(vin BLAS teen)
Treatment of Hodgkin lymphoma; lymphocytic lymphoma; histiocytic lymphoma; mycosis fungoides; testicular cancer; Kaposi sarcoma; histiocytosis X (Letterer-Siwe disease); has also been used for the treatment of refractory/resistant breast cancer and choriocarcinoma
Significant granulocytopenia (unless as a result of condition being treated); presence of bacterial infection
This preparation should be administered by individuals experienced in the administration of vinblastine sulfate.
Extravasation:It is extremely important that the intravenous needle or catheter be properly positioned before any vinblastine sulfate is injected. Leakage into surrounding tissue during intravenous administration of vinblastine may cause considerable irritation. If extravasation occurs, the injection should be discontinued immediately, and any remaining portion of the dose should then be introduced into another vein. Local injection of hyaluronidase and the application of moderate heat to the area of leakage help disperse the drug and are thought to minimize discomfort and the possibility of cellulitis.
Appropriate administration:For intravenous use only - fatal if given by other routes.
Note: Frequency and duration of therapy may vary by indication, concomitant combination chemotherapy and hematologic response. For IV use only. In order to prevent inadvertent intrathecal administration, the Institute for Safe Medication Practices (ISMP) strongly recommends dispensing vinblastine in a minibag (NOT a syringe).
Hodgkin lymphoma, lymphocytic lymphoma, histiocytic lymphoma, mycosis fungoides, testicular cancer, Kaposi sarcoma, histiocytosis X (Letterer-Siwe disease):Manufacturer 's labeling: IV: 3.7 mg/m2; adjust dose every 7 days (based on white blood cell response) up to 5.5 mg/m2 (second dose); 7.4 mg/m2 (third dose); 9.25 mg/m2 (fourth dose); and 11.1 mg/m2 (fifth dose); do not administer more frequently than every 7 days. Usual dosage range: 5.5 to 7.4 mg/m2 every 7 days; Maximum dose: 18.5 mg/m2; dosage adjustment goal is to reduce white blood cell count to ~3,000/mm3
Off-label and/or indication-specific dosing:
Hodgkin lymphoma (off-label dosing): IV:
ABVD regimen: 6 mg/m2 days 1 and 15 of a 28-day cycle (in combination with doxorubicin, bleomycin, and dacarbazine) for 2 cycles (early/favorable disease) or for 4 cycles (unfavorable disease) (Eich, 2010; Engert, 2007)
Stanford V regimen: 6 mg/m2 weeks 1, 3, 5, 7, 9, and 11 (in combination with doxorubicin, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone) (Bartlett, 1995; Horning, 2002)
Testicular cancer (off-label dosing): VeIP regimen: IV: 0.11 mg/kg daily for 2 days every 21 days (in combination with ifosfamide, cisplatin, and mesna) for 4 cycles (Loehrer, 1988; Loehrer, 1988 [correction]; Loehrer, 1998)
Bladder cancer (off-label use): IV:
Metastatic disease:
Dose-dense MVAC regimen: 3 mg/m2 day 2 every 14 days (in combination with methotrexate, doxorubicin, and cisplatin) until disease progression or unacceptable toxicity (Sternberg, 2001; Sternberg, 2006)
MVAC regimen: 3 mg/m2 days 2, 15, and 22 every 28 days (in combination with methotrexate, doxorubicin, and cisplatin) for up to 6 cycles (von der Maase, 2000) or 3 mg/m2 days 2, 15, and 22 every 28 days (in combination with methotrexate, doxorubicin, and cisplatin) until disease progression or unacceptable toxicity (Sternberg, 2001; Sternberg, 2006) or 3 mg/m2 days 1, 15, and 22 every 28 days (in combination with methotrexate, doxorubicin, and cisplatin) for up to 6 cycles (Bamias, 2004)
Neoadjuvant treatment:
MVAC regimen: 3 mg/m2 days 2, 15, and 22 every 28 days (in combination with methotrexate, doxorubicin, and cisplatin) for 3 cycles (Grossman, 2003)
