusion, depression, or insomnia
Mental Health: Effects on Psychiatric Treatment
May cause myelosuppression; use caution with clozapine and carbamazepine
Nursing: Physical Assessment/Monitoring
Use caution with impaired liver function or pre-existing neuromuscular disease. Premedication with antiemetic is advisable. Infusion site must be monitored closely to prevent extravasation (vesicant will cause tissue damage and necrosis). May cause severe constipation, paralytic ileus, intestinal obstruction, necrosis, and/or perforation; prophylactic bowel management regimen may be advisable. Assess CNS status (motor difficulties, seizure, depression), neuromuscular status (myalgia, peripheral neuropathy, cramping), and photophobia throughout therapy.
Oncology: Emetic Potential
Very low (<10%)
Oncology: Vesicant
Vesicant; see Management of Drug Extravasations.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injection, solution, as sulfate [preservative free]: 1 mg/mL (1 mL, 2 mL)
Vincasar PFS®: 1 mg/mL (1 mL, 2 mL)
References
Arndt C, Hawkins, D, Anderson JR, et al, “Age is a Risk Factor for Chemotherapy-Induced Hepatopathy With Vincristine, Dactinomycin and Cyclophosphamide,” J Clin Oncol, 2004, 22(10):1894-901.
Aronoff GR, Bennett WM, Berns JS, et al, Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children, 5th ed. Philadelphia, PA: American College of Physicians; 2007, p 102, 174.
Avramis VI, Sencer S, Periclou AP, et al, “A Randomized Comparison of Native Escherichia coli Asparaginase and Polyethylene Glycol Conjugated Asparaginase for Treatment of Children With Newly Diagnosed Standard-Risk Acute Lymphoblastic Leukemia: A Children's Cancer Group Study,” Blood, 2002, 99(6):1986-94.
Barlogie B, Smith L, and Alexanian R, “Effective Treatment of Advanced Multiple Myeloma Refractory to Alkylating Agents,” N Engl J Med, 1984, 310(21):1353-6.
Bermudez M, Fuster JL, Llinares E, et al, “Itraconazole-Related Increased Vincristine Neurotoxicity: Case Report and Review of Literature,” J Pediatr Hematol Oncol, 2005, 27(7):389-92.
Bohme A, Ganser A, and Hoelzer D, “Aggravation of Vincristine-Induced Neurotoxicity by Itraconazole in the Treatment of Adult ALL,” Ann Hematol, 1995, 71(6):311-2.
Bostrom BC, Sensel MR, Sather HN, et al, “Dexamethasone Versus Prednisone and Daily Oral Versus Weekly Intravenous Mercaptopurine for Patients With Standard-Risk Acute Lymphoblastic Leukemia: A Report from the Children's Cancer Group,” Blood, 2003, 101(10):3809-17.
Cairncross G, Berkey B, Shaew, et al, “Phase III Trial of Chemotherapy Plus Radiotherapy Compared With Radiotherapy Alone for Pure and Mixed Anaplastic Oligodendroglioma: Intergroup Radiation Therapy Oncology Group Trial 9402,” J Clin Oncol, 2006, 24(18):2707-14.
Coiffier B, Lepage E, Briere J, et al, “CHOP Chemotherapy Plus Rituximab Compared With CHOP Alone in Elderly Patients With Diffuse Large-B-Cell Lymphoma,” N Engl J Med, 2002, 346(4):235-42.
Crist WM, Anderson JR, Meza JL, et al, “Intergroup Rhabdomyosarcoma Study-IV: Results for Patients With Nonmetastatic Disease,” J Clin Oncol, 2001, 19(12):3091-102.
Diehl V, Franklin J, Pfreundschuh M, et al, “Standard and Increased-Dose BEACOPP Chemotherapy Compared With COPP-ABVD for Advanced Hodgkin's Disease,” N Engl J Med, 2003, 348(24):2386-95.
Eiden C, Palenzuela G, Hillaire-Buys D, et al, “Posaconazole-Increased Vincristine Neurotoxicity in a Child: A Case Report,” J Pediatr Hematol Oncol, 2009, 31(4):292-5.
Floyd J, Mirza I, Sachs B, et al, "Hepatotoxicity of Chemotherapy," Semin Oncol, 2006, 33(1):50-67.
Floyd JD, Nguyen DT, Lobins RL, et al, “Cardiotoxicity of Cancer Therapy,” J Clin Oncol, 2005, 23(30):7685-96.
Green DM, Cotton CA, Malogolowkin M, et al, “Treatment of Wilms Tumor Relapsing After Initial Treatment With Vincristine and Actinomycin D: A Report From the National Wilms Tumor Study Group,” Pediatr Blood Cancer, 2007, 48(5):493-9.
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