vincristine

ROUTE	ONSET	PEAK	DURATION
IV	unknown	4 days	7 days

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 , tissue necrosis (from extravasation)

Metab: hyperuricemia

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

Resp: bronchospasm

Interactions ⬆ ⬇

Drug-drug:

Bronchospasm may occur in patients who have been previously treated with mitomycin.
l-asparaginase may ↑ levels and risk of toxicity; give vincristine 12–24 hr before 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) as a single dose; may repeat weekly (not to exceed 2 mg/dose).
IV (Children >10 kg): 1.5–2 mg/m² as a single dose; may repeat weekly.
IV (Children <10 kg): 50 mcg/kg as a single dose; may repeat weekly.

Availability ⬆ ⬇

(Generic available)

Solution for injection: 1 mg/mL

Assessment ⬆ ⬇

Monitor BP, HR, and respiratory rate during therapy.
Monitor for hypersensitivity reaction (rash, edema, anaphylaxis) during infusion. If symptoms occur, immediately discontinue vincristine and treat as indicated.
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 (↓ level of consciousness, agitation, hallucinations).
Monitor intake, output, and daily weight. If ↓ urine output with hyponatremia occurs, it may indicate SIADH and usually responds to fluid restriction.
Assess nutritional status. If nausea or vomiting occurs, use an antiemetic to minimize symptoms.
Monitor for signs/symptoms of gout (↑ uric acid, joint pain, edema). Encourage patient to drink ≥2 liters of fluid per day. Allopurinol or alkalinization of urine may be used to ↓ uric acid levels.

Lab Test Considerations:

Monitor CBC with differential before starting and periodically throughout therapy. May cause slight leukopenia 4 days after therapy, which resolves within 7 days. Platelet count may ↑ or ↓.
- 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.

Implementation ⬆ ⬇

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. Vincristine 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 vincristine with vinblastine.
Should be administered by individuals experienced in the administration of this medication.
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:

Vincristine 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: Concentration: Administer undiluted at 1 mg/mL.
Rate: Administer each dose over 1 min through Y-site injection of a free-flowing infusion of 0.9% NaCl or D5W.
Y-Site Compatibility:
- acyclovir
- alemtuzumab
- allopurinol
- amikacin
- aminocaproic acid
- aminophylline
- amiodarone
- amphotericin B liposomal
- ampicillin
- ampicillin/sulbactam
- anidulafungin
- argatroban
- arsenic trioxide
- atracurium
- azithromycin
- aztreonam
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- butorphanol
- calcium chloride
- calcium gluconate
- carboplatin
- carmustine
- caspofungin
- cefazolin
- cefotetan
- cefoxitin
- ceftazidime
- ceftriaxone
- cefuroxime
- chlorpromazine
- ciprofloxacin
- cisatracurium
- cladribine
- cisplatin
- cladribine
- clindamycin
- cyclophosphamide
- cyclosporine
- cytarabine
- 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
- fosphenytoin
- ganciclovir
- gemcitabine
- gentamicin
- granisetron
- haloperidol
- heparin
- hetastarch
- hydrocortisone
- hydromorphone
- ifosfamide
- imipenem/cilastatin
- insulin regular
- isoproterenol
- ketorolac
- labetalol
- leucovorin
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- meropenem
- mesna
- methadone
- methohexital
- methotrexate
- methylprednisolone
- metoclopramide
- metoprolol
- metronidazole
- midazolam
- milrinone
- minocycline
- mitomycin
- mitoxantrone
- morphine
- moxifloxacin
- nalbuphine
- naloxone
- nicardipine
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- ondansetron
- oxaliplatin
- paclitaxel
- palonosetron
- pamidronate
- pemetrexed
- pentamidine
- pentobarbital
- phenobarbital
- phenylephrine
- piperacillin/tazobactam
- potassium acetate
- potassium chloride
- potassium phosphates
- procainamide
- prochlorperazine
- promethazine
- propranolol
- remifentanil
- rituximab
- rocuronium
- sargramostim
- sodium acetate
- sodium phosphates
- succinylcholine
- sufentanil
- tacrolimus
- theophylline
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- topotecan
- trastuzumab
- trimethoprim/sulfamethoxazole
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vinorelbine
- voriconazole
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- amphotericin B deoxycholate
- cefepime
- diazepam
- gemtuzumab ozogamicin
- idarubicin
- nafcillin
- pantoprazole
- phenytoin

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Emphasize need for periodic lab tests to monitor for side effects.
Instruct patient to notify health care provider immediately if redness, swelling, or pain at injection site occurs.
Instruct patient to report symptoms of neurotoxicity (numbness and tingling, pain, difficulty walking, persistent or severe constipation, abdominal pain). Advise patient to ↑ fluid intake, dietary fiber, and exercise to minimize constipation; stool softeners or laxatives may be used.
Advise patient to notify health care provider of signs and symptoms of urinary retention (difficulty urinating, weak stream, abdominal pain).
Advise patient to notify health care provider of fever; chills; sore throat; signs of infection; bleeding gums; bruising; petechiae; blood in urine, stool, or emesis; or mouth sores. Caution patient to avoid crowds and persons with known infections.
Discuss the possibility of hair loss. Explore coping strategies.
Instruct patient not to receive any vaccinations without advice of health care provider.
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. Contraception should be used during therapy and ≥2 mo after last dose.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