CMV regimen: 4 mg/m2 days 1 and 8 every 21 days (in combination with methotrexate, cisplatin, and leucovorin) for 3 cycles (Griffiths, 2011)
Melanoma, metastatic (off-label use): IV:
CVD regimen: 2 mg/m2 days 1 to 4 and 22 to 25 of a 6-week treatment cycle (in combination with cisplatin and dacarbazine); may repeat if tumor response (Eton, 2002)
CVD + immunotherapy regimen: 1.5 mg/m2 days 1 to 4 and 22 to 25 of a 6-week treatment cycle (in combination with cisplatin, dacarbazine, aldesleukin, and interferon alfa-2b); may repeat if tumor response (Eton, 2002)
Non-small cell lung cancer (off-label use): IV:
Adjuvant treatment after complete resection: 4 mg/m2 days 1, 8, 15, 22, and 29, then every 2 weeks (in combination with cisplatin) until last cisplatin dose (Arriagada, 2004)
Concurrent radiation: 5 mg/m2 days 1, 8, 15, 22, and 29 (in combination with cisplatin and concurrent radiation therapy) (Curran, 2011)
Soft tissue sarcoma (desmoid tumors, aggressive fibromatosis), advanced (off-label use): IV: 6 mg/m2 every 7 to 10 days (dose usually rounded to 10 mg) in combination with methotrexate for 1 year (Azzarelli, 2001)
Refer to adult dosing.
Note: Frequency and duration of therapy may vary by indication, concomitant combination chemotherapy and hematologic response. For IV use only. In order to prevent inadvertent intrathecal administration, the Institute for Safe Medication Practices (ISMP) strongly recommends dispensing vinblastine in a minibag (NOT a syringe).
Hodgkin lymphoma: IV: Initial dose: 6 mg/m2; do not administer more frequently than every 7 days or ABVD regimen (off-label dosing): IV: 6 mg/m2 days 1 and 15 of a 28-day cycle (in combination with doxorubicin, bleomycin, and dacarbazine) for 6 cycles (Hutchinson, 1998)
Letterer-Siwe disease: IV: Initial dose: 6.5 mg/m2; do not administer more frequently than every 7 days
Testicular cancer: IV: Initial dose: 3 mg/m2; do not administer more frequently than every 7 days
No dosage adjustment necessary.
The manufacturer 's labeling recommends the following adjustment: Serum bilirubin >3 mg/dL: Administer 50% of dose
The following adjustments have also been recommended (Floyd, 2006; Superfin, 2007):
Serum bilirubin 1.5 to 3 mg/dL or transaminases 2 to 3 times ULN: Administer 50% of dose
Serum bilirubin >3 times ULN: Avoid use.
Hazardous agent; use appropriate precautions for handling and disposal (NIOSH 2014 [group 1]). For infusion, may dilute in 25 to 50 mL NS or D5W; dilution in larger volumes ( ≥100 mL) of IV fluids is not recommended. Note: In order to prevent inadvertent intrathecal administration, the Institute for Safe Medication Practices (ISMP) strongly recommends dispensing vinblastine in a minibag (NOT in a syringe).
In order to prevent inadvertent intrathecal administration, the Institute for Safe Medication Practices (ISMP) strongly recommends dispensing vinblastine in a minibag (NOT in a syringe). For IV administration only. Fatal if given intrathecally. The preferred administration is as a short infusion in a 25 to 50 mL minibag. If administration via a minibag is not possible, may also be administered as an undiluted 1-minute infusion into a free flowing IV line to prevent venous irritation/extravasation. Prolonged administration times ( ≥30 to 60 minutes) and/or increased administration volumes may increase the risk of vein irritation and extravasation.
Vesicant; ensure proper needle or catheter placement prior to and during infusion. Avoid extravasation.
Extravasation management: If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase antidote; remove needle/cannula; apply dry warm compresses for 20 minutes 4 times a day for 1-2 days; elevate extremity (Perez Fidalgo, 2012). Remaining portion of the vinblastine dose should be infused through a separate vein.
