Vincristine sulfate


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Vincristine sulfate
Vincristine sulfate (Oncovin)
Vincristine sulfate
(vin- KRIS-teen)
Pregnancy Category: D Oncovin Vincasar PFS Vincrex (Abbreviation: VCR or LCR) (Rx)

Classification: Antineoplastic, plant alkaloid

See Also: See also Antineoplastic Agents .

Action/Kinetics: Inhibits mitosis at metaphase. The antineoplastic effect is due to interference with intracellular tubulin function by binding to microtubule and spindle proteins in the S phase. After IV use, drug is distributed within 15-30 min to tissues. Poorly penetrates blood-brain barrier. t 1/2, triphasic: initial, 5 min; intermediate, 2.3 hr; final, 85 hr. Approximately 80% is excreted in the feces and up to 20% in the urine. No cross-resistance with vinblastine.

Uses: Frequently used in combination therapy. ALL in children. Hodgkin's and non-Hodgkin's lymphomas (lymphocytic, mixed-cell, histiocytic, undifferentiated, nodular, and diffuse). Wilms' tumor, neuroblastoma, lymphosarcoma, rhabdomyosarcoma, reticulum cell sarcoma. Investigational: ITP; cancer of the breast, ovary, cervix, lung, colorectal area; malignant melanoma, osteosarcoma, multiple myeloma, ovarian germ cell tumors, mycosis fungoides, CLL, CML, Kaposi's sarcoma.

Contraindications: Use in demyelinating Charcot-Marie-Tooth syndrome or during radiation therapy. Lactation.

Special Concerns: Geriatric clients are more susceptible to the neurotoxic effects. Intrathecal use may cause death.

Additional Side Effects: Neurologic: Paresthesias, depression of deep tendon reflexes, foot drop, seizures difficulties in gait. GI: Intestinal necrosis or perforation. Constipation, paralytic ileus. Renal: Inappropriate ADH secretion (polyuria or dysuria). Acute uric acid nephropathy. Ophthalmic: Blindness, ptosis, diplopia, photophobia. Miscellaneous: CNS leukemia, leukopenia or complicating infection, bronchospasm SOB. Less bone marrow depression than vinblastine. Significant tissue irritation if leakage occurs during IV use.

Overdose Management: Symptoms: Exaggeration of side effects. Treatment: Treat side effects due to inappropriate secretion of ADH. Use an anticonvulsant (e.g., phenobarbital), if necessary. Prevent ileus by use of enemas, cathartics, or decompression of the GI tract. Monitor the CV system. Monitor blood counts daily to determine risk of infection and whether blood transfusions are necessary. Folinic acid, 100 mg IV q 3 hr for 24 hr and then q 6 hr for a minimum of 48 hr, may help with treating the symptoms of overdose.

Drug Interactions: Calcium channel blocking drugs / Accumulation of vincristine in cells Digoxin / Effect of digoxin Glutamic acid / Inhibits effect of vincristine Itraconazole / Risk of neurotoxicity R/T vincristine metabolism L-Asparaginase / Asparaginase liver clearance of vincristine Methotrexate / Possible hypotension Mitomycin C / Severe bronchospasm and acute SOB Phenytoin / Phenytoin effect R/T plasma levels

How Supplied: Injection: 1 mg/mL

?IV Only (Direct, Infusion)
Individualized with extreme care as overdose can be fatal. Adults, usual, initial: 0.4-1.4 mg/m 2 (or 0.01-0.03 mg/kg) 1 time/week; children: 1.5-2 mg/m 2 1 time/week. Children less than 10 kg or with body surface area less than 1 m 2: 0.05 mg/kg 1 time/week.
For hepatic insufficiency.
If serum bilirubin is 1.5-3, administer 50% of the dose; if serum bilirubin is more than 3.1 or AST is more than 180, omit the dose.