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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
Dosage
?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.
