Pharmacologic class: Vinca alkaloid
Therapeutic class: Antineoplastic
Pregnancy risk category D
Product is for I.V. use only. Intrathecal administration of other vinca alkaloids has resulted in death. Syringes containing this product should be labeled "WARNING. FOR I.V. USE ONLY. FATAL IF GIVEN INTRATHECALLY."
Make sure I.V. needle or catheter is properly positioned before injecting drug. Administration may lead to extravasation, causing local tissue necrosis and thrombophlebitis.
Blocks cell division and interferes with nucleic acid synthesis. Cell-cycle-phase specific.
Injection: 10 mg/ml in 1- and 5-ml vials
Indications and dosages
➣ Inoperable non-small-cell lung cancer
Adults: As monotherapy, 30 mg/m2 I.V. weekly given over 6 to 10 minutes. In combination therapy, 25 mg/m2 weekly given with cisplatin q 4 weeks. Alternatively, in combination therapy, 30 mg/m2 I.V. given with cisplatin on days 1 and 29, then q 6 weeks.
• Hepatic impairment
• Cervical, breast, or ovarian cancer
• Hypersensitivity to drug
• Pretreatment granulocyte count below 1,000 cells/mm3
Use cautiously in:
• hepatic impairment, decreased bone marrow reserve, past or present neuropathy
• history of radiation therapy
• females of childbearing age
• pregnant or breastfeeding patients (use not recommended)
• children (safety not established).
Follow facility protocols for handling and preparing chemotherapeutic drugs. Be especially careful to avoid eye contamination.
• Know that patient is usually premedicated with antiemetic.
Give by I.V. route only. (Intrathecal injection is fatal.)
• Before use, dilute drug in syringe with dextrose 5% in water or normal saline solution to yield a concentration of 1.5 to 3 mg/ml. Or dilute in I.V. bag of compatible solution to yield a concentration of 0.5 to 2 mg/ml.
• Administer into tubing of running I.V. line or directly into vein over 6 to 10 minutes. Immediately after injection, flush line with 75 to 125 ml of compatible I.V. solution.
CNS: fatigue, neurotoxicity
CV: chest pain, phlebitis
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, anorexia, pancreatitis, intestinal obstruction, paralytic ileus
Hematologic: anemia, bone marrow depression, severe granulocytopenia, neutropenia, thrombocytopenia
Musculoskeletal: joint, back, or jaw pain; myalgia
Respiratory: acute respiratory distress syndrome, acute shortness of breath, bronchospasm, interstitial pulmonary changes
Skin: alopecia, rash, skin reactions
Other: tumor site pain; irritation, pain, and phlebitis at I.V. site; sepsis
Drug-drug. Cisplatin, other antineoplastics: increased risk and severity of bone marrow depression
Mitomycin: increased risk of acute pulmonary reaction
Drug-diagnostic tests. Bilirubin, hepatic enzymes, liver function tests: increased values
Granulocytes, hemoglobin, platelets, white blood cells: decreased levels
• Monitor vital signs closely.
• Assess liver function tests and CBC with platelet count.
• Watch for signs and symptoms of infection.
• Observe injection site closely for reactions and extravasation.
Closely monitor neurologic and respiratory status. Drug may lead to acute pulmonary changes, especially in patients who previously received mitomycin.
• 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.
• Tell patient that hair loss is a common side effect but typically reverses once treatment ends.
• Instruct female of childbearing age to avoid pregnancy. Caution her not to breastfeed during therapy.
• Urge patient to practice good oral hygiene, to help prevent infected mouth sores.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.