Names and pronunciation
(vin-blast′een)
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Drug reference
(vin-blast′een)
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Func. class.: Antineoplastic
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Chem. class.: Vinca alkaloid
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Do not confuse: vinBLAStine/vinCRIStine/vinorelbine
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ACTION: Inhibits mitotic activity, arrests cell cycle at metaphase; inhibits RNA synthesis, blocks cellular use of glutamic acid needed for purine synthesis; vesicant
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USES: Breast, testicular cancer, lymphomas, neuroblastoma; Hodgkin’s/non-Hodgkin’s lymphoma; mycosis fungoides, histiocytosis, Kaposi’s sarcoma, Langerhans cell histiocytosis
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Unlabeled uses: Lung, bladder cancer; desmoid tumor
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CONTRAINDICATIONS: Preg nancy, breastfeeding, infants, hypersensi tivity, leukopenia, granulocytopenia, bone marrow suppression, infection Precautions: Renal/hepatic disease, tumor lysis syndrome
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Black Box Warning: Extravasation, in trathecal use Black Box Warning: Extravasation: as pirate, give hyaluronidase 150 units/mL in 1 mL NaCl, through IV catheter or sub cut in circular pattern around extravasat ed site, warm compress for extravasation for vesicant activity treatment Black Box Warning: Do not administer intrathecally; fatal IV inj route • Use a minibag if possible, or; give through sideport or directly over 1 min Y-site compatibilities: Acyclovir, alemtu zumab, alfentanil, allopurinol sodium, amifostine, amikacin, aminophylline, ami odarone, amphotericin B cholesteryl (Amphotec), amphotericin B lipid complex (Abelcet), ampicillin, ampicillin- sulbactam, anidulafungin, argatroban, arse nic trioxide, atenolol, atracurium, aztreo nam, bivalirudin, bleomycin, bretylium, bumetanide, buprenorphine, busulfan, bu torphanol, calcium chloride/gluconate, ca preomycin, carboplatin, carmustine, caspo fungin, cefazolin, cefoperazone, cefotaxime, cefotetan, cefOXitin, cefTAZidime, ceftazi dime (l-arginine), ceftizoxime, cefTRIAX one, cefuroxime, chloramphenicol sodium succinate, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, cisplatin, clindamycin, codeine, cyclophosphamide, cycloSPORINE, dacarbazine, DACTINomy cin, DAPTOmycin, DAUNOrubicin, dexa methasone, dexmedetomidine, dexrazox ane, digoxin, diltiaZEM, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DO Pamine, DOXOrubicin, DOXOrubicin lipo somal, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epiRUBicin, er tapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, filgras tim, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, gallium, ganciclo vir, garenoxacin, gatifloxacin, gem citabine, gentamicin, glycopyrrolate, granis etron, haloperidol, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, hy drOXYzine, IDArubicin, ifosfamide, imipe nem-cilastatin, inamrinone, insulin (regu lar), irinotecan, isoproterenol, ketorolac, labetalol, lepirudin, leucovorin, levoFLOXa cin, levorphanol, lidocaine, linezolid, LO Razepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, metaraminol, metha done, methohexital, methotrexate, methyl dopate, metoclopramide, metoprolol, met roNIDAZOLE, midazolam, milrinone, minocycline, mitoMYcin, mitoXANTRONE, morphine, moxifloxacin, nafcillin, nalbu phine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, ofloxacin, ondansetron, oxaliplatin, PACLi taxel, palonosetron, pamidronate, pan curonium, PEMEtrexed, pentamidine, pen tazocine, PENTobarbital, PHENobarbital, phentolamine, phenylephrine, piperacil lin, piperacillin-tazobactam, polymyxin B, potassium acetate/chloride/phosphates, procainamide, prochlorperazine, promethazine, propranolol, quiNIDine, quinupristin-dalfopristin, raNITIdine, remi fentanil, riTUXimab, sargramostim, sodium acetate/bicarbonate/phosphates, succinyl choline, SUFentanil, sulfamethoxazole- trimethoprim, tacrolimus, teniposide, the ophylline, thiopental, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, topote can, trastuzumab, trimethobenzamide, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, vori conazole, zidovudine, zoledronic acid Black Box Warning: Extravasation: local irritation, pain, burning, discoloration at IV site (vesicant) • Severe allergic reaction: rash, pruritus, urticaria, purpuric skin lesions, itching, flushing • Increased fluid intake to 2-3 L/day to prevent urate deposits, calculi formation • Pregnancy/breastfeeding: do not use in pregnancy; do not breastfeed
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SIDE EFFECTS CNS: Paresthesias, peripheral neuropathy, depression, headache, seizures, malaise CV: Tachycardia, orthostatic hypo/hyper tension GI: Nausea, vomiting, ileus, anorexia, stomatitis, constipation, abdominal pain, GI/rectal bleeding, hepatotoxicity, pharyngitis GU: Urinary retention, renal failure, hyperuricemia HEMA: Thrombocytopenia, leukopenia, myelosuppression, agranulocytosis, gran- ulocytosis, aplastic anemia, neutropenia, pancytopenia INTEG: Rash, alopecia, photosensitivity, extravasation, tissue necrosis META: SIADH RESP: Fibrosis, pulmonary infiltrate, bronchospasm SYST: Tumor lysis syndrome (TLS)
