vinblastine

vin-BLASS-teen

Therapeutic Classification: antineoplastics

Pharmacologic Classification: vinca alkaloids

High Alert

Palliative treatment of the following:
- Hodgkin lymphoma,
- Lymphocytic lymphoma,
- Histiocytic lymphoma,
- Advanced mycosis fungoides,
- Testicular carcinoma,
- Kaposi sarcoma,
- Breast cancer.

Binds to proteins of mitotic spindle, causing metaphase arrest. Cell replication is stopped as a result (cell cycle specific for M phase).

Therapeutic effects:

Death of rapidly replicating cells, particularly malignant ones.

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.

(effects on WBC counts)

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

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.

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

Metab: hyperuricemia

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

Resp: BRONCHOSPASM

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 ↓ levels and effectiveness of phenytoin.

IV (Adults ): Initial: 3.7 mg/m² (100 mcg/kg) as a 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 as a 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.

(Generic available)

Solution for injection: 1 mg/mL

Monitor BP, HR, and respiratory rate during therapy. Bronchospasm and acute or progressive dyspnea can be life-threatening and may occur at time of infusion or several hours to weeks later.
May cause nausea and vomiting. Monitor intake, output, appetite, and nutritional intake. Prophylactic antiemetics may be used. Adjust diet as tolerated.
Monitor for signs/symptoms of myelosuppression, consisting of anemia (weakness, fatigue, dizziness, pallor of skin and sclera), neutropenia (malaise, fatigue, fever, chills, sore throat, lymphadenopathy, infections), or thrombocytopenia (petechiae, purpura, epistaxis, bleeding). Assess for signs of infection during neutropenia.
Assess for bleeding (bleeding gums, bruising, petechiae, weakness, tachycardia, dyspnea, dizziness, pallor, fatigue, tarry stools, coffee ground emesis) and avoid IM injections and taking rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min.
Monitor for signs/symptoms of neuropathy or neurotoxicity (blurred or double vision, difficulty in walking, drooping eyelids, headache, fingers, toe or jaw pain, paresthesia in the fingers and toes, constipation, abdominal pain, urinary retention, postural hypotension, loss of deep tendon reflexes).
Monitor for signs/symptoms of gout (↑ uric acid, joint pain, edema). Encourage patient to drink ≥2 L of fluid per day. Allopurinol or alkalinization of urine may be used to ↓ uric acid levels.

Lab Test Considerations:

Monitor CBC with differential prior to and routinely throughout therapy. If WBC <2000 cells/mm³, hold subsequent doses until WBC ≥4000 cells/mm³. 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 (AST, ALT, LDH, bilirubin) and renal function (BUN, serum creatinine) before starting and periodically throughout therapy.
- May ↑ uric acid. Monitor periodically during therapy.
- Monitor serum sodium periodically, especially if SIADH suspected.

High Alert: 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.
High Alert: Do not confuse vinblastine with vincristine.
When preparing from a vial or ampule, wear double chemotherapy gloves, protective gown, respiratory (N95) protection, and hair and shoe covers; optimally prepare in a ventilated control device. When administering, add eye/face protection if there is a potential that the substance could splash. Severe irritation or corneal ulceration may occur in splashed into eye. Use a closed-system drug transfer device when dosage form allows. Prepare in a minibag, not a syringe. Single chemotherapy gloves are appropriate if administering from prefilled bag. Discard IV equipment in specially designated containers.
- Do not inject into extremities with impaired circulation; may cause thrombophlebitis.

IV Administration:

Vinblastine is a vesicant. If extravasation occurs, immediately stop infusion. Leave needle/cannula in place temporarily but do not flush the line. Gently aspirate extravasated solution; then remove needle/cannula. Elevate patient's extremity and apply dry warm compresses for 20 min 4 times day for 1–2 days. Initiate hyaluronidase antidote by injecting 1–6 mL (150 units/mL) into existing IV line; usual dose is 1 mL for each 1 mL of extravasated drug. If needle/cannula has been removed, inject SUBQ in a clockwise manner around area of extravasation or administer 1 mL as five separate 0.2 mL injections SUBQ into extravasation site; may repeat several times over next 3–4 hr.
IV Push: 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) chance of vein irritation and extravasation.
Y-Site Compatibility:
- acyclovir
- alemtuzumab
- allopurinol
- amikacin
- aminophylline
- amiodarone
- ampicillin
- ampicillin/sulbactam
- anidulafungin
- argatroban
- arsenic trioxide
- atracurium
- aztreonam
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- busulfan
- butorphanol
- calcium chloride
- calcium gluconate
- carboplatin
- carmustine
- caspofungin
- cefazolin
- cefotaxime
- cefotetan
- cefoxitin
- ceftazidime
- ceftriaxone
- cefuroxime
- chloramphenicol
- chlorpromazine
- ciprofloxacin
- cisatracurium
- cisplatin
- clindamycin
- cyclophosphamide
- cyclosporine
- dacarbazine
- dactinomycin
- daptomycin
- daunorubicin
- dexamethasone
- dexmedetomidine
- dexrazoxane
- digoxin
- diltiazem
- diphenhydramine
- dobutamine
- docetaxel
- dopamine
- doxorubicin hydrochloride
- doxorubicin liposomal
- doxycycline
- droperidol
- enalaprilat
- ephedrine
- epinephrine
- epirubicin
- ertapenem
- erythromycin
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fentanyl
- filgrastim
- fluconazole
- fludarabine
- fluorouracil
- foscarnet
- fosphenytoin
- ganciclovir
- gemcitabine
- gentamicin
- glycopyrrolate
- granisetron
- haloperidol
- heparin
- hetastarch
- hydralazine
- hydrocortisone
- hydromorphone
- idarubicin
- ifosfamide
- imipenem/cilastatin
- insulin regular
- irinotecan
- isoproterenol
- ketorolac
- labetalol
- leucovorin
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- meropenem
- mesna
- methadone
- methohexital
- methotrexate
- metoclopramide
- metoprolol
- metronidazole
- midazolam
- milrinone
- mitomycin
- mitoxantrone
- morphine
- moxifloxacin
- nafcillin
- nalbuphine
- naloxone
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- ondansetron
- oxaliplatin
- paclitaxel
- palonosetron
- pamidronate
- pemetrexed
- pentamidine
- pentobarbital
- phenobarbital
- phentolamine
- phenylephrine
- piperacillin/tazobactam
- potassium acetate
- potassium chloride
- potassium phosphates
- procainamide
- prochlorperazine
- promethazine
- propranolol
- remifentanil
- rituximab
- sargramostim
- sodium acetate
- sodium bicarbonate
- sodium phosphates
- succinylcholine
- sufentanil
- tacrolimus
- theophylline
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- topotecan
- trastuzumab
- trimethoprim/sulfamethoxazole
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vincristine
- vinorelbine
- voriconazole
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- amphotericin B deoxycholate
- amphotericin B liposomal
- cefepime
- dantrolene
- diazepam
- furosemide
- gemtuzumab ozogamicin
- pantoprazole
- phenytoin

Explain the purpose and side effects of vinblastine. Do not stop receiving without consulting health care provider. If an appointment is missed, contact health care provider as soon as possible to reschedule. Advise patient to read Medication Guide before starting and periodically during therapy in case of changes.
Explain need for continued medical follow-up to assess effectiveness and possible side effects of medication. Periodic lab tests will be needed.
Advise patient to notify health care provider if fever, chills, sore throat, or signs of infection occur. Caution patient to avoid crowds and persons with known infections.
Tell patient to report and seek treatment for signs and symptoms of bleeding (weakness; fast heartbeat; trouble breathing; dizziness; pale skin; tiredness; obvious bleeding in urine, stool, mouth, or nose). 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 provider.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
Rep: May cause fetal harm. Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected and to avoid breastfeeding during therapy. Adverse effects to a fetus may be caused by both men or women receiving treatment with vinblastine. Contraception should be used during therapy and for ≥2 mo after last dose. If need to use during pregnancy, avoid during 1st 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 lymphoma, may be administered safely and effectively in the latter phase of pregnancy. Encourage patient to enroll in the pregnancy registry for all cancers diagnosed during pregnancy at Cooper University Health (1-856-757-7876). May cause infertility in men.

Regression of malignancy without the appearance of detrimental side effects.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