Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 1mg/mL
powder for injection
- 10mg
Cancers
Testicular CA, Squamous cell CA of head & neck, Hodgkin's Dz, Kaposi's sarcoma; histiocytic lymphoma, mycosis fungoides, & Letterer-Siwe disease (histiocytosis X)
General Dosing Ranges
- 3.7-18 mg/m²/day IV q7-10days
- 1st dose 3.7 mg/m²/day IV
- Increased by 1.85 mg/m² qweek until WBC equal 3000/mm³
- Dose range: 5.5-7.4 mg/m²
- Not to exceed 18.5 mg/m²
Hodgkin's Disease
6 mg/m² q2week; part of combination treatment
Testicular Cancer
6 mg/m²/day x 2 days q3-4week; part of combination treatment
Bladder Cancer
3 mg/m² q7d x 3 out of 4week; part of combination treatment
Melanoma (Off-label)
2 mg/m² days 1-4 & 22-25 of 6week cycle
Nonsmall Lung Cancer (Off-label)
4 mg/m²/day on days 1,8,15,22, 29, then q 2week; part of combination treatment
Ovarian Cancer (Off-label)
0.11 mg/kg/day x 2 days q 3week; part of combination treatment
Prostate Cancer (Off-label)
4 mg/m²/week x 6 weeks of 8week cycle
Renal Impairment
Dose adjustment not necessary
Hepatic Impairment
Bilirubin 1.5-3 mg/dL or AST 60-180 units: Administer 50% of regular dose
Bilirubin 3-5 mg/dL: Administer 25% of regular dose
Bilirubin: >5 mg/dL or AST >180 units: Not recommended
Administration
Infuse over 1 minute
Monitor CBC
Dosage Forms & Strengths
injectable solution
- 1mg/mL
powder for injection
- 10mg
Cancers
Testicular CA, Squamous cell carcinoma CA of head & neck, Hodgkin's Dz, Kaposi's sarcoma; histiocytic lymphoma, mycosis fungoides, & Letterer-Siwe disease (histiocytosis X)
General dosing ranges
- 2.5- 12.5 mg/m² IV over 1 minute q7-10d
- 1st dose 2.5 mg/m² IV
- Increase by 1.25 mg/m² qWeek until WBC = 3000/mm³
- No more than 12.5 mg/m²
Hodgkin's Disease
6 mg/m²/day IV q 1-2 week x 3-4week
Not to exceed 12.5 mg/m²/week
Histiocytosis
Germ Cell Tumor
3 mg/m² IV at frequency not to exceed qweek
Administration
Infuse over 1 minute
Monitor CBC
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Adverse Effects
1-10%
Anemia
Leukopenia
Myelosuppression
Alopecia
Frequency Not Defined
Peripheral neuropathy
Hypertension
Bronchospasm
Nausea
Vomiting
Anorexia
Diarrhea
Constipation
Paralytic ileus
Jaw pain
Aspermia
Amenorrhea
Warnings
Black Box Warnings
The drug should be administered under the supervision of an experienced cancer chemotherapy physician in a facility equipped to diagnose and manage complications.
The needle should be properly positioned in the vein before this product is injected.
Leakage to surrounding tissue during IV administration may cause considerable irritation. Immediately discontinue the injection and introduce remaining portion of the dose into another vein. Local injection of hyaluronidase and the application of moderate heat to the area of leakage will help disperse the drug and may minimize the discomfort and possibility of cellulitis.
Intrathecal use may be fatal
Contraindications
Hypersensitivity
Intrathecal (IT) administration
Active bacterial infection
Myelosuppression
Cautions
Bone marrow depression, neuropathy, neuromuscular disease may occur
Caution when administering neurotoxic agents, ototoxic agents concomitantly
Caution in pulmonary disease, liver impairment, intestinal obstruction, paralytic ileus
Potential for jaw/parotid pain, hoarseness & dysphagia due to cranial neuropathy
Vesicant
Previous radiation treatment or chemotherapy
Avoid pregnancy
Preparation in IV infusion bag only
- On January 15, 2021, FDA alerted that vinca alkaloids should be prepared in IV infusion bags only
- Intrathecal (IT) administration will result in severe neurological injury and/or death
- Label update is to reduce the potential for unintended IT administration
Pregnancy & Lactation
Pregnancy Category: D
Lactation: not known if excreted in breast milk, do not nurse
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Vinca alkaloid; acts in M & S phases by inhibiting microtubule formation, which disrupts the formation of the mitotic spindle in turn causing subsequent inhibition on DNA/RNA synthesis
Pharmacokinetics
Half-Life (triphasic): 4 min, 1.4 hr, & 24.8 hr
Peak Plasma: 150 ng/mL
Protein Bound: 99%
Vd: 27.3 L/kg
Metabolism: CYP3A4 activity
Metabolites: Desacetylvinblastine
Clearance: 0.74 L/kg/hr
Excretion: Bile (99%), urine (1%)
Administration
IV Incompatibilities
Syringe: furosemide
Y-site: cefepime, furosemide
IV Compatibilities
Solution
- D5W
- 0.9% NaCl
- Lactated Ringer (LR)
IV Preparation
Prepare in infusion bag only
Dilute in 25-50 mL infusion bag of NS, D5W, or LR
Dilution in larger volumes (≥100 mL) is not recommended
IV Administration
Vesicant
For IVPB use only; fatal if given intrathecally
Always properly position IV needle or catheter before any infusion
Complete infusion in ~1 minute
Prolonged infusions (≥30 to 60 minutes) may increase risk of vein irritation and extravasation
Avoid extravasation; may cause sloughing
Extravasation Management
Terminate injection or infusion immediately & aspirate back as much as possible
Apply warm pack for 15-20 min QID & elevate
Storage
Intact vials: Refrigerate at 2-8ºC; protect from light
Images
Patient Handout
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
