Names and pronunciation
(vin-kris′teen)
PDF page 1372
Loading InternPractice…
Drug reference
(vin-kris′teen)
PDF page 1372
Func. class.: Antineoplastic—miscel laneous
PDF page 1372
Chem. class.: Vinca alkaloid
PDF page 1372
Do not confuse: vinCRIStine/vinBLAStine/vinorelbine
PDF page 1372
ACTION: Inhibits mitotic activity, arrests cell cycle at metaphase; inhibits RNA synthesis, blocks cellular use of glutamic acid needed for purine synthesis; vesicant
PDF page 1372
USES: Lymphomas, neuroblastoma, Hodgkin’s disease, acute lymphoblastic and other leukemias, rhabdomyosarcoma, Wilms’ tumor, non-Hodgkin’s lymphoma, malignant glioma, soft-tissue sarcoma; liposomal: Philadelphia chromosome— negative ALL in second or greater relapse or that has progressed after ≥2 antileukemia therapies
PDF page 1372
Unlabeled uses: CNS tumors, chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), Ewing sarcoma, tro phoblastic tumors, merkel cell carcinoma, multiple myeloma, ovarian germ cell tumors, malignant pheochromocytoma
PDF page 1372
CONTRAINDICATIONS: Preg nancy, breastfeeding, infants, hypersensi tivity, radiation therapy
PDF page 1372
Black Box Warning: Intrathecal use Precautions: Renal/hepatic disease, hypertension, neuromuscular disease Black Box Warning: Extravasation Black Box Warning: Label syringes: IV use only, fatal if given intrathecally IV route • Label syringe for “IV Use Only” • Give by IV injection by those experi enced with the product • Give IV push through sidearm of free- flowing IV (D5 or NS), inject over at least 1 min, flush with NS • May be mixed in 50 mL minibag D5 or NS, given over 15 min, use of minibag is recommended • Protect from light, use diluted solution within 6 hr (room temperature) or 24 hr (refrigerated) Black Box Warning: Hyaluronidase 150 units/mL in 1 mL NaCl; apply warm com press for extravasation Y-site compatibilities: Acyclovir, alem tuzumab, alfentanil, allopurinol, ami fostine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphoteri cin B cholesteryl, amphotericin B lipid complex, amphotericin B liposome, am picillin, ampicillin-sulbactam, anidula fungin, argatroban, arsenic trioxide, asparaginase, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenor phine, butorphanol, calcium chloride/ gluconate, capreomycin, CARBOplatin, carmustine, caspofungin, ceFAZolin, ce foperazone, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chlorproMAZINE, cimeti dine, ciprofloxacin, cisatracurium, CIS platin, cladribine, clindamycin, co deine, cyclophosphamide, cycloSPORINE, cytarabine, D5W-dex trose 5%, dacarbazine, DACTINomycin, DAPTOmycin, DAUNOrubicin, DAUNO rubicin citrate liposome, dexametha sone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doxacurium, doxapram, DOXOrubicin, DOXOrubicin liposomal, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epiRUBicin, ertapenem, erythromycin, esmolol, eto poside, famotidine, fenoldopam, fen taNYL, filgrastim, fluconazole, fludara bine, fluorouracil, foscarnet, fosphenytoin, gallium, ganciclovir, garenoxacin, gatifloxacin, gemcitabine, gentamicin, granisetron, haloperidol, heparin, hydrocortisone sodium phos phate/succinate, HYDROmorphone, hy drOXYzine, ifosfamide, imipenem-cilas tatin, inamrinone, insulin (regular), isoproterenol, ketorolac, labetalol, lepi rudin, leucovorin, levoFLOXacin, levor phanol, lidocaine, linezolid, LORaze pam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperi dine, meropenem, mesna, methadone, methohexital, methotrexate, methyl PREDNISolone, metoclopramide, meto prolol, metroNIDAZOLE, midazolam, milrinone, minocycline, mitoMYcin, mitoXANtrone, mivacurium, morphine, moxifloxacin, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreo tide, ondansetron, oxaliplatin, PACLi taxel (solvent/surfactant), palonose tron, pamidronate, pancuronium, PEMEtrexed, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phenyl ephrine, piperacillin, piperacillin–tazo bactam, potassium acetate/chloride/ phosphates, procainamide, prochlor perazine, promethazine, propranolol, quinupristin-dalfopristin, ranitidine, remifentanil, riTUXimab, rocuronium, sargramostim, sodium acetate/phos phates, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacroli mus, teniposide, theophylline, thiopen