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vincristine sulfate (VCR)
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.
Unknown. Thought to block cell division and interfere with synthesis of nucleic acid. Cell-cycle-phase specific.
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
• Hepatic impairment
• Brain, hepatic, ovarian, testicular, and other cancers
• Kaposi's sarcoma
• Idiopathic thrombocytopenic purpura
• Hypersensitivity to drug
• Demyelinating form of Charcot-Marie-Tooth disease
• Intrathecal use
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).
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.
CNS: agitation, insomnia, depression, mental status changes, ascending peripheral neuropathy, transient cortical blindness, seizures, coma
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
Other: tissue necrosis (with extravasation), phlebitis at I.V. site
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
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.
• 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.