Indications
Vincristine Sulphate is an anticancer (chemotherapy) medicine. It is used, usually together with other cancer medicines, to treat acute leukaemias (especially acute lymphoblastic leukaemia), Hodgkin and non-Hodgkin lymphomas, and several childhood and adult solid tumours such as neuroblastoma, Wilms tumour, rhabdomyosarcoma and some brain tumours.
How It Works
Cancer cells divide quickly. To divide, a cell builds a framework of tiny tubes (microtubules) that pulls its chromosomes apart. Vincristine, a vinca alkaloid originally from the periwinkle plant, binds to the building blocks of these tubes and stops the framework from forming, so the cancer cell cannot complete division and dies.
Dosage and Administration
Vincristine is given only by trained doctors or nurses in a hospital or cancer centre, as a slow injection or short infusion into a vein, usually once a week as part of a treatment plan. The dose is worked out by the cancer specialist from body surface area and is given as prescribed. It must be given into a vein only. Giving it into the spine (intrathecal injection) is fatal.
Interactions
- Azole antifungals such as Itraconazole, Voriconazole and Posaconazole, and other strong CYP3A4 inhibitors, can raise its level and greatly increase nerve damage.
- Other medicines that damage nerves, such as Isoniazid and some other chemotherapy drugs, add to nerve side effects.
- It may reduce the effect of Phenytoin and alter levels of Digoxin.
- Live vaccines must not be given during treatment.
Contraindications
- Allergy to Vincristine or other vinca alkaloids.
- Injection into the spinal fluid (intrathecal use), which is fatal.
- People with the demyelinating form of Charcot-Marie-Tooth disease.
- Use with radiotherapy that includes the liver.
Side Effects
Common: tingling or numbness in hands and feet, loss of reflexes, jaw or muscle pain, constipation, hair loss, tiredness and weakness. Other effects include stomach cramps, hoarse voice, drooping eyelids, low sodium and, less often, low blood counts. Leakage of the drug outside the vein can badly damage the skin.
Get urgent medical help for severe constipation or stomach pain (possible blocked bowel), pain or swelling at the injection site, difficulty walking or weakness, fever or signs of infection, trouble passing urine, fits or confusion, or breathing difficulty.
Pregnancy and Lactation
Vincristine can harm an unborn baby. Women should avoid pregnancy and use reliable contraception during treatment and for some time after, as advised; men should also use contraception. Breastfeeding must be stopped during treatment.
Precautions and Warnings
- For intravenous use only; given by experienced staff.
- Nerve damage is the main dose-limiting effect; report tingling, weakness or constipation early.
- A laxative plan is often started to prevent constipation.
- Use with care in liver disease, existing nerve disease and in older people.
- Blood counts and salts are checked regularly.
Overdose
Overdose can cause severe nerve damage, paralysis of the bowel, seizures and bone marrow suppression. It is a medical emergency managed in hospital with supportive treatment.
Therapeutic Class
Antineoplastic, vinca alkaloid (microtubule inhibitor).
Storage
Hospital medicine: store as directed on the pack, usually in a refrigerator at 2 to 8°C, protected from light, do not freeze. Keep out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.