vinblastine

Resp: BRONCHOSPASM.

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

GU: gonadal suppression.

Derm: alopecia, dermatitis, vesiculation.

Endo: syndrome of inappropriate antidiuretic hormone (SIADH).

Hemat: anemia, leukopenia, thrombocytopenia.

Local: phlebitis at IV site.

Metab: hyperuricemia.

Neuro: neuritis, paresthesia, peripheral neuropathy , SEIZURES, mental depression, neurotoxicity, weakness.

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 ⬆ ⬇

Doses may vary greatly, depending on tumor, schedule, condition of patient, and blood counts

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.

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 subcut, 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.
- Do not inject into extremities with impaired circulation; may cause thrombophlebitis.

IV Administration:

IV Push:
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: Dilution in large volumes (100–250 mL) or prolonged infusion (30 min) increases chance of vein irritation and extravasation.
Y-Site Compatibility:
- acyclovir
- alemtuzumab
- alfentanil
- allopurinol
- amifostine
- amikacin
- aminophylline
- amiodarone
- amphotericin B lipid complex
- ampicillin
- ampicillin/sulbactam
- anidulafungin
- argatroban
- 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 hydrochloride
- 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
- fenoldopam
- fentanyl
- filgrastim
- fluconazole
- fludarabine
- fluorouracil
- foscarnet
- fosphenytoin
- ganciclovir
- gemcitabine
- gentamicin
- glycopyrrolate
- granisetron
- haloperidol
- heparin
- hetastarch
- hydralazine
- hydrocortisone
- hydromorphone
- idarubicin
- ifosfamide
- imipenem/cilastatin
- insulin
- irinotecan
- isoproterenol
- ketorolac
- labetalol
- leucovorin calcium
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- meropenem
- mesna
- methotrexate
- methyldopate
- metoclopramide
- metoprolol
- metronidazole
- midazolam
- milrinone
- mitomycin
- mitoxantrone
- morphine
- moxifloxacin
- nafcillin
- nalbuphine
- naloxone
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- ondansetron
- oxaliplatin
- paclitaxel
- palonosetron
- pamidronate
- pancuronium
- pemetrexed
- pentamidine
- pentobarbital
- phenobarbital
- phenylephrine
- piperacillin/tazobactam
- potassium chloride
- potassium phosphates
- procainamide
- prochlorperazine
- promethazine
- propranolol
- quinupristin/dalfopristin
- remifentanil
- rituximab
- sargramostim
- sodium acetate
- sodium bicarbonate
- sodium phosphates
- succinylcholine
- sufentanil
- tacrolimus
- theophylline
- thiopental
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- topotecan
- trastuzumab
- tripmethoprim/sulfamethoxazole
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vincristine
- vinorelbine
- voriconazole
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- amphotericin B deoxycholate
- amphotericin B liposome
- cefepime
- dantrolene
- diazepam
- furosemide
- pantoprazole
- phenytoin.

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: vinca alkaloids

Availability ⬆ ⬇

(Generic available)

Solution for injection: 1 mg/mL;
Powder for injection (requires reconstitution): 10 mg/vial;

Time/Action Profile ⬆ ⬇

(effects on white blood cell counts)

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

Assessment ⬆ ⬇

Monitor BP, pulse, and respiratory rate during therapy. Bronchospasm can be life-threatening and may occur at time of infusion or several hrs 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.
Assess injection site frequently for redness, irritation, or inflammation. If extravasation occurs, infusion must be stopped and restarted elsewhere to avoid damage to subcut 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, creatinine) prior to and periodically throughout therapy.
- May cause ↑ uric acid. Monitor periodically during therapy.

Pot. Nursing Diagnoses ⬆ ⬇

Risk for infection (Adverse Reactions).
Imbalanced nutrition: less than body requirements (Adverse Reactions).

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.
Rep: Advise patient that this medication may have teratogenic effects. 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 ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