Hyaluronidase: If needle/cannula still in place, administer 1-6 mL hyaluronidase (150 units/mL) into the existing IV line; the usual dose is 1 mL hyaluronidase for each 1 mL of extravasated drug (Perez Fidalgo, 2012; Schulmeister, 2011). If needle/cannula was removed, inject 1-6 mL (150 units/mL) subcutaneously in a clockwise manner using 1 mL for each 1 mL of drug extravasated (Schulmeister, 2011) or administer 1 mL (150 units/mL) as 5 separate 0.2 mL injections (using a 25-gauge needle) subcutaneously into the extravasation site (Polovich, 2009).
Hazardous agent; use appropriate precautions for handling and disposal (NIOSH 2014 [group 1]).
Note: Dispense in an overwrap which bears the statement Do not remove covering until the moment of injection. Fatal if given intrathecally. For IV use only." If dispensing in a syringe (minibag is preferred) should be labeled: "Fatal if given intrathecally. For IV use only."
Store intact vials under refrigeration at 2 � �C to 8 � �C (36 � �F to 46 � �F). Protect from light.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous, as sulfate:
Generic: 1 mg/mL (10 mL)
Solution Reconstituted, Intravenous, as sulfate:
Generic: 10 mg (1 ea)
Stable in D5W, LR, NS.
Y-site administration: Incompatible with cefepime, furosemide.
Afatinib: P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Afatinib. Management: Per US labeling: if requiring chronic use of P-gp inducers, increase afatinib dose by 10mg as tolerated; reduce to original afatinib dose 2-3 days after stopping P-gp inducers. Per Canadian labeling: avoid combination if possible. Consider therapy modification
Aprepitant: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy
BCG (Intravesical): Immunosuppressants may diminish the therapeutic effect of BCG (Intravesical). Avoid combination
BCG (Intravesical): Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical). Avoid combination
Bosentan: May decrease the serum concentration of CYP3A4 Substrates. Monitor therapy
Brentuximab Vedotin: P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Brentuximab Vedotin. Specifically, concentrations of the active monomethyl auristatin E (MMAE) component may be decreased. Monitor therapy
CloZAPine: Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased. Monitor therapy
Coccidioides immitis Skin Test: Immunosuppressants may diminish the diagnostic effect of Coccidioides immitis Skin Test. Monitor therapy
Conivaptan: May increase the serum concentration of CYP3A4 Substrates. Avoid combination
CYP3A4 Inducers (Moderate): May decrease the serum concentration of CYP3A4 Substrates. Monitor therapy
CYP3A4 Inducers (Strong): May increase the metabolism of CYP3A4 Substrates. Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. Consider therapy modification
CYP3A4 Inhibitors (Moderate): May decrease the metabolism of CYP3A4 Substrates. Monitor therapy
CYP3A4 Inhibitors (Strong): May decrease the metabolism of CYP3A4 Substrates. Consider therapy modification
Dabigatran Etexilate: P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Dabigatran Etexilate. Management: Avoid concurrent use of dabigatran with p-glycoprotein inducers when possible. Closely monitor for decreased levels/effects of dabigatran if concomitantly administering p-glycoprotein inducers, particularly strong inducers. Avoid combination
Dabrafenib: May decrease the serum concentration of CYP3A4 Substrates. Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects). Consider therapy modification
Dasatinib: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy
Deferasirox: May decrease the serum concentration of CYP3A4 Substrates. Monitor therapy
Deferiprone: Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone. Avoid combination
Denosumab: May enhance the adverse/toxic effect of Immunosuppressants. Specifically, the risk for serious infections may be increased. Monitor therapy
Dipyrone: May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased Avoid combination
DOXOrubicin (Conventional): P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of DOXOrubicin (Conventional). Management: Seek alternatives to P-glycoprotein inducers in patients treated with doxorubicin whenever possible. One U.S. manufacturer (Pfizer Inc.) recommends that these combinations be avoided. Consider therapy modification
Echinacea: May diminish the therapeutic effect of Immunosuppressants. Consider therapy modification
Enzalutamide: May decrease the serum concentration of CYP3A4 Substrates. Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring. Consider therapy modification
Fingolimod: Immunosuppressants may enhance the immunosuppressive effect of Fingolimod. Management: Avoid the concomitant use of fingolimod and other immunosuppressants when possible. If combined, monitor patients closely for additive immunosuppressant effects (eg, infections). Consider therapy modification
