Dosing and uses of Velban (vinblastine)
Adult dosage forms and strengths
injectable solution
- 1mg/mL
powder for injection
- 10mg
Cancers
Testicular CA, Squamous cell CA of head & neck, Hodgkin's Dz, Kaposi's sarcoma; histiocytic lymphoma, mycosis fungoides, & Letterer-Siwe disease (histiocytosis X)
General Dosing Ranges
- 3.7-18 mg/sq.meter/day IV q7-10d
- 1st dose 3.7 mg/sq.meter/day IV
- Incr by 1.85 mg/sq.meter qweek until WBC equal 3000/cu.mm
- NMT 18.5 mg/sq.meter
Hodgkin's Disease
6 mg/sq. meter q2week; part of combination treatment
Testicular Cancer
6 mg/sq. meter/day x2d q3-4week; part of combination treatment
Bladder Cancer
3 mg/sq. meter q7d x 3 out of 4week; part of combination treatment
Melanoma (Off-label)
2 mg/sq. meter days 1-4 & 22-25 of 6week cycle
Nonsmall Lung Cancer (Off-label)
4 mg/sq. meter/day on days 1,8,15,22, 29, then q 2week; part of combination treatment
Ovarian Cancer (Off-label)
0.11 mg/kg/day x 2d q 3week; part of combination treatment
Prostate Cancer (Off-label)
4 mg/sq. meter/week x 6week of 8week cycle
Other Information
May be used in multi-drug treatment
Infuse over 1 minute
Monitor CBC
Hepatic impairment
- Decrease dose by half if bilirubin >3 mg/dL [>51 umol/L]
Pediatric dosage forms and strengths
injectable solution
- 1mg/mL
powder for injection
- 10mg
Cancers
Testicular CA, Squamous cell carcinoma CA of head & neck, Hodgkin's Dz, Kaposi's sarcoma; histiocytic lymphoma, mycosis fungoides, & Letterer-Siwe disease (histiocytosis X)
General dosing ranges
- 2.5- 12.5 mg/sq meter IV q7-10d
- 1st dose 2.5 mg/sq.meter IV
- Incr by 1.25 mg/sq.meter qWeek until WBC = 3000/cu.mm
- No more than 12.5 mg/sq.meter
Hodgkin's Disease
2.5-6 mg/sq.meter/day q 1-2 week x 3-4week
NMT12.5 mg/sq. meter/week
Histiocytosis
0.4 mg/kg q7-10d
Germ Cell Tumor
0.2 mg/kg on days 1 & 2 q3week x 4 cycles
Other Information
May be used in multi-drug Treatment
Infuse over 1 minute
Monitor CBC
Hepatic impairment
- Decrease dose by half if bilirubin >3 mg/dL [> 51 umol/L]
Velban (vinblastine) adverse (side) effects
1-10%
Anemia
Leukopenia
Myelosuppression
Alopecia
Frequency not defined
Peripheral neuropathy
Hypertension
Bronchospasm
Nausea
Vomiting
Anorexia
Diarrhea
Constipation
Paralytic ileus
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.
The needle should be properly positioned in the vein before this product is injected.
Leakage to surrounding tissue during IV administration may cause considerable irritation. Immediately discontinue the injection and introduce any remaining portion of the dose into another vein. Local injection of hyaluronidase and the application of moderate heat to the area of leakage will help disperse the drug and may minimize the discomfort and possibility of cellulitis.
Intrathecal use may be fataL
Contraindications
Hypersensitivity
Intrathecal (IT) administration
Myelosuppression
Cautions
Intrathecal administration will result in death
Bone marrow depression, neuropathy, neuromuscular dz, neurotoxic agents, ototoxic agents, pulmonary disease, liver impairment, intestinal obstruction, paralytic ileus
Potential for jaw/parotid pain, hoarseness & dysphagia d/t cranial neuropathy
Vesicant
Previous radiation Tx or chemotherapy
Avoid pregnancy
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 Velban (vinblastine)
Half-Life (triphasic): 4 min, 1.4 hr, & 24.8 hr
Peak Plasma: 150 ng/mL
Protein Bound: 43-99%
Vd: 27.3 L/kg
Metabolism: by CYP3A4
Metabolites: desacetylvinblastine
Clearance: 0.74 L/kg/hr
Excretion: bile, urine
Mechanism of action
Vinca alkaloid; acts in G & S phases by inhibiting microtubule formation, inhibits DNA/RNA synthesis
Administration
IV Incompatibilities
Syringe: furosemide
Y-site: cefepime, furosemide
IV Preparation
IV push
- 1 mg/mL (dose/syringe); max syringe size for IVP is a 30 mL syringe & syringe should be <75% full
- Powder: reconstitute w/ 10 mL NS or bacteriostatic NS to obtain 1 mg/mL soln
Continuous infusion: 250-1000 mL D5W or NS (dose)
IV Administration
Vesicant
IV administration ONLY; fatal if given intrathecally
May be administered IVP directly into vein or into free flowing IV
IVP over at least 1 min is desired route of administration d/t potential for extravasation
Has also been administered by continuous infusion; central line only for continuous infusion
Avoid extravasation; may cause sloughing
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
Protect from light
