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Vinblastine intravenous

Updated 2 Feb 2023 | Vinca alkaloids and etoposide

Presentation

Injections containing vinblastine sulfate.

Drugs List

  • vinblastine 10mg/10ml injection
  • Therapeutic Indications

    Uses

    Breast cancer where standard therapy ineffective/unsuitable
    Carcinoma - testes
    Choriocarcinoma: resistant to other agents
    Hodgkin's disease
    Kaposi's sarcoma
    Letterer Siwe disease (histocytosis X)
    Lymphoma
    Mycosis fungoides
    Renal cell carcinoma

    Dosage

    Due to the complexity and specialist nature of dosage regimens for the treatment of malignant disease, specific dosing information on this agent is not included.
    Doses may vary significantly if this agent is used as monotherapy or different combinations.
    When using this agent, specialist literature, national guidelines, cancer network protocols and Trust chemotherapy protocols should be consulted.

    Patients with Hepatic Impairment

    The elimination of vinblastine may be altered in patients with hepatic impairment, necessitating dose modification.

    Reduce dose by 50% in patients with a direct serum bilirubin value above 3mg/100ml.

    Additional Dosage Information

    Leucopenia
    Patients should be maintained on the maximum weekly dose that does not produce leucopenia below 3,000 cells/cubic millimetre.
    A further dose of vinblastine should not be given until the white cell count has recovered to at least 4,000 cells/cubic millimetre, regardless of the dosage interval.

    If therapeutic effect is seen before leucopenia occurs, there is no need to increase subsequent doses above this level.

    Administration

    For intravenous use only. Fatal if given by other routes.

    The NPSA issued the following guidance in August 2008

    When vinca alkaloids are prescribed, dispensed or administered in adult or adolescent units:

    Doses in syringes should no longer be used.

    The prescribed dose should be supplied from the hospital pharmacy ready to administer in a 50ml minibag of sodium chloride 0.9%.

    The following warning should be prominently displayed on the label of all vinca alkaloid doses 'For Intravenous Use Only - Fatal if Administered by Other Routes'

    There should be judicious use of colour and design on the label, outer packaging and delivery bags to further differentiate minibags containing vinca alkaloids from other minibag infusions.

    The vinca alkaloid should be infused intravenously over 5 to 10 minutes and the patient closely monitored for signs of extravasation. Incidents of extravasation should be reported and shared via the National Extravasation Information Service ( www.extravasation.org.uk )

    NB. The use of minibags to administer vinca alkaloids to children in paediatric units is not recommended. Local protocols should be consulted for information regarding the volume and method of administration in such patients.

    Avoid administration in an extremity with impaired circulation due to the risk of thrombosis.

    Contraindications

    Acute infection
    Breastfeeding
    Leucopenia
    Pregnancy

    Precautions and Warnings

    Cachexia
    Bone marrow infiltrated with malignant cells
    Hepatic impairment
    Myelosuppression
    Skin ulcer

    Dose adjustment may be necessary in patients with hepatic impairment
    Advise ability to drive/operate machinery may be affected by side effects
    Give pre-treatment counselling and consideration of sperm cryopreservation
    Treat and control infections prior to commencing therapy
    Treatment to be prescribed under the supervision of a specialist
    Avoid contact with eyes
    Consult local policy on the safe use of anti-cancer drugs
    For intravenous use only
    If extravasation occurs follow local policy & seek expert help immediately
    Staff: Not to be handled by pregnant staff
    Monitor full blood count and differential WBC before and during therapy
    Investigate signs and symptoms suggesting an infection
    Monitor auditory function, esp if hearing loss or other ototoxic agents
    Monitor for constipation; give laxatives as required
    Advise patient to report symptoms of infection immediately
    Advise patient not to take St John's wort concurrently
    Advise patient grapefruit products may increase plasma level
    May cause impaired fertility
    Female: Ensure adequate contraception during treatment

    Myelosuppression is the dose limiting factor. Granulocyte nadir is expected from day 5 to 10. Recovery is rapid and usually complete within 7 to 14 days.

    Patients should be carefully monitored for infection until the white cell count has returned to normal, if leucopenia with less than 2,000 white blood cells/cubic millimetre occurs following a dose. A more profound leucopenic response may occur when administered to patients with cachexia or ulcerated areas of skin. The treatment of elderly patients with either of these conditions should be avoided.