Fosaprepitant: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy
Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates. Avoid combination
Idelalisib: May increase the serum concentration of CYP3A4 Substrates. Avoid combination
Itraconazole: May increase the serum concentration of VinBLAStine. Monitor therapy
Ivacaftor: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy
Ledipasvir: P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Ledipasvir. Avoid combination
Leflunomide: Immunosuppressants may enhance the adverse/toxic effect of Leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Management: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Patients receiving both leflunomide and another immunosuppressant should be monitored for bone marrow suppression at least monthly. Consider therapy modification
Lenograstim: Antineoplastic Agents may diminish the therapeutic effect of Lenograstim. Consider therapy modification
Linagliptin: P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Linagliptin. Management: Strongly consider using an alternative to any strong P-glycoprotein inducer in patients who are being treated with linagliptin. If this combination is used, monitor patients closely for evidence of reduced linagliptin effectiveness. Consider therapy modification
Lopinavir: May increase the serum concentration of VinBLAStine. Management: Monitor closely for signs and symptoms of vinblastine toxicity; consider temporary interruption of lopinavir/ritonavir antiviral therapy if patients develop significant toxicity with concurrent use. Consider therapy modification
Luliconazole: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy
Macrolide Antibiotics: May increase the serum concentration of Antineoplastic Agents (Vinca Alkaloids). Macrolides may also increase the distribution of Vinca Alkaloids into certain cells and/or tissues. Management: Consider an alternative to using a macrolide antibiotic when possible in order to avoid the potential for increased vinca alkaloid toxicity. Exceptions: Azithromycin (Systemic); Fidaxomicin; Roxithromycin. Consider therapy modification
MiFEPRIStone: May increase the serum concentration of CYP3A4 Substrates. Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. Avoid cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus. Consider therapy modification
MitoMYcin (Systemic): Antineoplastic Agents (Vinca Alkaloids) may enhance the adverse/toxic effect of MitoMYcin (Systemic). Specifically, the risk of pulmonary toxicity may be increased. Monitor therapy
Mitotane: May decrease the serum concentration of CYP3A4 Substrates. Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane. Consider therapy modification
Natalizumab: Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased. Avoid combination
Netupitant: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy
Nivolumab: Immunosuppressants may diminish the therapeutic effect of Nivolumab. Consider therapy modification
Osimertinib: May increase the serum concentration of CYP3A4 Substrates. Osimertinib may decrease the serum concentration of CYP3A4 Substrates. Monitor therapy
Palbociclib: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy
P-glycoprotein/ABCB1 Inducers: May decrease the serum concentration of P-glycoprotein/ABCB1 Substrates. P-glycoprotein inducers may also further limit the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Monitor therapy
P-glycoprotein/ABCB1 Inhibitors: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates. P-glycoprotein inhibitors may also enhance the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Monitor therapy
P-glycoprotein/ABCB1 Substrates: P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of P-glycoprotein/ABCB1 Substrates. P-glycoprotein inducers may also further limit the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Monitor therapy
Pimecrolimus: May enhance the adverse/toxic effect of Immunosuppressants. Avoid combination
Posaconazole: May enhance the adverse/toxic effect of Antineoplastic Agents (Vinca Alkaloids). Posaconazole may increase the serum concentration of Antineoplastic Agents (Vinca Alkaloids). Management: Consider vinca alkaloid dose adjustment. Specific dose adjustment guidelines are not currently available. Monitor response to vinca alkaloid therapy, including development of vinca alkaloid toxicities (e.g., gastrointestinal toxicity, neurotoxicity). Consider therapy modification
Ranolazine: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates. Monitor therapy
Ritonavir: May increase the serum concentration of VinBLAStine. Management: Monitor closely for signs and symptoms of vinblastine toxicity; consider temporary interruption of ritonavir antiviral therapy if patients develop significant toxicity with concurrent use. Consider therapy modification
Roflumilast: May enhance the immunosuppressive effect of Immunosuppressants. Consider therapy modification
