Vinblastine
Mechanism :
Mechanism of action of vinblastine sulfate is different from that of other recognized antineoplastic agents. Tissue-culture studies suggest an interference with metabolic pathways of amino acids leading from glutamic acid to the citric acid cycle and to urea. A number of in vitro and in vivo studies have demonstrated that vinblastine sulfate produces a stathmokinetic effect and various atypical mitotic figures.
Indication :
- Hodgkin’s lymphoma
- Lymphoma- anaplastic large cell
- Testicular Carcinoma
- Squamous cell carcinoma of head & neck
- Kaposi’s sarcoma
- Histiocytic lymphoma
- Mycosis fungoides, & Letterer-Siwe disease (histiocytosis X).
Contraindications :
Vinblastine sulfate is contraindicated in patients who have significant granulocytopenia, in the presence of bacterial infection. Such infections must be brought under control prior to the initiation of therapy with vinblastine sulfate.
Dosing :
General dosing:
Initial 2.5 mg/m², increase dose at weekly intervals in increments of about 1.25 mg/m² until leukocyte count decreases to about 3000/mm³, or maximum weekly dose of 12.5 mg/m² is reached. Dose is not increased once leukocyte count reaches approximately 3000 cells/mm³, instead, a dose of 1 increment smaller to be administered at weekly intervals for maintenance i.e. patient receives the maximum dose that does not cause leucopenia. If oncolytic activity is encountered before leucopenic effect, then there is no need to increase subsequent doses. Next is not administered, even though 7 days have lapsed unless the leukocyte count has returned to at least 4000/mm³. Duration of maintenance therapy depends on disease state and the antineoplastic agent combination.
Always consult the current treatment protocol for details of dosage and scheduling. Maximum single dose 10 mg.
Hodgkin’s disease:
6 mg/m²/day IV, every 1-2 weeks, for 3-4 weeks.
Histiocytosis:
0.4 mg/kg IV, every 7-10 days.
Germ cell tumour:
3 mg/m², IV, once a week.
Adverse Effect :
Abdominal pain, constipation, nausea, vomiting, leukopenia, thrombocytopenia, anemia, peripheral neuropathy, alopecia, paralytic ileus.
Interaction :
Phenytoin: Reduced blood levels of the anticonvulsant and to have increased seizure activity.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unlikely to be dialysed. Dose as in normal renal function |
| HD | Unlikely to be dialysed. Dose as in normal renal function |
| HDF/High flux | Unknown dialysability. Dose as in normal renal function |
| CAV/VVHD | Unlikely to be dialysed. Dose as in normal renal function |
Hepatic Dose :
If the serum bilirubin is between 1.5 to 3 mg/dL or the transaminase levels are 2 to 3 times the upper limit of normal (ULN): Give half the dose.
Do not use if serum bilirubin is greater than 3 times the upper limit of normal.