This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo

Vincristine sulfate intravenous

Updated 2 Feb 2023 | Vinca alkaloids and etoposide


Infusions of vincristine sulphate

Drugs List

  • ONCOVIN 1mg/1ml injection
  • vincristine 1mg/1ml injection
  • vincristine 2mg/2ml injection
  • vincristine 5mg/5ml injection
  • Therapeutic Indications


    Idiopathic thrombocytopenic purpura
    Myeloma - multiple
    Tumours - solid

    Vincristine is used alone or in conjunction with other oncolytic drugs for the treatment of:

    Leukaemias including acute lymphocytic leukaemia, chronic lymphocytic leukaemia, acute myelogenous leukaemia and blastic crisis of chronic myelogenous leukaemia

    Malignant lymphomas including Hodgkin's disease and non-Hodgkin's lymphomas

    Multiple myeloma

    Solid tumours including breast carcinoma, small cell bronchogenic carcinoma, head and neck carcinoma and soft tissue sarcomas

    Paediatric solid tumours, including Ewing's sarcoma, embryonal rhabdomyosarcoma, neuroblastoma, Wilm's tumour, retinoblastoma and medulloblastoma

    Idiopathic thrombocytopenic purpura (ITP). Patients with true ITP refractory to splenectomy and short-term treatment with adrenocortical steroids may respond to vincristine but the drug is not recommended as primary treatment of this disorder.


    Whilst the doses stated below are those recommended by the manufacturer, local cancer network protocols for the relevant indication should be consulted.

    Vincristine sulfate is for intravenous administration only. Fatal if given by other routes.

    Great care should be taken in calculating the dose as overdosage may be extremely serious or even fatal. The dose should be calculated on an individual basis and should not be increased beyond the level which produces therapeutic benefit.


    The recommended dose is 1.4 mg to 1.5 mg/square metre body surface area (maximum of 2 mg/square metre) once a week, by intravenous injection.


    The recommended dose is 1.4 mg to 1.5 mg/square metre body surface area (maximum of 2 mg/square metre) once a week, by intravenous injection.


    The usual dose is 1.5 mg to 2 mg/square metre body surface area (maximum of 2 mg/square metre) once weekly intravenous injection.

    For children weighing 10 kg or less the starting dose should be 0.05 mg/kg administered as a weekly intravenous injection.

    Patients with Hepatic Impairment

    Reduced doses are recommended in patients with obstructive jaundice or other hepatic impairment. Patients with hepatic disease sufficient to decrease biliary excretion may experience an increase in the severity of side effects. A 50% reduction in dose is recommended for patients having a direct serum bilirubin value above 3 mg/100ml (51 micromol/L).


    For Intravenous use only. Fatal if given by all 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 ( )

    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.


    Hypersensitivity to benzyl alcohol
    Demyelinating Charcot-Marie-Tooth syndrome
    Severe hepatic impairment

    Precautions and Warnings

    Children under 3 years
    Concurrent radiotherapy to the liver
    Spinal cord irradiation
    Decreased gastrointestinal motility
    Hepatic impairment
    Ischaemic heart disease
    Neurological disorder
    Neuromuscular disorder
    Pulmonary disease

    Advise ability to drive/operate machinery may be affected by side effects
    Give pre-treatment counselling and consideration of sperm cryopreservation
    Previous/Concurrent medicine consider washout period: See prescribing info
    Treatment to be prescribed under the supervision of a specialist
    Some presentations may contain benzyl alcohol
    For intravenous use only
    If extravasation occurs follow local policy & seek expert help immediately
    Perform full blood count before each treatment cycle
    Monitor for constipation; give laxatives as required
    Monitor uric acid levels
    Advise patient to report symptoms of infection immediately
    Discontinue if bronchospasm or decreased respiratory function occur
    Advise patient not to take St John's wort concurrently
    Advise patient grapefruit products may increase plasma level
    Male & female: Contraception required during & for 6 months after treatment

    The neurotoxic effect of vincristine may be additive with other neurotoxic agents or increased by spinal cord irradiation and neurological disease.

    Vincristine should not be re-administered in patients who experience acute dyspnoea and/or severe bronchospasm. These reactions have most commonly been reported when used in conjunction with Mitomycin-C and may be more serious in patients with pre-existing pulmonary dysfunction. Reactions may occur within minutes and up to 2 weeks following vincristine administration. Progressive dyspnoea requiring chronic therapy may occur.

    Routine prophylactic regimen against constipation is recommended. Some manufacturers contraindicate vincristine in patients with impending ileus and/or constipation, especially in children.

    If central nervous system leukaemia is diagnosed, additional agents may be required as vincristine does not appear to cross the blood-brain barrier in adequate amounts.

    Some brands of vincristine contain benzyl alcohol which may cause toxic reactions and anaphylactoid reactions in infants and children up to 3 years old.

    Pregnancy and Lactation


    Vincristine is contraindicated in pregnancy.

    Reports of development toxicity including; neonatal pancytopenia, intrauterine growth retardation and foetal death have been reported when vincristine was used in human pregnancy.

    Animal studies have shown embryocidal and teratogenic effects.

    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 ( ) or if this is unavailable at the backup site ( ).


    Vincristine is contraindicated in breastfeeding.

    It is unknown whether vincristine sulfate is excreted in human breast milk. Due to the potential for adverse reactions vincristine should not be used.

    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

    Side Effects

    Abdominal cramps
    Back pain
    Bone marrow depression
    Bone pain
    Coronary artery disorder
    Cortical blindness (transient)
    Cranial nerve palsies
    Difficulty in walking
    Double vision
    Foot drop
    Gait abnormality
    Gastro-intestinal perforation
    Hepatic veno-occlusive disease
    Inappropriate secretion of antidiuretic hormone
    Injection site reactions
    Intestinal necrosis
    Jaw pain
    Limb pain
    Loss of balance
    Loss of deep tendon reflexes
    Mouth ulcers
    Muscle wasting
    Muscle weakness
    Myocardial infarction
    Necrosis (injection site)
    Neuritic pain
    Optic atrophy
    Pain in parotid gland
    Paralytic ileus
    Pharyngeal pain
    Sensory disturbances
    Testicular pain
    Urinary retention
    Weight loss


    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 ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: May 2015

    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 (online) London: BMJ Group and Pharmaceutical Press. Accessed on 8 May 2015.

    Martindale: The Complete Drug Reference (online) London: Brayfield A (ed). Pharmaceutical Press. Accessed on 8 May 2015.

    Paediatric Formulary Committee. BNF for Children (online) London: BMJ Group, Pharmaceutical Press, and RCPCH Publications. Accessed on 8 May 2015.

    Summary of Product Characteristics: Oncovin. Genus. Revised October 2014.

    Summary of Product Characteristics: Vincristine Sulfate. Hospira UK Ltd. Revised December 2008.

    Summary of Product Characteristics: Vincristine Sulfate. Teva. Revised October 2010.

    Access the full UK drug database with a FREE Medscape UK Account
    It takes just a few minutes, and you’ll get unlimited access to information on over 11,000 UK drugs.
    Register for Free

    Already a member? Log in

    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

    FDB Logo

    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.