Trade Names:Vinblastine Sulfate- Injection 10 mg
Vinblastine interferes with metabolic pathways of amino acids leading from glutamic acid to the citric acid cycle and urea. Vinblastine has an effect on cell energy production required for mitosis and interferes with nucleic acid synthesis.
Rapidly absorbed 15 to 30 min following IV triphasic serum decay pattern.
Undergoes rapid distribution (from blood to tissue) and extensive tissue binding.
Metabolized by the hepatic P450 3A cytochromes. The metabolite, deacetyl vinblastine, is more active than parent drug.
Major route of excretion is the biliary system (liver). Terminal t ½ is 24.8 h.
Toxicity may be enhanced. A dose reduction is recommended. In patients with a direct serum bilirubin value more than 3 mg/dL, a 50% dose reduction is recommended.Pregnancy
Category D . Information is very limited.
Hodgkin disease, non-Hodgkin lymphoma, mycosis fungoides, advanced testicular carcinoma, Kaposi sarcoma, choriocarcinoma, breast cancer.Children
Hodgkin disease, non-Hodgkin lymphoma, mycosis fungoides, Letterer-Siwe disease, choriocarcinoma.
Non-small cell lung carcinoma, bladder cancer, cervical cancer, refractory idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia.
Leukopenia; presence of bacterial infection (infections must be under control prior to initiating therapy); significant granulocytopenia unless it is a result of the disease being treated.
IV Initially 3.7 mg/m 2 as a single dose/wk. Then increase at weekly intervals in 1.8 mg/m 2 increments until the leukocyte count decreases to about 3,000/mm 3 . The maximum weekly dose is 18.5 mg/m 2 .Pediatric
IV Initially 2.5 mg/m 2 as a single dose/wk. Then increase at weekly intervals in 1.25 mg/m 2 increments until the leukocyte count decreases to about 3,000/mm 3 . The maximum weekly dose is 12.5 mg/m 2 .MaintenanceAdults
IV The maintenance dose is 1.8 mg/m 2 less than the dose required to produce a leukocyte count of 3,000/mm 3 every 7 to 14 days. The optimum weekly dose is normally 5.5 to 7.4 mg/m 2 . Maintenance doses should not be given until the WBC reaches 4,000/mm 3 . For an adequate trial, vinblastine must be continued for at least 4 to 6 wk.Children
IV The maintenance dose is 1.25 mg/m 2 less than the dose required to produce a leukocyte count of 3,000/mm 3 every 7 to 14 days. Maintenance doses should not be given until the WBC reaches 4,000/mm 3 . For an adequate trial, vinblastine must be continued for at least 4 to 6 wk.Adjustment in Hepatic InsufficiencyAdults
IV Reduce the dose 50% in patients with a direct serum bilirubin exceeding 3 mg/dL.
Refrigerate. Protect from light. Unopened vials are stable at room temperature for 2 wk, but this is not recommended for storage. Solutions reconstituted with bacteriostatic sodium chloride 0.9% are stable for 30 days in the refrigerator. Solutions reconstituted with preservative-free sodium chloride 0.9% should be used within 24 h.
Vinblastine elimination may be reduced by CYP-450 enzyme inhibitors.Erythromycin
Erythromycin may decrease metabolism of vinblastine causing increased toxicity.Mitomycin
Acute shortness of breath and severe bronchospasm have occurred following concomitant or previous use of mitomycin.Phenytoin
May reduce phenytoin plasma concentration.
None well documented.
Malaise; weakness; dizziness; numbness of digits or paresthesia; loss of deep tendon reflexes; peripheral neuritis; mental depression; headache; convulsions.
Syndrome of inappropriate antidiuretic hormone secretion.
Pharyngitis; vesiculation of the mouth; mucositis; ileus; diarrhea; constipation; anorexia; abdominal pain; rectal bleeding; hemorrhagic enterocolitis; bleeding from an old peptic ulcer.
Amenorrhea; loss of sperm or semen.
Bone marrow suppression, usually selective for leukocytes, nadir at 5 to 10 days.
Bone or jaw pain acutely.
Acute bronchospasm, especially in combination with mitomycin.
WarningsIV use only
Intrathecal use of other vinca alkaloids has been fatal. Label syringe “Warning - For IV Use Only; fatal if given intrathecally.”Granulocytopenia
May be severe and predispose to infection. Do not administer to patients with granulocyte counts less than 1,000 cells/mm 3 .Avoid extravasation
Proper placement of needle/catheter prior to administration. Extravasation can cause severe local necrosis. Local irritation or phlebitis may occur. Refer to your institution specific protocol.
Category D .
Toxicity may be enhanced in the presence of hepatic insufficiency. A dose reduction is recommended.
Follow dosage adjustment guidelines recommended for adults.
Leukopenia is expected. If leukopenia (less than 2,000 WBC/mm 3 ) occurs following a dose of this drug, carefully watch the patient for evidence of infection until a safe WBC count has returned.
Acute shortness of breath and severe bronchospasm have occurred. These reactions occur most frequently when used with mitomycin.
Side effects are dose-related. Expect exaggerated effects.
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