Dosing and uses of Oncovin, Vincasar PFS (vincristine)
Adult dosage forms and strengths
injectable solution
- 1mg/mL
Acute Leukemia
1.4 mg/m² IV qWeek
Combination Therapy
Cancers
- Hodgkin's Disease, Non Hodgkin's Malignant Lymphomas, Rhabdomyosarcoma, Neuroblastoma, and Wilm's Tumor
- Consult dose modifications in multi-drug regimens
Uveal Melanoma (Orphan)
Indicated for metastatic uveal melanoma
Orphan indication sponsor
- Hana Biosciences, Inc; 7000 Shoreline Court; Suite 370; South San Francisco, CA 94080
Renal Impairment
Dose adjustment not necessary
Hepatic Impairment
Decrease dose 50% if direct bilirubin >3 mg/dL [51 umol/L]
Monitor: CBC
Other Indications & Uses
ALL, AML, CML, Hodgkin's disease, NHL, neuroblastoma, sarcomas, small cell lung cancer, Wilms' tumor, brain tumors
Off-label: breast cancer, idiopathic thrombocytopenic purpura, Kaposi's sarcoma, bladder cancer
Pediatric dosage forms and strengths
injectable solution
- 1mg/mL
Acute Leukemia
2 mg/m² IV qWeek
<10 kg: 0.05 mg/kg/dose IV qWeek
>10 kg: 1.5-2 mg/m²/dose
Combination Therapy
Cancers
- Hodgkin's Disease, Non Hodgkin's Malignant Lymphomas, Rhabdomyosarcoma, Neuroblastoma, and Wilm's Tumor
- Consult dose modifications in multi-drug regimens
Administration
Stool softeners or stimulant laxatives may ease severe constipation
APAP or opioid may ease jaw pain
Other Information
Hepatic Impairment
- Decr. dose 50% if direct bilirubin >3 mg/dL [51 umol/L]
Monitor: CBC
Oncovin, Vincasar PFS (vincristine) adverse (side) effects
>10%
Alopecia (20-70%)
Frequency not defined
Peripheral neuropathy
Paresthesia
Sensory loss
Acute uric acid nephropathy
Loss of deep-tendon reflexes
Hypertension
Hypotension
Nausea
Vomiting
Constipation
Paralytic ileus
Myelosuppression
Leukopenia
Gait changes
Jaw pain
Aspermia
Amenorrhea
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
Properly position needle in the vein before administration; leakage to surrounding tissue during IV administration may cause considerable irritation
If extravasation occurs, the injection should be discontinued immediately and any remaining portion of the dose should then be introduced into another vein
Local injection of hyaluronidase and the application of moderate heat to the area of leakage help disperse the drug and may minimize discomfort and the possibility of cellulitis
Intrathecal use may be fataL
Contraindications
Hypersensitivity
Charcot-Marie-Tooth syndrome (demyelinating form), intrathecal (IT) administration
Cautions
Intrathecal administration will result in death
Bone marrow depression, neuropathy, neuromuscular dz, neurotoxic agents, ototoxic agents, pulmonary dz, hepatic impairment, potential CYP3A4 intxns, avoid extravasation
Withhold if neurotoxicity develops-usually reversible
Potential for jaw/parotid pain, hoarseness & dysphagia due to cranial neuropathy
Vesicant
Avoid pregnancy
Risk of paralytic ileus
Pregnancy and 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.
Pharmacology of Oncovin, Vincasar PFS (vincristine)
Mechanism of action
Vinca alkaloid; acts in M & S phases by inhibiting microtubule formation, inhibits DNA/RNA synthesis
Pharmacokinetics
Half-Life: 10.5-155 hr
Protein Bound: 44%
Vd: 8.4 L/kg
Metabolism: Hepatic (CYP3A4)
Clearance: 146 mL/min
Excretion: Feces (80%); urine (20%)
Administration
IV Incompatibilities
Syringe: furosemide
Y-site: cefepime, furosemide, idarubicin, sodium bicarbonate
IV Compatibilities
Additive: bleomycin, cytarabine, doxorubicin, doxorubicin/ondansetron, fluorouracil, methotrexate
Syringe: bleomycin, cisplatin, cyclophosphamide, doxapram, doxorubicin, droperidol, fluorouracil, heparin, leucovorin, methotrexate, metoclopramide, mitomycin, vinblastine
Y-site: allopurinol, amifostine, ampho B cholSO4, aztreonam, bleomycin, cisplatin, cladribin, cyclophosphamide, doxorubicin, doxorubicin liposomal, droperidol, etoposide PO4, fligrastim, fludarabine, fluorouracil, gatifloxacin, gemcitabine, granisetron, heparin, leucovorin, linezolid, melphalan, methotrexate, metoclopramide, mitomycin, ondansetron, paclitaxel, piperacillin-tazobactam, sargramostim, teniposide, thiotepa, topotecan, vinbastine, vinorelbine
IV Preparation
IVP: 1 mg/mL (dose/syringe); max syringe size for IVP is a 30 mL syringe & syringe should be <75% fulL
IVPB: dose/50 mL D5W
IV Administration
Vesicant
IV use ONLY; fatal if given intrathecally
Desired route: IVP administered within 1 min
Has also been administered IVPB over 15 min; central line only for IVPB
Has also been given as slow infusion (4-8 hr) or cont infusion
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
