Generic Name

Vincristine Sulphate

Precaution

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. Lactation: not known if excreted in breast milk, do not nurse

Indication

Acute lymphoblastic leukaemia, Acute myeloid leukaemia, AIDS-related Kaposi's sarcoma, Brain tumours, Hodgkin's disease, Neuroblastoma, Non-Hodgkin's lymphoma, Small cell lung cancer, Wilm's tumour

Contra Indication

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.

Dose

N/A

Side Effect

>10% Alopecia (20-70%) Frequency Not Defined 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.

Pregnancy Category

Mode of Action

Vincristine arrests cell division at the metaphase stage by inhibiting microtubule formation in the mitotic spindle.

Interaction

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.

Pregnancy Category Note

Pregnancy Category: D Lactation: not known if excreted in breast milk, do not nurse

Adult Dose

Intravenous Acute lymphoblastic 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. Hepatic impairment: Dose adjustment may be needed. Serum bilirubin >3 mg/100ml: Reduce dose by 50%.

Child Dose

Intravenous Acute lymphoblastic leukaemia 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.

Renal Dose

Renal Impairment Dose adjustment not necessary

Administration

N/A