vincristine

Absorption: IV administration results in complete bioavailability.

Distribution: Rapidly and widely distributed; extensively bound to tissues.

Metabolism/Excretion: Metabolized by the liver and eliminated in the feces via biliary excretion.

Half-Life: 10.5–37.5 hr.

Time/Action Profile ⬆ ⬇

(effects on blood counts‡)

ROUTE	ONSET	PEAK	DURATION
IV	unknown	4 days	7 days

‡Usually mild.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

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

Adv. Reactions/Side Effects ⬆ ⬇

Derm: alopecia

EENT: cortical blindness, diplopia

Endo: syndrome of inappropriate antidiuretic hormone (SIADH)

GI: nausea, vomiting, abdominal cramps, anorexia, constipation, ileus, stomatitis

GU: gonadal suppression, nocturia, oliguria, urinary retention

Hemat: anemia, leukopenia, thrombocytopenia (mild and brief)

Local: phlebitis at IV site, tissue necrosis (from extravasation)

Metab: hyperuricemia

Neuro: ascending peripheral neuropathy, agitation, insomnia, mental depression, mental status changes

Resp: bronchospasm

Interactions ⬆ ⬇

Drug-drug:

Bronchospasm may occur in patients who have been previously treated with mitomycin.
l-asparaginase may ↓ hepatic metabolism of vincristine (give vincristine 12–24 hr prior to asparaginase).
May ↓ antibody response to live-virus vaccines and ↑ risk of adverse reactions.

Route/Dosage ⬆ ⬇

IV (Adults ): 10–30 mcg/kg (0.4–1.4 mg/m²); may repeat weekly (not to exceed 2 mg/dose).
IV (Children >10 kg): 1.5–2 mg/m² single dose; may repeat weekly.
IV (Children <10 kg): 50 mcg/kg single dose; may repeat weekly.

Availability ⬆ ⬇

(Generic available)

Solution for injection: 1 mg/mL

Assessment ⬆ ⬇

Monitor BP, pulse, and respiratory rate during therapy. Report significant changes.
Monitor neurologic status. Assess for paresthesia (numbness, tingling, pain), loss of deep tendon reflexes (Achilles reflex is usually first involved), weakness (wrist drop or footdrop, gait disturbances), cranial nerve palsies (jaw pain, hoarseness, ptosis, visual changes), autonomic dysfunction (ileus, difficulty voiding, orthostatic hypotension, impaired sweating), and CNS dysfunction (decreased level of consciousness, agitation, hallucinations). Notify physician if these symptoms develop, as they may persist for mo.
Monitor intake and output ratios and daily weight; report significant discrepancies. Decreased urine output with concurrent hyponatremia may indicate SIADH, which usually responds to fluid restriction.
Assess infusion site frequently for redness, irritation, or inflammation. If extravasation occurs, infusion must be stopped and restarted elsewhere to avoid damage to SUBQ tissue. Cellulitis and discomfort may be minimized by infiltration with hyaluronidase and application of moderate heat or by application of cold compresses.
Assess nutritional status. An antiemetic may be used to minimize nausea and vomiting.
Monitor for symptoms of gout (increased uric acid, joint pain, edema). Encourage patient to drink at least 2 liters 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 periodically throughout therapy. May cause slight leukopenia 4 days after therapy, which resolves within 7 days. Platelet count may ↑ or ↓.
- Monitor liver function studies (AST, ALT, LDH, bilirubin) and renal function studies (BUN, 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. Vincristine must be dispensed in an overwrap stating "For IV use only." Overwrap should remain in place until immediately before administration.
Do not confuse vincristine with vinblastine.
Solution should be prepared in a biologic cabinet. Wear gloves, gown, and mask while handling medication. Discard IV equipment in specially designated containers.

IV Administration:

Diluent: Does not need to be reconstituted.Concentration: Administer undiluted at 1 mg/mL.
Rate: Administer each dose IV push over 1 min through Y-site injection of a free-flowing infusion of 0.9% NaCl or D5W.

Patient/Family Teaching ⬆ ⬇

Instruct patient to notify health care professional immediately if redness, swelling, or pain at injection site occurs.
Instruct patient to report symptoms of neurotoxicity (paresthesia, pain, difficulty walking, persistent constipation). Inform patient that increased fluid intake, dietary fiber, and exercise may minimize constipation. Stool softeners or laxatives may be used. Patient should inform health care professional if severe constipation or abdominal discomfort occurs, as this may be a sign of neuropathy.
Advise patient to notify health care professional if fever; chills; sore throat; signs of infection; bleeding gums; bruising; petechiae; blood in urine, stool, or emesis; or mouth sores occur. Caution patient to avoid crowds and persons with known infections.
Discuss with patient the possibility of hair loss. Explore coping strategies.
Instruct patient not to receive any vaccinations without advice of health care professional.
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.
Emphasize need for periodic lab tests to monitor for side effects.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