VINBLASTINE SULFATE

VINBLASTINE SULFATE
(vin-blast'een)
Classifications: antineoplastic; mitotic inhibitor;
Therapeutic: antineoplastic

Prototype: Vincristine
Pregnancy Category: D

Availability

10 mg powder for injection; 1 mg/mL vial

Action

Cell cycle–specific 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.

Therapeutic Effect

Interrupts the cell cycle in metaphase, thus preventing cell replication.

Uses

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.

Contraindications

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.

Cautious Use

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

Antineoplastic
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

Administration

Intravenous

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: Mental depression, 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.

Interactions

Drug: Mitomycin may cause acute shortness of breath and severe bronchospasm; may decrease phenytoin levels; alfa interferons, erythromycin, itraconazole may increase vinblastine toxicity.

Pharmacokinetics

Distribution: Concentrates in liver, platelets, and leukocytes; poor penetration of blood–brain barrier. Metabolism: Partially in liver. Elimination: In feces and urine. Half-Life: 24 h.

Nursing Implications

Assessment & Drug Effects

  • Lab tests: Monitor WBC count. Recovery from leukopenic nadir occurs usually within 7–14 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 nadir period.
  • 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.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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