    Thrombocyte count is not usually significantly lowered by vinblastine. However, patients with prior bone marrow suppression from radiation or medication may show thrombocytopenia (less than 150,000 platelets/cubic millimetre). Recovery is rapid, normally within a few days.

    Vinblastine may cause a severe local reaction on extravasation. If extravasation occurs during administration, the injection should be discontinued immediately and continued through another injection site. Always follow local protocols for extravasation. Local injection of hyaluronidase and application of heat to the area have been used to disperse the drug and minimise tissue damage and discomfort.

    It is not recommended to use live vaccines during therapy as there is a risk of generalised vaccine disease which may be fatal.

    Pregnancy and Lactation

    Pregnancy

    Vinblastine sulfate is contraindicated in pregnancy.

    At the time of writing there are no adequate and controlled studies using vinblastine in pregnant women, and the drug should be used during pregnancy only in life-threatening situations or severe disease for which safer drugs cannot be used or are ineffective. If the patient becomes pregnant during therapy, the risks of potential hazards to the foetus must be explained.

    Vinblastine causes resorption of foetuses in animals and produces gross foetal abnormalities in surviving offspring.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

    Lactation

    Vinblastine sulfate is contraindicated in breastfeeding.

    At the time of writing there are no data on the excretion of vinblastine into breast milk. Due to the potential for serious adverse reactions in the nursing infant, it should not be given to nursing mothers. Schaefer advises that breastfeeding should not take place until 7 days after the treatment has stopped.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at:
    https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

    Side Effects

    Abdominal pain
    Acute respiratory distress syndrome
    Aggravation of peptic ulcer
    Alopecia
    Anaemia
    Anorexia
    Aspermatogenesis
    Asthenia
    Bone pain
    Bronchospasm
    Cellulitis
    Cerebrovascular accident
    Constipation
    Convulsions
    Deafness
    Depression
    Diarrhoea
    Dizziness
    Dyspnoea
    Enterocolitis
    Extravasation
    Headache
    Hypertension
    Ileus
    Inappropriate secretion of antidiuretic hormone
    Infections
    Injection site reactions
    Jaw pain
    Leucopenia
    Loss of deep tendon reflexes
    Malaise
    Myalgia
    Myelosuppression
    Myocardial infarction
    Nausea
    Numbness
    Nystagmus
    Oral mucositis
    Paraesthesia
    Peripheral neuritis
    Pharyngitis
    Phlebitis
    Raynaud's syndrome
    Rectal bleeding
    Skin ulcer
    Stomatitis
    Thrombocytopenia
    Tumour pain
    Vertigo
    Vestibular and auditory damage
    Vomiting
    Weakness

    Overdosage

    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

    Further Information

    Last Full Review Date: February 2014

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Joint Formulary Committee. British National Formulary. 66th ed. London: BMJ Group and Pharmaceutical Press; 2013.

    Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press https://www.medicinescomplete.com [Accessed on February 27, 2014].

    Paediatric Formulary Committee. BNF for Children 2013-2014. London: BMJ Group, Pharmaceutical Press, and RCPCH Publications; 2013.

    Paediatric Formulary Committee. BNF for Children (online) London: BMJ Group, Pharmaceutical Press, and RCPCH Publications https://www.medicinescomplete.com [Accessed on February 27, 2014].

    Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

    Summary of Product Characteristics: Velbe injection 10mg. Genus Pharmaceuticals Ltd. Revised April 2009.

    Summary of Product Characteristics: Vinblastine Sulfate 1mg/ml injection. Hospira UK Ltd. Revised December 2012.

    Napos. Vinblastine drug porphyrinogenicity monograph.
    Available at: https://www.drugs-porphyria.com/monograph.php?id=2990
    Last revised: January 22, 2010
    Last accessed: February 24, 2014.

    NPSA Rapid Response Report 11 August 2008. Using Vinca Alkaloid Minibags (Adult/Adolescent Units).
    Available at: https://www.nrls.npsa.nhs.uk/alerts/?entryid45=59890
    Last accessed: February 24, 2014.

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