VINBLASTINE SULFATE
(vin-blast′een)
Classifications: ANTINEOPLASTIC; MITOTIC INHIBITOR; VINCA ALKALOID
Therapeutic: ANTINEOPLASTIC
Prototype: Vincristine
Pregnancy Category: D
AVAILABILITY
Intravenous solution
ACTION & THERAPEUTIC EFFECT
Cell cycle–specific drug that interferes with
microtubules that form mitotic spindle fibers required to complete the process
of mitosis. Has an effect on cell energy production needed for mitosis and
interferes with nucleic acid synthesis. Interrupts the cell cycle in
metaphase,
thus preventing cell replication.
USES
Palliative treatment of Hodgkin’s disease and
non-Hodgkin’s lymphomas, choriocarcinoma, lymphosarcoma, neuroblastoma, mycosis
fungoides, advanced testicular germinal cell cancer, histiocytosis, and other
malignancies resistant to other chemotherapy. Used singly or in combination
with other chemotherapeutic drugs.
CONTRAINDICATIONS
Severe bone marrow suppression, significant granulocytopenia
unless it is a result of the disease being treated; bacterial infection,
adynamic ileus; older adult patients with cachexia
or skin ulcers; men and women of childbearing
potential; pregnancy (category D), lactation
CAUTIOUS USE
Malignant cell infiltration of bone marrow;
leukopenia; obstructive jaundice, hepatic impairment; history of gout; use of small
amount of drug for long periods; use in eyes.
ROUTE & DOSAGE
Antineoplastic
Adult: IV 5.5 to 7.4 mg/m2 weekly, dose varies based on protocol and may
increase incrementally up to 18.5 mg/m2 if tolerated
Child: IV 3–6 mg/m2, dose varies based on protocol and may increase up to
12.5 mg/m2 if
Tolerated
Hepatic Impairment Dosage Adjustment
Bilirubin 1.5–3 mg/dL: Reduce dose 50%; bilirubin over 3 mg/dL: Reduce dose 75%
ADMINISTRATION
Intravenous
PREPARE: Direct: Add 10 mL NS to 10 mg of
drug to yield 1 mg/mL. Do not use other diluents.
- Avoid contact with eyes. Severe irritation and persisting corneal
changes may occur. Flush immediately and thoroughly with copious amounts of water.
Wash both eyes; do not assume one eye escaped contamination.
ADMINISTER:
Direct: Drug is usually injected
into tubing of running IV infusion of NS or D5W over period of 1 min.
- Stop injection promptly if extravasation occurs. Use applications
of moderate heat and local injection of hyaluronidase to help disperse extravasated
drug.
- Observe injection site for sloughing.
- Restart infusion in another vein.
INCOMPATIBILITIES:
Y-site: Amphotericin B,
cefepime, dantrolene, diazepam, furosemide, gemtuzumab, lansoprazole, pantoprazole,
phenytoin.
- Refrigerate reconstituted solution in tight, light-resistant
containers up to 30 days without loss of potency.
ADVERSE EFFECTS (≥1%)
Body as a Whole: Fever, weight loss, muscular pains, weakness, parotid gland pain
and tenderness, tumor site pain, Raynaud’s phenomenon. CNS: Mental
depression, peripheral neuritis, numbness and paresthesias of tongue
and extremities, loss of deep tendon reflexes, headache, convulsions. GI: Vesiculation
of mouth, stomatitis, pharyngitis, anorexia, nausea, vomiting, diarrhea,
ileus, abdominal pain, constipation, rectal bleeding, hemorrhagic
enterocolitis, bleeding of old peptic ulcer.
Hematologic: Leukopenia,
thrombocytopenia, and anemia. Skin: Alopecia (reversible), vesiculation,
photosensitivity, phlebitis, cellulitis, and sloughing following extravasation (at injection site). Urogenital: Urinary retention,
hyperuricemia, aspermia. Respiratory: Bronchospasm.
INTERACTIONS
Drug: Mitomycin may cause acute shortness of breath and severe bronchospasm; may
decrease phenytoin levels; ALFA INTERFERONS, erythromycin, itraconazole
may increase vinblastine toxicity.
PHARMACOKINETICS
Distribution: Concentrates in
liver, platelets, and leukocytes; poor penetration of blood–brain barrier. Metabolism:
Partially in liver. Elimination: In feces and urine. Half-Life: 24
h.
NURSING IMPLICATIONS
Vinblastine extravasation has been associated
with severe tissue irritation. Vinblastine is fatal if given intrathecally.
Assessment & Drug Effects
- Monitor for and report promptly unexplained bruising or bleeding.
- Adverse reactions seldom persist beyond 24 h with exception of leukopenia,
and neurological adverse effects.
- Monitor GI adverse effects which may range from nausea and
vomiting to severe constipation.
- Report promptly if oral mucosa tissue breakdown is noted.
- Montior lab tests: Baseline and periodic CBC with differential and
platelet count.
Patient & Family Education
- Be aware that temporary mental depression sometimes occurs on second
or third day after treatment begins.
- Avoid exposure to infection, injury to skin or mucous membranes,
and excessive physical stress.
- Report immediately to prescriber development of sore mouth, sore throat,
fever, or chills.
- Notify prescriber promptly about onset of symptoms of
agranulocytosis (see Appendix F). Do not delay seeking appropriate treatment.
Great article !Vincristine is a chemotherapy drug used to treat many cancers, including leukaemia, lymphoma, myeloma, breast cancer and head and neck cancer.
ReplyDeleteGet the best Vincristine Injection - StanfordChem
Vinblastine sulfate, also called cellblastin, derived from C. roseus, as a microtubule disrupter and antineoplastic agent, it binds tubulin and disrupts microtubule assembly and proper formation of the mitotic spindle, which leads to the assembly of microtubules and causing M phase-specific cell cycle arrest. Vinblastine Sulfate
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"Nursing Implications for Vinblastine Sulfate"