vinblastine

Absorption: IV administration results in complete bioavailability.

Distribution: Does not cross the blood-brain barrier well.

Metabolism/Excretion: Converted by the liver to an active antineoplastic compound; excreted in the feces via biliary excretion, with some renal elimination.

Half-Life: 24 hr.

Time/Action Profile ⬆ ⬇

(effects on WBC counts)

ROUTE	ONSET	PEAK	DURATION
IV	5–7 days	10 days	7–14 days

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Infection;
↓bone marrow reserve;
Hepatic impairment (↓ dose by 50% if serum bilirubin >3 mg/dL);
Rep: Women of reproductive potential;

Adv. Reactions/Side Effects ⬆ ⬇

Derm: alopecia, dermatitis, vesiculation

Endo: syndrome of inappropriate antidiuretic hormone (SIADH)

GI: nausea, vomiting, anorexia, constipation, diarrhea, stomatitis

GU: gonadal suppression

Hemat: anemia, leukopenia, thrombocytopenia

Local: phlebitis at IV site

Metab: hyperuricemia

Neuro: depression, neuritis, paresthesia, peripheral neuropathy, SEIZURES, weakness

Resp: BRONCHOSPASM

Interactions ⬆ ⬇

Drug-drug:

Additive bone marrow depression with other antineoplastics or radiation therapy.
Bronchospasm may occur in patients who have been previously treated with mitomycin.
May ↓ antibody response to live-virus vaccines and ↑ risk of adverse reactions.
May ↓ phenytoin levels.

Route/Dosage ⬆ ⬇

IV (Adults ): Initial: 3.7 mg/m² (100 mcg/kg), single dose; ↑ weekly as tolerated by 1.8 mg/m² (50 mcg/kg) to maximum of 18.5 mg/m² (usual dose is 5.5–7.4 mg/m²). Maintenance: 10 mg 1–2 times/mo or one increment less than last dose every 7–14 days.
IV (Children ): Initial: 2.5 mg/m², single dose; ↑ weekly as tolerated by 1.25 mg/m² to maximum of 7.5 mg/m². Maintenance: one increment less than last dose every 7 days.

Availability ⬆ ⬇

(Generic available)

Solution for injection: 1 mg/mL

Assessment ⬆ ⬇

Monitor BP, pulse, and respiratory rate during therapy. Bronchospasm can be life-threatening and may occur at time of infusion or several hr to wk later.
Monitor for bone marrow depression. Assess for bleeding (bleeding gums, bruising, petechiae, guaiac stools, urine, and emesis) and avoid IM injections and taking rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. Anemia may occur. Monitor for increased fatigue, dyspnea, and orthostatic hypotension.
May cause nausea and vomiting. Monitor intake and output, appetite, and nutritional intake. Prophylactic antiemetics may be used. Adjust diet as tolerated.
Vinblastine is a vesicant. Assess injection site frequently for redness, irritation, or inflammation. If extravasation occurs, infusion must be stopped and restarted elsewhere to avoid damage to SUBQ tissue. Standard treatment includes infiltration with hyaluronidase and application of heat.
Monitor for symptoms of gout (increased uric acid, joint pain, edema). Encourage patient to drink at least 2 L of fluid per day. Allopurinol or alkalinization of urine may be used to decrease uric acid levels.

Lab Test Considerations:

Monitor CBC prior to and routinely throughout therapy. If WBC <2000, subsequent doses are usually withheld until WBC is ≥4000. The nadir of leukopenia occurs in 5–10 days and recovery usually occurs 7–14 days later. Thrombocytopenia may also occur in patients who have received radiation or other chemotherapy agents.
- Monitor liver function studies (AST, ALT, LDH, bilirubin) and renal function studies (BUN, serum creatinine) prior to and periodically throughout therapy.
- May cause ↑ uric acid. Monitor periodically during therapy.

Implementation ⬆ ⬇

Fatalities have occurred with chemotherapeutic agents. Before administering, clarify all ambiguous orders; double check single, daily, and course-of-therapy dose limits; have second practitioner independently double check original order, dose calculations, and infusion pump settings. Do not administer SUBQ, IM, or intrathecally (IT). IT administration is fatal. Vinblastine must be dispensed in an overwrap stating, "For IV use only." Overwrap should remain in place until immediately before administration.
Do not confuse vinblastine with vincristine.
Solution should be prepared in a biologic cabinet. Wear gloves, gown, and mask while handling medication. Discard IV equipment in specially designated containers. Prepare in a minibag, not a syringe.
- Do not inject into extremities with impaired circulation; may cause thrombophlebitis.

IV Administration:

Diluent: Dilute each 10 mg with 10 mL of 0.9% NaCl for injection with phenol or benzyl alcohol. Solution is clear. Reconstituted medication is stable for 28 days if refrigerated.Concentration: 1 mg/mL.
Rate: Administer each single dose over 1 min through Y-site injection of a free-flowing infusion of 0.9% NaCl or D5W.
Intermittent Infusion: Diluent: Dilute in 25 to 50 mL of 0.9% NaCl, D5W, or LR. Dilution in large volumes (100–250 mL) or prolonged infusion (30 min) increases chance of vein irritation and extravasation.

Patient/Family Teaching ⬆ ⬇

Advise patient to notify health care professional if fever; chills; sore throat; signs of infection; bleeding gums; bruising; petechiae; or blood in urine, stool, or emesis occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor. Caution patient not to drink alcoholic beverages or take products containing aspirin or NSAIDs.
Instruct patient to inspect oral mucosa for redness and ulceration. Advise patient that, if ulceration occurs, to avoid spicy foods, use sponge brush, and rinse mouth with water after eating and drinking. Topical agents may be used if mouth pain interferes with eating. Stomatitis pain may require treatment with opioid analgesics.
Instruct patient to report symptoms of neurotoxicity (paresthesia, pain, difficulty walking, persistent constipation).
Advise patient that jaw pain, pain in organs containing tumor tissue, nausea, and vomiting may occur. Avoid constipation and report other adverse reactions.
Discuss with patient the possibility of hair loss. Explore coping strategies.
Instruct patient not to receive any vaccinations without advice of health care professional.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Rep: May cause fetal harm. Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding during therapy. Contraception should be used during and for at least 2 mo after therapy is concluded. If chemotherapy is indicated, avoid during the first trimester, leave a 3-wk time period between the last chemotherapy dose and anticipated delivery, and do not administer chemotherapy beyond week 33 of gestation. If treatment cannot be deferred until after delivery in patients with early stage Hodgkin's lymphoma, may be administered safely and effectively in the latter phase of pregnancy. Advise patient to enroll in the pregnancy registry for all cancers diagnosed during pregnancy at Cooper Health (877-635-4499).
Emphasize need for periodic lab tests to monitor for side effects.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