Classifications: antineoplastic; mitotic inhibitor; Therapeutic: antineoplastic
Pregnancy Category: D
10 mg powder for injection; 1 mg/mL vial
Cell cyclespecific drug that interferes with microtubules that form the mitotic spindle fibers required to complete
the process of mitosis. Has an effect on cell energy production needed for mitosis and interferes with nucleic acid synthesis.
Interrupts the cell cycle in metaphase, thus preventing cell replication.
Palliative treatment of Hodgkin's disease and non-Hodgkin's lymphomas, choriocarcinoma, lymphosarcoma, neuroblastoma, mycosis
fungoides, advanced testicular germinal cell cancer, histiocytosis, and other malignancies resistant to other chemotherapy.
Used singly or in combination with other chemotherapeutic drugs.
Severe bone marrow suppression, leukopenia, bacterial infection, adynamic ileus; pregnancy (category D), lactation, men
and women of childbearing potential, older adult patients with cachexia or skin ulcers.
Malignant cell infiltration of bone marrow; obstructive jaundice, hepatic impairment; history of gout; use of small amount
of drug for long periods; use in eyes.
Route & Dosage
Adult: IV 3.7 mg/m2 infused over 1 min qwk, may increase up to 18.5 mg/m2 if tolerated
Child: IV 2.5 mg/m2 infused over 1 min qwk, may increase up to 12.5 mg/m2 if tolerated
PREPARE: Direct: Add 10 mL NS to 10 mg of drug (yields 1 mg/mL). Do not use other diluents. Avoid contact with eyes. Severe irritation and
persisting corneal changes may occur. Flush immediately and thoroughly with copious amounts of water. Wash both eyes; do
not assume one eye escaped contamination.
ADMINISTER: Direct: ??Drug is usually injected into tubing of running IV infusion of NS or D5W over period of 1 min.??Stop injection promptly if extravasation occurs. Use applications of moderate heat and local injection of hyaluronidase to
help disperse extravasated drug.??Observe injection site for sloughing.??Restart infusion in another vein.
INCOMPATIBILITIES Solution/additive: Furosemide, heparin. Y-site: Cefepime, doxorubicin, furosemide.
- Refrigerate reconstituted solution in tight, light-resistant containers up to 30 d without loss of potency.
Adverse Effects (≥1%) Body as a Whole:
Fever, weight loss, muscular pains, weakness, parotid gland pain and tenderness, tumor site pain, Raynaud's phenomenon. CNS:
, peripheral neuritis
, numbness and paresthesias of tongue and extremities, loss of deep tendon reflexes,
headache, convulsions. GI:
Vesiculation of mouth, stomatitis
, pharyngitis, anorexia, nausea, vomiting, diarrhea
, ileus, abdominal pain, constipation
, rectal bleeding, hemorrhagic enterocolitis,
bleeding of old peptic ulcer
. Hematologic: Leukopenia, thrombocytopenia
, and anemia
. Skin: Alopecia (reversible),
vesiculation, photosensitivity, phlebitis, cellulitis, and sloughing following extravasation (at injection site). Urogenital:
Urinary retention, hyperuricemia,
aspermia. Respiratory: Bronchospasm.
may cause acute shortness of breath and severe bronchospasm; may decrease phenytoin
levels; alfa interferons
, erythromycin, itraconazole
may increase vinblastine toxicity
Concentrates in liver, platelets
, and leukocytes
; poor penetration of bloodbrain barrier. Metabolism:
Partially in liver. Elimination:
In feces and urine. Half-Life:
Assessment & Drug Effects
- Lab tests: Monitor WBC count. Recovery from leukopenic nadir occurs usually within 714 d. With high doses, total leukocyte
count may not return to normal for 3 wk.
- Do not administer drug unless WBC count has returned to at least 4000/mm3, even if 7 d have passed.
- Monitor for unexplained bruising or bleeding, which should be promptly reported, even though thrombocyte reduction seldom
occurs unless patient has had prior treatment with other antineoplastics.
- Adverse reactions seldom persist beyond 24 h with exception of epilation, leukopenia, and neurological adverse effects.
- Monitor bowel elimination pattern and bowel sounds to recognize severe constipation or paralytic ileus. A stool softener
may be necessary.
- Inspect skin surfaces over pressure areas daily if patient is not ambulating. Note condition of skin of older adults especially.
- Report promptly if oral mucosa tissue breakdown is noted.
Patient & Family Education
- Be aware that temporary mental depression sometimes occurs on second or third day after treatment begins.
- Avoid exposure to infection, injury to skin or mucous membranes, and excessive physical stress, especially during leukocyte
- Notify physician promptly about onset of symptoms of agranulocytosis (see Appendix F). Do not delay seeking appropriate treatment.
- Avoid exposure to sunlight unless protected with sunscreen lotion (SPF >12) and clothing.