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INTERACTIONS Increase: synergism—bleomycin • Do not use with radiation Increase: bleeding risk—NSAIDs, anti coagulants, thrombolytics, antiplatelets Increase: toxicity, bone marrow suppression—antineoplastics Increase: action of methotrexate Increase: adverse reactions—live virus vaccines Increase: toxicity—CYP3A4 inhibitors (aprepitant, antiretroviral protease inhibi- tors, clarithromycin, danazol, delavirdine, diltiaZEM, erythromycin, fluconazole, FLUoxetine, fluvoxaMINE, imatinib, keto- conazole, mibefradil, nefazodone, telithro- mycin, voriconazole) Decrease: vinBLAStine effect—CYP3A4 inducers (barbiturates, bosentan, carBA Mazepine, efavirenz, phenytoins, nevira pine, rifabutin, rifAMPin) Drug/Herb • Avoid use with St. John’s wort Drug/Lab Test Increase: uric acid, bilirubin Decrease: HB, platelets, WBC
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DOSAGE AND ROUTES Doses vary greatly Breast cancer • Adult: IV 4.5 mg/m2 on day 1 of every 21 days in combination with DOXOrubi V cin and thiotepa Hodgkin’s disease • Adult: IV 6 mg/m2 on days 1 and 15 of every 28 days with DOXOrubicin, bleo mycin, dacarbazine (ABVD regimen) • Child: IV 2.5-6 mg/m2/day once q1- 2wk × 3-6 wk, max weekly dose 12.5 mg/m2 Letterer-Sine disease • Child: IV 6.5 mg/m2 Testicular cancer (germ cell) • Child: IV 3 mg/m2/day on days 1 through 5 with other antineoplastics Bladder cancer (unlabeled) • Adult: IV 3 mg/m2 on day 2, q14days in combination with other antineoplastics NSCLC (unlabeled) • Adult: IV 4 mg/m2 on days 1, 8, 15, 22, 29, then q2wk with cisplatin
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Available forms: Inj, powder 10 mg for 10 mL IV; sol for inj 1 mg/mL
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Administer: • Use safe handling procedures
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Assess: • B/P baseline and during use • Bone marrow toxicity CBC, differen- tial, platelet count weekly; withhold prod- uct if WBC is <2000/mm3 or platelet count is <75,000/mm3; notify prescriber; RBC, Hct, HB may be decreased, nadir occurs on days 4-10 (leukopenia) and continues for another 1-2 wk • Infection: check for sore mouth/throat, fever, rash, bruising, cough, flulike symp- toms, diarrhea, nausea • Tumor lysis syndrome: monitor for hyperkalemia, hyperphosphatemia, hyper- uricemia; usually occurs with leukemia, lymphoma; alkalinization of the urine, al- lopurinol should be used to prevent urate nephropathy; monitor electrolytes and re- nal function (BUN, uric acid, urine CCR) • Hepatitis: transient hepatitis may oc- cur with continuous IV • Bleeding: hematuria, guaiac, bruis ing, petechiae, mucosa or orifices • Bronchospasm: can be life-threatening; usually occurs when giving mitoMYcin • Effects of alopecia on body image; dis cuss feelings about body changes • Sensitivity of feet/hands, which pre cedes neuropathy • Liver toxicity: Jaundiced skin, sclera; dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea • Buccal cavity q8hr for dryness, sores, ulcerations, white patches, oral pain, bleeding, dysphagia • Brushing of teeth bid-tid with soft V brush or cotton-tipped applicator for sto matitis, use unwaxed dental floss
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Evaluate: • Therapeutic response: decreased tu mor size, spread of malignancy
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report any bleeding, white spots, ulcerations in mouth to prescriber; to examine mouth daily • To report any changes in breathing or coughing; to avoid exposure to persons with infection • That hair may be lost during treatment; that a wig or hairpiece may make patient feel better; that new hair may be different in color, texture • To report change in gait or numbness in extremities; may indicate neuropathy • To avoid foods with citric acid, hot temperature, or rough texture • To wear sunscreen, protective clothing, sunglasses • To avoid receiving vaccinations • Infection: to report sore throat, flulike symptoms; to avoid persons with known infections • Pregnancy: not to breastfeed; that product may cause male infertility; to notify prescriber if pregnancy is planned or suspected HIGH ALERT
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PHARMACOKINETICS Half-life (triphasic) <5 min, 50-155 min, 23-85 hr; metabolized in liver; excreted in urine, feces; crosses blood-brain barrier
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• Adult: IV 4.5 mg/m2 on day 1 of every 21 days in combination with DOXOrubi V cin and thiotepa Hodgkin’s disease
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• Adult: IV 6 mg/m2 on days 1 and 15 of every 28 days with DOXOrubicin, bleo mycin, dacarbazine (ABVD regimen)
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• Adult: IV 3 mg/m2 on day 2, q14days in combination with other antineoplastics NSCLC (unlabeled)
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• Adult: IV 4 mg/m2 on days 1, 8, 15, 22, 29, then q2wk with cisplatin
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