Home Drug Guide Vincristine Sulfate

Drug Guide

Generic Name

Vincristine Sulfate

Brand Names Oncovin, Vincrex, Vincasar Pfs, Vincristine Sulfate Pfs, Marqibo Kit

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Vinca alkaloid

FDA Approved Indications

Acute lymphoblastic leukemia (ALL)
Hodgkin's lymphoma
Non-Hodgkin's lymphomas
Neuroblastoma
Wilms tumor

Mechanism of Action

Vincristine binds to tubulin, inhibiting microtubule formation in mitotic spindle fibers, leading to cell cycle arrest at metaphase and apoptosis.

Dosage and Administration

Adult: Dosage varies based on condition; typical dose is 1.4 mg/m^2 IV once weekly. Careful dose adjustments are necessary for toxicity.

Pediatric: Typically 0.05 to 0.16 mg/kg IV weekly, not exceeding adult dose, with adjustments based on response and toxicity.

Geriatric: Use with caution; monitor for increased toxicity.

Renal Impairment: Adjust dosage as needed; no specific guidelines but monitor closely.

Hepatic Impairment: Use caution; no specific guidelines—monitor for toxicity.

Pharmacokinetics

Absorption: Not applicable (administered IV).

Distribution: Wide distribution; crosses blood-brain barrier to some extent.

Metabolism: Hepatic metabolism; primarily through cytochrome P450 enzymes.

Excretion: Primarily via bile; small amount via urine.

Half Life: Approximately 85 hours in adults.

Contraindications

Hypersensitivity to vincristine or other vinca alkaloids.

Precautions

Neurotoxicity risk — monitor neurological status, avoid intrathecal administration.
Leukopenia, gastrointestinal disturbances, and SIADH should be monitored.
Pregnancy — teratogenic, and potential fetal harm. Use during pregnancy only if clearly needed.

Adverse Reactions - Common

Peripheral neuropathy (Common)
Hair loss (Less common)
Constipation (Common)
SIADH (syndrome of inappropriate antidiuretic hormone secretion) (Less common)

Adverse Reactions - Serious

Severe neurotoxicity (e.g., seizures, paralysis) (Rare)
Myelosuppression (neutropenia, thrombocytopenia) (Less common)
Extravasation leading to tissue necrosis (Serious, if occurs)

Drug-Drug Interactions

Potential additive neurotoxicity with other neurotoxic agents
Caution with CYP3A4 inhibitors/inducers affecting metabolism.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Neurological status, complete blood counts, signs of extravasation.

Diagnoses:

Risk for peripheral neurotoxicity
Risk for infection due to myelosuppression

Implementation: Administer IV as prescribed, monitor IV site for extravasation, provide supportive care for side effects.

Evaluation: Assess for neurotoxicity, hematologic response, and overall patient tolerance.

Patient/Family Teaching

Report numbness, tingling, weakness or paralysis.
Avoid contact with people with infections due to immunosuppression.
Report signs of tissue necrosis at injection site.

Special Considerations

Black Box Warnings:

Neurotoxicity — risk of irreversible effects.

Genetic Factors: None specific.

Lab Test Interference: May cause false-positive tests for bilirubin or certain enzymes.

Overdose Management

Signs/Symptoms: Severe neurotoxicity, paralysis, seizures.

Treatment: Supportive care; no specific antidote. Immediate discontinuation and supportive measures are essential.

Storage and Handling

Storage: Store at controlled room temperature, away from light.

Stability: Stable at room temperature for the duration of the shelf life.