VINCRISTINE SULFATE

(vin-kris'teen)

Classifications: antineoplastic; mitotic inhibitor;
Therapeutic: antineoplastic
Pregnancy Category: D

Availability

1 mg/mL injection

Action

Cell cycle–specific vinca alkaloid (obtained from periwinkle plant Vinca rosea); analog of vinblastine. Arrests mitosis at metaphase by inhibition of mitotic spindle function, thereby inhibiting cell division.

Therapeutic Effect

Induction of metaphase arrest in 50% of cells results in inhibition of cancer cell proliferation.

Uses

Acute lymphoblastic and other leukemias, Hodgkin's disease, lymphosarcoma, neuroblastoma, Wilms' tumor, lung and breast cancer, reticular cell carcinoma, and osteogenic and other sarcomas.

Unlabeled Uses

Idiopathic thrombocytopenic purpura, alone or adjunctively with other antineoplastics.

Contraindications

Obstructive jaundice; pregnancy (category D), lactation, men and women of childbearing potential; active infection; adynamic ileus; radiation of the liver; patient with demyelinating form of Charcot-Marie-Tooth syndrome.

Cautious Use

Leukopenia; preexisting neuromuscular or neurological disease; hypertension; hepatic or biliary tract disease; elderly; patients receiving drugs with neurotoxic potential.

Route & Dosage

Antineoplastic
Adult: IV 1.4 mg/m² (max: 2 mg/m²) at weekly intervals
Child: IV >10 kg, 1–2 mg/m² at weekly intervals; <10 kg, 0.05 mg/kg initial weekly dose, then titrate

Hepatic Impairment
Bilirubin 1.5–3 mg/dL: use 50% of dose; 3–5 mg/dL: use 25% of dose; >5 mg/dL: skip dose

Administration

Intravenous

PREPARE: Direct: Reconstitute with provided solution (bacteriostatic NaCl), sterile water, or NS to concentrations of 0.01 to 1.0 mg/mL. Note: Vincristine is available in solution form, which does not require reconstitution. 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 infusion over a 1 min period. Stop injection promptly if extravasation occurs. Use applications of moderate heat and local injection of hyaluronidase to help disperse extravasated drug. Restart infusion in another vein. Observe injection site for sloughing.

INCOMPATIBILITIES Solution/additive: Furosemide. Y-site: Cefepime, furosemide, idarubicin, sodium bicarbonate.

Store solution in the refrigerator.

Adverse Effects (≥1%)

CNS: Peripheral neuropathy, neuritic pain, paresthesias, especially of hands and feet; foot and hand drop, sensory loss, athetosis, ataxia, loss of deep tendon reflexes, muscle atrophy, dysphagia, weakness in larynx and extrinsic eye muscles, ptosis, diplopia, mental depression. Special Senses: Optic atrophy with blindness; transient cortical blindness, ptosis, diplopia, photophobia. GI: Stomatitis, pharyngitis, anorexia, nausea, vomiting, diarrhea, abdominal cramps, severe constipation (upper-colon impaction), paralytic ileus (especially in children), rectal bleeding; hepatotoxicity. Urogenital: Urinary retention, polyuria, dysuria, SIADH (high urinary sodium excretion, hyponatremia, dehydration, hypotension); uric acid nephropathy. Skin: Urticaria, rash, alopecia, cellulitis and phlebitis following extravasation (at injection site). Body as a Whole: Convulsions with hypertension, malaise, fever, headache, pain in parotid gland area, weight loss. Metabolic: Hyperuricemia, hyperkalemia. CV: Hypertension, hypotension. Respiratory: Bronchospasm.

Interactions

Drug: Mitomycin may cause acute shortness of breath and severe bronchospasm; may decrease digoxin, phenytoin levels.

Pharmacokinetics

Distribution: Concentrates in liver, platelets, and leukocytes; poor penetration of blood–brain barrier. Metabolism: Partially in liver (CYP3A4). Elimination: Primarily in feces. Half-Life: 10–155 h.

Nursing Implications

Assessment & Drug Effects

Monitor I&O ratio and pattern, BP, and temperature daily.
Monitor for and report steady weight gain.
Lab tests: Monitor serum electrolytes and CBC with differential. Complete bone marrow remission in leukemia varies widely and may not occur for as long as 100 d after therapy is started.
Be aware that neuromuscular adverse effects, most apt to appear in the patient with preexisting neuromuscular disease, usually disappear after 6 wk of treatment. Children are especially susceptible to neuromuscular adverse effects.
Assess for hand muscular weakness, and check deep tendon reflexes (depression of Achilles reflex is the earliest sign of neuropathy). Also observe for and report promptly: Mental depression, ptosis, double vision, hoarseness, paresthesias, neuritic pain, and motor difficulties.
Provide special protection against infection or injury during leukopenic days. Leukopenia occurs in a significant number of patients; leukocyte count in children usually reaches nadir on fourth day and begins to rise on fifth day after drug administration.
Avoid use of rectal thermometer or intrusive tubing to prevent injury to rectal mucosa.
Monitor ability to ambulate and supply support as needed.
Start a prophylactic regimen against constipation and paralytic ileus at beginning of treatment (paralytic ileus is most likely to occur in young children).

Patient & Family Education

Notify physician promptly of stomach, bone, or joint pain, and swelling of lower legs and ankles.
Report changes in bowel habit as soon as manifested.
Report a steady gain or sudden weight change to physician.

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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