Adult: As monotherapy or in combination with other chemotherapeutic agents: Usual dose: 1.4-1.5 mg/m2 once weekly via IV infusion over 5-10 minutes either directly into an IV catheter/needle or into a running IV infusion. Alternatively, doses may be given via IV inj over 1 minute into a freely running IV infusion. Max: 2 mg weekly. Individualise the dose based on the patient's clinical response and tolerability. Dosage and treatment recommendations may vary among individual products and between countries (refer to specific product guideline or local treatment protocols). Child: As monotherapy or in combination with other chemotherapeutic agents: In patients weighing ≤10 kg: Initially, 0.05 mg/kg once weekly; >10 kg: 1.4-2 mg/m2 once weekly. Max: 2 mg weekly. All doses are administered via IV infusion over 5-10 minutes either directly into an IV catheter/needle or into a running IV infusion. Alternatively, doses may be given via IV inj over 1 minute into a freely running IV infusion. Individualise the dose based on the patient's clinical response and tolerability. Dosage and treatment recommendations may vary among individual products and between countries (refer to specific product guideline or local treatment protocols).
What are the brands available for Vincristine in Hong Kong?
Dose reduction may be needed. For patients with >3 mg/100 mL direct serum bilirubin: Reduce the dose by 50%.
Reconstitution
IV infusion: Dilute in a 25 mL or 50 mL NaCl 0.9% inj or dextrose 5% in water infusion bag. Do not add extra fluid into the vial before removal of the dose in an attempt to empty it. Recommendations for dilution may vary among individual products and between countries (refer to specific product guidelines).
Incompatibility
Any solution used for dilution that may change the pH beyond 3.5-5.5 range.
Contraindications
Demyelinating form of Charcot-Marie-Tooth syndrome; patients who are receiving radiation therapy through ports that include the liver. Administration via IM, SC, or intrathecal route. Lactation.
Special Precautions
Patient with pre-existing neuromuscular disease or pulmonary dysfunction; leucopenia or a complicating infection; history of gout or urate renal stones. To prevent constipation, consider initiation of routine prophylactic bowel management regimen (e.g. use of enemas or laxatives). Avoid extravasation or accidental contamination of eyes. Concomitant use with other neurotoxic drugs, asparaginase, and azole antifungals; coadministration with live vaccines. Hepatic impairment. Children and elderly. Pregnancy.
Adverse Reactions
Significant: Neurotoxicity, including altered mental status (e.g. confusion, insomnia, depression); gastrointestinal effects (e.g. constipation, intestinal perforation or necrosis, paralytic ileus); acute dyspnoea and severe bronchospasm (particularly in combination with mitomycin); acute uric acid nephropathy, granulocytopenia; severe local reactions (e.g. pain, cellulitis, phlebitis), particularly if extravasation occurs. Rarely, may increase the risk of developing secondary malignancies (particularly in combination with carcinogenic chemotherapeutic agents). Blood and lymphatic system disorders: Anaemia, leucopenia, thrombocytopenia. Ear and labyrinth disorders: Vertigo, deafness. Endocrine disorders: Rarely, SIADH. Gastrointestinal disorders: Nausea, vomiting, abdominal pain, diarrhoea, stomatitis, oral ulceration. General disorders and administration site conditions: Fever. Hepatobiliary disorders: Hepatic veno-occlusive disease (particularly in children). Immune system disorders: Rarely, hypersensitivity reactions (e.g. rash, anaphylaxis, oedema). Investigations: Decreased weight. Metabolism and nutrition disorders: Decreased appetite, dehydration. Musculoskeletal and connective tissue disorders: Myalgia, bone pain, jaw pain. Nervous system disorders: Convulsion, paraesthesia, peroneal nerve palsy. Renal and urinary disorders: Polyuria, dysuria, urinary retention. Respiratory, thoracic and mediastinal disorders: Oropharyngeal pain, acute respiratory distress syndrome. Skin and subcutaneous tissue disorders: Alopecia. Vascular disorders: Hypertension, hypotension.
Women of childbearing potential must use proven birth control methods during therapy and for at least 7 months after stopping the treatment. Men with female partners of childbearing potential should use proven birth control methods during treatment and for at least 4 months after the last dose.