Siltuximab: May decrease the serum concentration of CYP3A4 Substrates. Monitor therapy
Simeprevir: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy
Sipuleucel-T: Immunosuppressants may diminish the therapeutic effect of Sipuleucel-T. Monitor therapy
Sofosbuvir: P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Sofosbuvir. Avoid combination
St Johns Wort: May decrease the serum concentration of CYP3A4 Substrates. Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. Consider therapy modification
Stiripentol: May increase the serum concentration of CYP3A4 Substrates. Management: Use of stiripentol with CYP3A4 substrates that are considered to have a narrow therapeutic index should be avoided due to the increased risk for adverse effects and toxicity. Any CYP3A4 substrate used with stiripentol requires closer monitoring. Consider therapy modification
Tacrolimus (Topical): May enhance the adverse/toxic effect of Immunosuppressants. Avoid combination
Tocilizumab: May decrease the serum concentration of CYP3A4 Substrates. Monitor therapy
Tofacitinib: Immunosuppressants may enhance the immunosuppressive effect of Tofacitinib. Management: Concurrent use with antirheumatic doses of methotrexate or nonbiologic disease modifying antirheumatic drugs (DMARDs) is permitted, and this warning seems particularly focused on more potent immunosuppressants. Avoid combination
Tolterodine: VinBLAStine may increase the serum concentration of Tolterodine. Management: Reduce tolterodine dose to 1 mg twice daily (regular release formulation) or 2 mg daily (extended release formulation) (adult doses) and monitor for increased levels/effects of tolterodine with initiation of vinblastine therapy. Consider therapy modification
Trastuzumab: May enhance the neutropenic effect of Immunosuppressants. Monitor therapy
Vaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting an immunosuppressant. If vaccinated during immunosuppressant therapy, revaccinate at least 3 months after immunosuppressant discontinuation. Consider therapy modification
Vaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of Vaccines (Live). Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live organism vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants. Avoid combination
Velpatasvir: P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Velpatasvir. Avoid combination
VinCRIStine (Liposomal): P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of VinCRIStine (Liposomal). Avoid combination
Voriconazole: May enhance the adverse/toxic effect of Antineoplastic Agents (Vinca Alkaloids). Voriconazole may increase the serum concentration of Antineoplastic Agents (Vinca Alkaloids). Consider therapy modification
CBC with differential and platelet count, serum uric acid, hepatic function tests
Frequency not defined.
Common:
Cardiovascular: Hypertension
Central nervous system: Malaise
Dermatologic: Alopecia
Gastrointestinal: Constipation
Hematologic: Myelosuppression, leukopenia/granulocytopenia (nadir: 5-10 days; recovery: 7-14 days; dose-limiting toxicity)
Neuromuscular & skeletal: Bone pain, jaw pain, tumor pain
Less common:
Cardiovascular: Angina, cerebrovascular accident, coronary ischemia, ECG abnormalities, limb ischemia, MI, myocardial ischemia, Raynauds phenomenon
Central nervous system: Depression, dizziness, headache, neurotoxicity (duration: >24 hours), seizure, vertigo
Dermatologic: Dermatitis, photosensitivity (rare), rash, skin blistering
Endocrine & metabolic: Aspermia, hyperuricemia, SIADH
Gastrointestinal: Abdominal pain, anorexia, diarrhea, gastrointestinal bleeding, hemorrhagic enterocolitis, ileus, metallic taste, nausea (mild), paralytic ileus, rectal bleeding, stomatitis, toxic megacolon, vomiting (mild)
Genitourinary: Urinary retention
Hematologic: Anemia, thrombocytopenia (recovery within a few days), thrombotic thrombocytopenic purpura
Local: Cellulitis (with extravasation), irritation, phlebitis (with extravasation), radiation recall
Neuromuscular & skeletal: Deep tendon reflex loss, myalgia, paresthesia, peripheral neuritis, weakness
Ocular: Nystagmus
Otic: Auditory damage, deafness, vestibular damage
Renal: Hemolytic uremic syndrome
Respiratory: Bronchospasm, dyspnea, pharyngitis
Concerns related to adverse effects:
- Bone marrow suppression: Leukopenia commonly occurs; granulocytopenia may be severe with higher doses. The leukocyte nadir generally occurs 5 to 10 days after administration; recovery typically occurs 7 to 14 days later. Monitor for infections if WBC <2,000/mm3. Leukopenia may be more pronounced in cachectic patients and patients with skin ulceration and may be less pronounced with lower doses used for maintenance therapy. Leukocytes and platelets may fall considerably with moderate doses when marrow is infiltrated with malignant cells (further use in this situation is not recommended). Thrombocytopenia and anemia may occur rarely.
