vinCRIStine sulfate (redirected from Vincasar PFS)

vin·cris·tine sulfate (vn-krstn)

n.

The sulfate salt of a dimeric alkaloid obtained from a plant of the genus Vinca that exhibits antineoplastic activity similar to that of vinblastine sulfate and is used especially in the treatment of lymphocytic lymphosarcoma and acute leukemia.

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vinCRIStine sulfate

[vinkris′tēn, -tin]

an antimitotic antineoplastic.

indications It is prescribed in the treatment of many neoplastic diseases, such as leukemia, neuroblastoma, lymphomas, and sarcomas. It is often used in combination therapy since its dose-limiting toxicity is different from that of most other cancer chemotherapy drugs.

contraindications Pregnancy, leukopenia, preexisting neuromuscular disease, or known hypersensitivity to this drug prohibits its use. Intrathecal administration of vinCRIStine has caused deaths and is therefore also contraindicated.

adverse effects Neurotoxicity is the dose-limiting toxicity. Constipation, abdominal pain, and alopecia also may occur. VinCRIStine is a vesicant, so prompt attention is required if extravasation occurs. Leukopenia seldom occurs at usual clinical doses but can become significant at higher doses.

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vincristine sulfate (VCR) Warning - Hazardous drug!

Oncovin (UK), Vincasar PFS

Pharmacologic class: Vinca alkaloid

Therapeutic class: Antineoplastic

Pregnancy risk category D

FDA Boxed Warning

• Drug should be administered only by individuals experienced in giving it.

Make sure needle is positioned properly in vein before injecting drug. Leakage into surrounding tissue during I.V. administration may cause considerable irritation. If it does, discontinue injection immediately and inject remaining portion of dose into another vein. To treat extravasation, administer local injection of hyaluronidase and apply moderate heat to affected area.
• Drug is fatal if given intrathecally. Give I.V. only.

Action

Unknown. Thought to block cell division and interfere with synthesis of nucleic acid. Cell-cycle-phase specific.

Availability

Solution for injection: 1 mg/ml in 1-, 2-, and 5-ml vials

⊘Indications and dosages

➣ Acute leukemia

Adults: 0.4 to 1.4 mg/m² I.V. weekly, not to exceed 2 mg/dose. (Dosages higher than 2 mg may be used depending on patient, physician, protocol, and facility.)

Children weighing more than 10 kg (22 lb): 2 mg/m² I.V. weekly

Children weighing 10 kg (22 lb) or less: 0.05 mg/kg I.V. weekly

Dosage adjustment

• Hepatic impairment

Off-label uses

• Brain, hepatic, ovarian, testicular, and other cancers
• Neuroblastoma
• Kaposi's sarcoma
• Idiopathic thrombocytopenic purpura

Contraindications

• Hypersensitivity to drug
• Demyelinating form of Charcot-Marie-Tooth disease
• Intrathecal use

Precautions

Use cautiously in:
• infections, decreased bone marrow reserve, hepatic impairment, acute uric acid nephropathy, neuromuscular disease, pulmonary dysfunction, other chronic debilitating illnesses
• females of childbearing age
• pregnant or breastfeeding patients (use not recommended).

Administration

☞ Follow facility protocol for handling and preparing chemotherapeutic drugs. Be especially careful to avoid eye contamination.
• Be aware that patient is usually premedicated with antiemetic.
☞ Give by I.V. route only. (Intrathecal injection is fatal.)
• Inject into tubing of running I.V. line, or inject directly into vein over 1 minute.
• Avoid extravasation (may cause tissue necrosis). If extravasation occurs, stop injection, inject hyaluronidase locally, and apply moderate heat.
• Know that drug may be used with other antineoplastics in some diseases.

Route	Onset	Peak	Duration
I.V.	Unknown	4 days	7 days

Adverse reactions

CNS: agitation, insomnia, depression, mental status changes, ascending peripheral neuropathy, transient cortical blindness, seizures, coma

EENT: diplopia

GI: nausea, vomiting, constipation, abdominal cramps, stomatitis, anorexia, paralytic ileus

GU: nocturia, urinary retention, gonadal suppression, oliguria

Hematologic: anemia, leukopenia, thrombocytopenia (mild and brief)

Metabolic: hyperuricemia, syndrome of inappropriate antidiuretic hormone secretion

Respiratory: bronchospasm

Skin: alopecia

Other: tissue necrosis (with extravasation), phlebitis at I.V. site

Interactions

Drug-drug. Asparaginase: decreased hepatic metabolism of vincristine

Live-virus vaccines: decreased antibody response to vaccine, increased risk of adverse reactions

Mitomycin: increased risk of bronchospasm and shortness of breath

Drug-diagnostic tests. Platelets: increased or decreased count

Uric acid: increased level

White blood cells: decreased count (slight leukopenia) 4 days after therapy, resolving within 7 days

Patient monitoring

☞ Assess respiratory status. Drug may cause bronchospasm, especially in patients who previously received mitomycin.
• Monitor blood pressure.
• Evaluate neurologic status. Know that neurotoxicity is a dose-limiting adverse reaction.
• Monitor CBC with platelet count. Watch for signs and symptoms of blood dyscrasias.
• Stay alert for signs and symptoms of infection.

Patient teaching

• Explain drug therapy to patient. Emphasize importance of follow-up laboratory tests.
• Advise patient to promptly report signs and symptoms of infection and to take his temperature daily.
• Urge patient to practice good oral hygiene, to help prevent infected mouth sores.
• Instruct female of childbearing age to avoid pregnancy. Caution her not to breastfeed during therapy.
• Tell patient that hair loss is a common side effect but typically reverses once treatment ends.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.