Monitoring Parameters
Obtain CBC with differential before each dose. Monitor LFTs, serum electrolytes (particularly serum Na), and serum uric acid. Hepatitis B virus screening with HBsAg, hepatitis B core antibody, total Ig or IgG, and antibody to HBsAg is recommended before or at the beginning of systemic chemotherapy. Closely monitor the infusion site. Assess for signs and symptoms of hepatotoxicity, peripheral neuropathy, and constipation/ileus.
Overdosage
Symptoms: Extensions of the common adverse effects. Management: Supportive treatment. May restrict fluid intake and administer loop diuretics to prevent adverse effects resulting from SIADH. May give enemas or cathartics for ileus prevention. Administer anticonvulsants as indicated. May consider giving folinic acid. Closely monitor the CV system and obtain blood counts daily to guide transfusion requirements.
Drug Interactions
Increased risk of acute dyspnoea and severe bronchospasm with mitomycin. Concurrent use with azole antifungals (e.g. fluconazole, itraconazole) may increase vincristine plasma concentrations which may result in enhanced neurotoxicity and other adverse effects. May cause additive neurotoxicity with isoniazid and other agents acting on the nervous system. May reduce vincristine hepatic clearance and increase toxicity when given with asparaginase; if concomitantly used, administer vincristine 12-24 hours before the asparaginase dose. May decrease the blood levels of phenytoin leading to increased seizure activity. CYP3A4 inhibitors and inducers may reduce and increase the metabolism of vincristine, respectively. May increase the cellular uptake of methotrexate by malignant cells. May cause severe hepatotoxicity, including veno-occlusive disease with dactinomycin. Increased risk of myelosuppression with doxorubicin and granulocyte-colony stimulating factors (G-CSFs), such as filgrastim and pegfilgrastim. May increase the risk of temporary or permanent hearing impairment with ototoxic agents (e.g. platinum-based antineoplastic agents). Reduced clearance with nifedipine. Coadministration with live vaccines may reduce the antibody response to the vaccine and may increase vaccine-associated adverse effects.
Food Interaction
St. John's wort may increase the metabolism of vincristine.
Lab Interference
Action
Description: Mechanism of Action: Vincristine, a vinca alkaloid, is an antineoplastic agent with broad-spectrum anti-tumour activity. It binds to tubulin and inhibits the formation of microtubules, leading to the disruption of mitotic spindle assembly and the arrest of cellular metaphase. Vincristine may also block glutamic acid utilisation, thereby interfering with nucleic acid and protein synthesis. Pharmacokinetics: Distribution: Rapidly and widely distributed into the tissues; concentrated in blood platelets. Poorly penetrates the blood-brain barrier. Plasma protein binding: 75%. Metabolism: Extensively metabolised in the liver primarily by CYP3A4 and CYP3A5 isoenzymes. Excretion: Mainly via faeces (70-80%); urine (10-20%). Terminal half-life elimination: Approx 85 hours (range: 19-155 hours).
Chemical Structure
Vincristine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 5978, Vincristine. https://pubchem.ncbi.nlm.nih.gov/compound/Vincristine. Accessed Nov. 25, 2024.
Storage
Intact vial: Store between 2-8°C. Do not freeze. Protect from light. Diluted solution for IV infusion: May be stored at 25°C for 8 hours under normal light conditions or up to 24 hours when protected from light. This is a cytotoxic drug. Follow applicable procedures for receiving, handling, administration, and disposal.
L01CA02 - vincristine ; Belongs to the class of plant alkaloids and other natural products, vinca alkaloids and analogues. Used in the treatment of cancer.
References
Anon. Vincristine Sulfate. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 07/10/2024.Brayfield A, Cadart C (eds). Vincristine Sulfate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/10/2024.DBL Vincristine Sulfate Injection (Hospira Malaysia Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 07/10/2024.Joint Formulary Committee. Vincristine Sulfate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/10/2024.Pfizer New Zealand Limited. DBL Vincristine Sulfate Injection data sheet 05 July 2024. Medsafe. http://www.medsafe.govt.nz. Accessed 07/10/2024.Vincristine Sulfate 1 mg/mL Solution for Injection (Hospira UK Limited). MHRA. https://products.mhra.gov.uk. Accessed 07/10/2024.Vincristine Sulfate Injection, Solution (Hospira, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 07/10/2024.Vincristine. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 07/10/2024.
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