- Extravasation: [US Boxed Warning]: Vinblastine is a vesicant; ensure proper needle or catheter placement prior to and during infusion. Avoid extravasation. Extravasation may cause significant irritation. Individuals administering should be experienced in vinblastine administration. If extravasation occurs, discontinue immediately and initiate appropriate extravasation management, including local injection of hyaluronidase and moderate heat application to the affected area. Use a separate vein to complete administration.
- Gastrointestinal toxicity: Stomatitis may occur (rare); may be disabling, but is usually reversible.
- Neurotoxicity: May rarely cause disabling neurotoxicity; usually reversible. Seizures and severe and permanent CNS damage has occurred with higher then recommended doses and/or when administered more frequently than recommended.
- Pulmonary toxicity: Acute shortness of breath and severe bronchospasm have been reported, most often in association with concurrent administration of mitomycin; may occur within minutes to several hours following vinblastine administration or up to 14 days following mitomycin administration; use caution in patients with preexisting pulmonary disease.
Disease-related concerns:
- Hepatic impairment: Use with caution in patients with hepatic impairment; toxicity may be increased; may require dosage modification.
- Ischemic heart disease: Use with caution in patients with ischemic heart disease.
Concurrent drug therapy issues:
- Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.
Dosage form specific issues:
- Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol ( ≥99 mg/kg/day) have been associated with a potentially fatal toxicity ( "gasping syndrome " �) in neonates; the "gasping syndrome " � consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP [Inactive" 1997]; CDC, 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors, 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer 's labeling.
Special handling:
- Hazardous agent: Use appropriate precautions for handling and disposal (NIOSH 2014 [group 1]). Avoid eye contamination (exposure may cause severe irritation).
Other warnings/precautions:
- Experienced physician: [US Boxed Warning]: Should be administered under the supervision of an experienced cancer chemotherapy physician.
- NOT for intrathecal use: [US Boxed Warning]: For IV use only. Intrathecal administration may result in death. To prevent administration errors, the Institute for Safe Medication Practices (ISMP) Targeted Medication Safety Best Practices for Hospitals initiative strongly recommends dispensing vinblastine diluted in a minibag (ISMP, 2014). If not dispensed in a minibag, affix an auxiliary label stating For intravenous use only - fatal if given by other routes" and also place in an overwrap labeled "Do not remove covering until moment of injection." Vinblastine should NOT be prepared during the preparation of any intrathecal medications. After preparation, keep vinblastine in a location away from the separate storage location recommended for intrathecal medications. Vinblastine should NOT be delivered to the patient at the same time with any medications intended for central nervous system administration.
D
Adverse effects were observed in animal reproduction studies. May cause fetal harm if administered during pregnancy. Women of childbearing potential should avoid becoming pregnant during vinblastine treatment. Aspermia has been reported in males who have received treatment with vinblastine.
Vinblastine binds to tubulin and inhibits microtubule formation, therefore, arresting the cell at metaphase by disrupting the formation of the mitotic spindle; it is specific for the M and S phases. Vinblastine may also interfere with nucleic acid and protein synthesis by blocking glutamic acid utilization.
Hepatic (via CYP3A) to active metabolite
Feces (30% to 36%); urine (12% to 17%)
Terminal: ~25 hours
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience hair loss or bone pain. Have patient report immediately to prescriber signs of infection, signs of bleeding (vomiting blood or vomit that looks like coffee grounds; coughing up blood; blood in the urine; black, red, or tarry stools; bleeding from the gums; abnormal vaginal bleeding; bruises without a reason or that get bigger; or any bleeding that is very bad or that will not stop), severe injection site pain or irritation, angina, tachycardia, passing out, arrhythmia, burning or numbness feeling, severe constipation, severe abdominal pain, loss of strength and energy, shortness of breath, severe jaw pain, severe headache, depression, hearing impairment, or tinnitus (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.