Vincristine

Product: 
Vincristine
Formalary: 
Specialty Formalary
Category: 
Oncology
Trade Name: 
Oncovin, formally known as leurocristine; Marqibo
Packing: 
Vial
Potency: 
10mg
In Treatment of: 
Vincristine is delivered via intravenous infusion for use in various types of chemotherapy regimens. Its main uses are in non-Hodgkin's lymphoma as part of the chemotherapy regimen CHOP, Hodgkin's lymphoma as part of MOPP, COPP, BEACOPP, or the less popular Stanford V chemotherapy regimen, in acute lymphoblastic leukemia, and in treatment for nephroblastoma (Wilms tumor, a kidney tumor most common in young children). It is also used to induce remission in ALL with Dexamethasone and L-Asparaginase. Vincristine is occasionally used as an immunosuppressant, for example, in treating thrombotic thrombocytopenic purpura (TTP) or chronic idiopathic thrombocytopenic purpura (ITP). It is used in combination with prednisone to treat childhood leukemia.
Adverse Effects: 
The main side-effects of vincristine are peripheral neuropathy, hyponatremia, constipation, and hair loss. Peripheral neuropathy can be severe, and hence a reason to avoid, reduce, or stop the use of vincristine. One of the first symptoms of peripheral neuropathy is foot drop: A person with a family history of foot drop and/or Charcot-Marie-Tooth disease (CMT) may benefit from genetic testing for CMT before taking vincristine. Accidental injection of vinca alkaloids into the spinal canal (intrathecal administration) is highly dangerous, with a mortality rate approaching 100 percent. The medical literature documents cases of ascending paralysis due to massive encephalopathy and spinal nerve demyelination, accompanied by intractable pain, almost uniformly leading to death; a handful of survivors were left with devastating neurological damage with no hope of recovery. Rescue treatments consist of washout of the cerebrospinal fluid and administration of protective medications. A significant series of inadvertent intrathecal vincristine administration occurred in China in 2007 when batches of cytarabine and methotrexate (both often used intrathecally) manufactured by the company Shanghai Hualian were found to be contaminated with vincristine.
Contraindication: 
Vincristine is contraindicated in patients with demyelinating conditions including Charcot-Marie-Tooth syndrome. Vincristine is contraindicated in patients with hypersensitivity to vincristine sulfate or any of the other components of Vincristine (vinCRIStine sulfate LIPOSOME injection). Vincristine is contraindicated for intrathecal administration.
Special Precaution: 
In some cases during an intravenous (IV) infusion, the drug may leak out of the vein and under the skin, where it may damage the tissue. This may cause pain, blisters, or even open sores or scarring. Tell the nurse right away if you notice redness, pain, or swelling at or near the IV site. You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor may give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor. This drug may cause sores in the mouth or on the lips, which often occur within the first few weeks after starting treatment. This can cause mouth pain, bleeding, or even trouble eating. Your doctor or nurse can suggest ways to reduce this, such as changing the way you eat or how you brush your teeth. If needed, your doctor can prescribe medicine to help with the pain. This drug may increase your risk of constipation, which in some cases can be severe. Your doctor will likely prescribe a laxative or similar medicine to help prevent this from happening. Let your doctor know if constipation starts, especially if you have pain. This drug may cause damage to certain nerves in the body, which can lead to a condition called peripheral neuropathy. This can cause numbness, weakness, pain, or feelings of burning or tingling, often in the hands or feet. These are sometimes related to being exposed to hot or cold temperatures. These symptoms can sometimes progress to include trouble walking or holding things in your hands. Let your doctor know right away if you notice any of these symptoms. If they are severe enough, this drug may need to be stopped or the dose reduced until they get better. This drug can cause the rapid killing of tumor cells, which in some cases has led to serious kidney damage within the first 24 hours of treatment (a condition known as tumor lysis syndrome). This is more likely if you have a very large number of cancer cells in the body. If your doctor feels you might be at risk, he or she will give you medicines and/or fluids to help prevent this. Your doctor will likely test your blood before and during your treatment, to check for the effects of the drug on blood counts or on blood chemistry. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether. Keep all your appointments for doctor visits and lab tests. This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum. This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body’s ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools. Report any trouble breathing, shortness of breath, and tightness or swelling in your throat to your doctor right away. Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor’s OK. This drug may affect your immune system, which could make vaccinations ineffective, or could even lead to serious infections. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.
Interaction: 
Some other chemotherapy drugs, including asparaginase, mitomycin, and doxorubicin (Adriamycin), may raise the risk of certain side effects from this drug if used at the same time. These drugs may cause earlier or more severe side effects if taken while being treated with vincristine: 1. the anti-depressant drug nefazodone (Serzone) 2. antibiotics erythromycin, clarithromycin 3. anti-fungal antibiotics such as ketoconazole and itraconazole 4. certain blood pressure medicines such as diltiazem and verapamil 5. HIV drugs such as indinavir, ritonavir, nelfinavir, amprenavir, and others 6. Blood levels of the anti-seizure drug phenytoin may be reduced by vincristine, and raise the risk of seizures. There may be more drugs that interact with vincristine. Check with your doctor, nurse, or pharmacist about your other medicines, herbs, and supplements, and whether alcohol can cause problems with this medicine. Interactions with foods Grapefruit or grapefruit juice may change the level of this drug in your blood. Check with your doctor, nurse, or pharmacist about whether these or other foods may be a problem. Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.
Dosages: 
Vincristine is given as an injection in a vein, usually over about a minute. Tell the nurse if you notice swelling, pain, burning, or discomfort in the vein or near the site where it is given. The dose and how often you get the medicine depend on your weight, your blood counts, how well your liver is working, and the type of cancer being treated. This medicine may be given along with other chemotherapy.

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