tal, thiotepa, ticarcillin, ticarcillin-cla vulanate, tigecycline, tirofiban, tobramycin, topotecan, trastuzumab, trimethobenzamide, vancomycin, vaso pressin, vecuronium, verapamil, vin BLAStine, vinorelbine, voriconazole, zi dovudine, zoledronic acid Black Box Warning: Extravasation: pain, swelling, poor blood return; if ex travasation occurs, local inj of hyaluroni dase and moderate heat to area may help disperse product • Pregnancy/breastfeeding: do not use in pregnancy, breastfeeding • Bleeding: hematuria, guaiac, bruising, petechiae, mucosa or orifices q8hr • Effects of alopecia on body image; discuss feelings about body changes • Buccal cavity q8hr for dryness, sores, ulcerations, white patches, oral pain, bleeding, dysphagia • Symptoms indicating severe allergic reaction: rash, pruritus, urticaria, pur puric skin lesions, itching, flushing
PDF pages 1372, 1373, 1374
SIDE EFFECTS CNS: Decreased reflexes, numbness, weakness, motor difficulties, CNS depression, cranial nerve paralysis, sei- zures, peripheral neuropathy CV: Orthostatic hypotension EENT: Diplopia GI: Nausea, vomiting, anorexia, sto matitis, constipation, paralytic ileus, abdominal pain, hepatotoxicity GU: Renal tubular obstruction V HEMA: Thrombocytopenia, leukopenia, myelosuppression, anemia INTEG: Alopecia, extravasation SYST: Tumor lysis syndrome (TLS)
PDF page 1373
INTERACTIONS Decrease: immune response—vaccines, toxoids Decrease: digoxin level—digoxin Decrease: vinCRIStine effect—CYP3A4 inducers (barbiturates, bosentan, carBA Mazepine, efavirenz, phenytoins, nevira pine, rifabutin, rifAMPin) • Do not use with radiation • Acute pulmonary reactions: mitoMY- cin C • Increase: toxicity—CYP3A4 inhibitors (aprepitant, antiretroviral protease in- hibitors, clarithromycin, danazol, delavir- dine, diltiaZEM, erythromycin, flucon- azole, FLUoxetine, fluvoxaMINE, imatinib, ketoconazole, mibefradil, nefazodone, telithromycin, voriconazole) Drug/Herb • Avoid use with St. John’s wort Drug/Lab Test Increase: uric acid Decrease: HB, WBC, platelets, sodium
PDF page 1374
DOSAGE AND ROUTES • Adult: IV 0.4-1.4 mg/m2/wk, max 2 mg • Child: IV 1-2 mg/m2/wk, max 2 mg
PDF page 1372
Available forms: Inj 1 mg/mL
PDF page 1372
Administer: • Cytotoxic: Use safe handling procedures • Vesicant, IV route only
PDF page 1372
Assess: • CBC, differential, platelet count be fore each dose; withhold product if WBC is <4000/mm3 or platelet count is <75,000/mm3; notify prescriber; RBC, Hct, HB; may be decreased, nadir oc curs on day 4-10 (leukopenia); contin ues for another 1-2 wk • Bronchospasm/dyspnea: more com- mon with mitoMYcin • GI autonomic neuropathy: presents as severe constipation, cramps, ileus • Hepatic studies before, during therapy (bilirubin, AST, ALT, LDH) as needed or monthly • Sensitivity of feet/hands, which pre cedes neuropathy • Tumor lysis syndrome: hyperkale- mia, hyperphosphatemia, hyperuricemia, hypocalcemia; more common in leuke- mia, lymphoma; use alkalinization of urine with allopurinol, monitor electro- lytes, renal function (BUN, urine, CCR, uric acid)
PDF page 1374
Evaluate: • Therapeutic response: decreased tu mor size, spread of malignancy
PDF page 1374
CLINICAL CONSIDERATIONS
PDF page 1374
Patient and caregiver information: • To brush teeth bid-tid with soft brush or cotton-tipped applicator for stomati tis; to use unwaxed dental floss • To report change in gait or numb ness in extremities; may indicate neu ropathy • To report any bleeding, white spots, or ulcerations in mouth to prescriber; to examine mouth daily • To increase bulk, fluids, exercise to prevent constipation • Infection: to report sore throat, fever, flulike symptoms; to avoid persons with known infection • To avoid vaccinations • That hair may be lost; that hair will grow back but with different texture, color • Pregnancy/breastfeeding: to notify prescriber if pregnancy is planned or suspected; to use effective contracep- tion during and for 2 mo after therapy; not to breastfeed HIGH ALERT
PDF pages 1374, 1375
PHARMACOKINETICS Half-life (triphasic) <5 min, 50-155 min, 23-85 hr; metabolized in liver; excreted in bile, feces; crosses placental, blood- brain barrier
PDF page 1373
• Adult: IV 0.4-1.4 mg/m2/wk, max 2 mg
PDF page 1372
• Child: IV 1-2 mg/m2/wk, max 2 mg
PDF page 1372