Vincristine
Mechanism :
The mechanisms of action of vincristine remain under investigation. The mechanism of action of vincristine has been related to the inhibition of microtubule formation in mitotic spindle, resulting in an arrest of dividing cells at the metaphase stage.
Indication :
- Acute lymphoblastic leukemia
- Hodgkin’s disease
- Non-Hodgkin’s lymphoma
- Sarcomas
- Rhabdomyosarcoma
- Neuroblastoma
- Wilms tumour
Contraindications :
Patients with the demyelinating form of Charcot-Marie-Tooth syndrome should not be given vincristine. Not for intrathecal use. When chemotherapy is being given in conjunction with radiation therapy through portals which include the liver, the use of vincristine should be delayed until radiation therapy has been completed.
Dosing :
Acute leukemia:
1.5-2 mg/m², every week, IV. Start with 0.05/kg/dose <10 kg every week, intravenous in children <10 kg.
Adverse Effect :
Commonly seen adverse reactions are alopecia, abdominal pain, pain in jaw, bones and joints, peripheral neuropathy, constipation, autonomic neuropathy.
Others: Neuropathic pain, sensory loss, paresthesia, difficulty in walking, loss of deep tendon reflexes, muscle wasting, ataxia, paresis, foot drop and cranial nerve palsies, especially ocular palsies and laryngeal nerve paralysis, pharyngeal pain, parotid gland pain, bone pain, back pain, limb pain and myalgias. Convulsions, frequently with hypertension, have been reported in a few patients receiving vincristine. Leukopenia, anemia and thrombocytopenia, constipation, abdominal cramps, paralytic ileus, diarrhea, weight loss, nausea, vomiting, oral ulceration, intestinal necrosis and/or perforation, and anorexia have occurred.
Interaction :
Phenytoin: Vincristine may reduce serum levels of phenytoin.
Nifedipine, Itraconazole, Cimetidine or Ranitidine: Vincristine plasma clearance can be reduced.
L-asparaginase: May reduce hepatic clearance of vincristine.
Vinca alkaloid: Acute shortness of breath and severe bronchospasm have been reported following the administration of vinca alkaloids.
Mitomycin: Serious when there is pre-existing pulmonary dysfunction.
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.