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vinblastine sulfate (VLB)
Pharmacologic class: Vinca alkaloid
Therapeutic class: Antineoplastic
Pregnancy risk category D
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.
Arrests mitosis and blocks cell division, interfering with nucleic acid synthesis. Cell-cycle-phase specific.
Lyophilized powder for injection: 10-mg vial
Indications and dosages
➣ Hodgkin's disease; advanced testicular cancer; lymphoma; AIDS-related Kaposi's sarcoma; bladder cancer; renal cancer; non-small-cell lung cancer; melanoma; breast cancer; choriocarcinoma; histiocytosis X; mycosis fungoides
Adults: 3.7 mg/m2 I.V. weekly; may increase to a maximum of 18.5 mg/m2 I.V. weekly, based on response. Withhold weekly dose if white blood cell (WBC) count is less than 4,000 cells/mm3. May increase dosage in increments of 1.8 mg/m2 if needed, but not after WBC count drops to approximately 3,000 cells/mm3.
• Hepatic impairment
• Hypersensitivity to drug
• Significant granulocytopenia from causes other than disease being treated
• Uncontrolled bacterial infections
• Intrathecal use
• Elderly patients with cachexia or skin ulcers
Use cautiously in:
• hepatic or pulmonary dysfunction, renal disease with hypertension, malignant-cell infiltration of bone marrow, neuromuscular disease
• females of childbearing age
• pregnant or breastfeeding patients (use not recommended).
Follow facility protocol for handling and preparing chemotherapeutic drugs. Take special care to avoid eye contamination.
• Know that patient is usually premedicated with antiemetic.
Give by I.V. route only. (Intrathecal injection is fatal.)
• Reconstitute powder in 10-mg vial with 10 ml of normal saline solution for injection, to a concentration of 1 mg/ml. Refrigerate solution and protect from light; discard after 28 days.
• Inject I.V. dose into tubing of running I.V. line, or inject directly into vein over about 1 minute.
• Avoid extravasation, which may cause tissue necrosis. If extravasation occurs, stop injection, inject hyaluronidase locally, and apply moderate heat.
CNS: headache, malaise, depression, paresthesia, loss of deep tendon reflexes, peripheral neuropathy and neuritis, cerebrovascular accident, seizures
CV: hypertension, tachycardia, myocardial infarction
GI: nausea, vomiting, diarrhea, constipation, bleeding ulcer, abdominal pain, stomatitis, anorexia, paralytic ileus
Hematologic: anemia, thrombocytopenia, leukopenia
Metabolic: hyperuricemia, syndrome of inappropriate antidiuretic hormone secretion
Musculoskeletal: bone pain, muscle pain and weakness
Respiratory: shortness of breath, acute bronchospasm, pulmonary infiltrates
Skin: alopecia, skin irritation
Other: weight loss; jaw pain; tumor site pain; sloughing, cellulitis, and phlebitis at I.V. site; tissue necrosis (with extravasation)
Drug-drug. Erythromycin, other CYP450 inhibitors: increased vinblastine toxicity
Mitomycin: increased risk of bronchospasm and shortness of breath
Phenytoin: decreased phenytoin blood level
Assess respiratory status closely. Drug may cause acute shortness of breath and bronchospasm, especially in patients who previously received mitomycin.
• Check injection site for extravasation.
• Monitor blood pressure.
• Assess CBC. Stay alert for signs and symptoms of infection.
• Monitor closely for numbness and tingling of hands or feet and other adverse reactions.
• Explain drug therapy to patient. Emphasize importance of follow-up laboratory tests.
• Tell patient to promptly report signs and symptoms of infection and to take his temperature daily.
• Inform patient that drug may cause pain over tumor site.
• Instruct female of childbearing age to avoid pregnancy. Caution her not to breastfeed during therapy.
• Encourage patient to practice good oral hygiene to help prevent infected mouth sores.
• Inform patient that hair loss is a common side effect but typically reverses after treatment ends.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.