vinblastine (Rx)

Brand and Other Names:Velban
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 1mg/mL

powder for injection

  • 10mg
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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
more...

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

0.4 mg/kg IV q7-10days 

Germ Cell Tumor

3 mg/m² IV at frequency not to exceed qweek 

Administration

Infuse over 1 minute

Monitor CBC

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Interactions

Interaction Checker

and vinblastine

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     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            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

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            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

            Intrathecal administration will result in death

            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

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            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.

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            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%)

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            Administration

            IV Incompatibilities

            Syringe: furosemide

            Y-site: cefepime, furosemide

            IV Preparation

            IV push

            • 1 mg/mL (dose/syringe); max syringe size for IVP is a 30 mL syringe & syringe should be <75% full
            • Powder: reconstitute w/ 10 mL NS or bacteriostatic NS to obtain 1 mg/mL soln

            Continuous infusion: 250-1000 mL D5W or NS (dose)

            IV Administration

            Vesicant

            IV administration ONLY; fatal if given intrathecally

            May be administered IVP directly into vein or into free flowing IV

            IVP over at least 1 min is desired route of administration d/t potential for extravasation

            Has also been administered by continuous infusion; central line only for continuous infusion

            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

            Store intact vials under refrigeration at 2-8°C

            Protect from light

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            Images

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            Formulary

            FormularyPatient Discounts

            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.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.