Vincristine

Vincristine Brand Names

  • Oncovin
  • Vincasar PFS

What is Vincristine

Vincristine is a member of the vinca alkaloid class of naturally occurring cancer chemotherapy agents, which are extracted from the Catharanthus rosea or periwinkle plant.

Vincristine is similar to vinblastine in action and structure, but their toxicities and spectrum of activity differ significantly.

Vincristine has increased cellular retention as compared to vinblastine which may account for vincristine’s increased potency with bolus dosing while both drugs are equitoxic with prolonged tissue exposure.

The dose-limiting toxicity of vincristine is neurotoxicity while the dose limiting toxicity of other vinca alkaloids is myelosuppression.

The difference may be due to increased binding of vincristine to axonal microtubules.

Vincristine is cell cycle-phase specific agent used in the management of many different malignancies including acute lymphoblastic leukemia, breast carcinoma, Hodgkin lymphoma, non-Hodgkin’s lymphoma, multiple myeloma, soft-tissue sarcomas, osteogenic sarcoma, and brain tumors.

Indications

  1. acute lymphocytic leukemia (ALL)
  2. head and neck cancer
  3. Hodgkin lymphoma
  4. immune thrombocytopenic purpura (ITP)
  5. Kaposi’s sarcoma
  6. malignant glioma
  7. multiple myeloma
  8. neuroblastoma
  9. non-Hodgkin’s lymphoma (NHL)
  10. rhabdomyosarcoma
  11. small cell lung cancer (SCLC)
  12. thymoma
  13. trophoblastic disease
  14. Wilms’ tumor

Side Effects

  1. abdominal pain
  2. alopecia
  3. anaphylactoid reactions
  4. anemia
  5. anorexia
  6. ataxia
  7. back pain
  8. bone pain
  9. bowel necrosis
  10. bronchospasm
  11. coma
  12. constipation
  13. diarrhea
  14. dizziness
  15. dyspnea
  16. dysuria
  17. edema
  18. fever
  19. GI perforation
  20. headache
  21. hearing loss
  22. hypertension
  23. hyperuricemia
  24. hyponatremia
  25. hyporeflexia
  26. hypotension
  27. ileus
  28. injection site reaction
  29. leukopenia
  30. muscle paralysis
  31. myalgia
  32. myocardial infarction
  33. nausea
  34. nephrolithiasis
  35. neuropathic pain
  36. nystagmus
  37. optic atrophy
  38. oral ulceration
  39. paresthesias
  40. peripheral neuropathy
  41. polyuria
  42. rash
  43. seizures
  44. SIADH
  45. sinusoidal obstruction syndrome (SOS)
  46. skin irritation
  47. thrombocytopenia
  48. urinary retention
  49. veno-occlusive disease (VOD)
  50. vertigo
  51. vomiting
  52. weight loss

Monitoring Parameters

  • LFTs
  • serum bilirubin (total and direct)
  • serum sodium

Contraindications

  • accidental exposure
  • biliary tract disease
  • bone marrow suppression
  • breast-feeding
  • extravasation
  • geriatric
  • hepatic disease
  • herpes infection
  • hyperkalemia
  • hyperphosphatemia
  • hyperuricemia
  • hypocalcemia
  • hyponatremia
  • ileus
  • infection
  • intramuscular administration
  • intrathecal administration
  • neurological disease
  • neurotoxicity
  • ocular exposure
  • pregnancy
  • radiation therapy
  • requires an experienced clinician
  • subcutaneous administration
  • tumor lysis syndrome (TLS)
  • vaccination
  • varicella
  • viral infection

Interactions

  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Alpha interferons
  • Amiodarone
  • Amobarbital
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Amprenavir
  • Anticoagulants
  • Antithrombin III
  • Apalutamide
  • Apixaban
  • Aprepitant, Fosaprepitant
  • Argatroban
  • Armodafinil
  • Asparaginase Erwinia chrysanthemi
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Atazanavir
  • Atazanavir; Cobicistat
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Barbiturates
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Betrixaban
  • Bexarotene
  • Bivalirudin
  • Boceprevir
  • Bortezomib
  • Bosutinib
  • Brigatinib
  • Butabarbital
  • Cabozantinib
  • Capmatinib
  • Carbamazepine
  • Carvedilol
  • Ceritinib
  • Chloramphenicol
  • Cimetidine
  • Clarithromycin
  • Clozapine
  • Cobicistat
  • Conivaptan
  • Crizotinib
  • Cyclosporine
  • Dabigatran
  • Dabrafenib
  • Dalteparin
  • Danaparoid
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Delavirdine
  • Desirudin
  • Desmopressin
  • Dexamethasone
  • Dextromethorphan; Quinidine
  • Diclofenac
  • Diclofenac; Misoprostol
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Dronedarone
  • Drospirenone; Ethinyl Estradiol
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Echinacea
  • Edoxaban
  • Elbasvir; Grazoprevir
  • Eliglustat
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Enoxaparin
  • Enzalutamide
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Eslicarbazepine
  • Esomeprazole; Naproxen
  • Ethinyl Estradiol
  • Ethinyl Estradiol; Desogestrel
  • Ethinyl Estradiol; Ethynodiol Diacetate
  • Ethinyl Estradiol; Etonogestrel
  • Ethinyl Estradiol; Levonorgestrel
  • Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
  • Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
  • Ethinyl Estradiol; Norelgestromin
  • Ethinyl Estradiol; Norethindrone
  • Ethinyl Estradiol; Norethindrone Acetate
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Ethinyl Estradiol; Norgestimate
  • Ethinyl Estradiol; Norgestrel
  • Etodolac
  • Etravirine
  • Famotidine; Ibuprofen
  • Febuxostat
  • Felbamate
  • Fenoprofen
  • Filgrastim, G-CSF
  • Flurbiprofen
  • Flutamide
  • Fondaparinux
  • Fosamprenavir
  • Fosphenytoin
  • Gadobenate Dimeglumine
  • Ganciclovir
  • Glecaprevir; Pibrentasvir
  • grapefruit juice
  • Heparin
  • Hydrocodone; Ibuprofen
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Idelalisib
  • Imatinib
  • Indinavir
  • Indomethacin
  • Interferon Alfa-2a
  • Interferon Alfa-2b
  • Interferon Alfa-2b; Ribavirin
  • Interferon Alfa-n3
  • Interferon Alfacon-1
  • Isavuconazonium
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Istradefylline
  • Itraconazole
  • Ixabepilone
  • Ketoconazole
  • Ketoprofen
  • Ketorolac
  • L-Asparaginase Escherichia coli
  • Lansoprazole; Naproxen
  • Lapatinib
  • Ledipasvir; Sofosbuvir
  • Lepirudin
  • Letermovir
  • Live Vaccines
  • Lopinavir; Ritonavir
  • Lumacaftor; Ivacaftor
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Mefloquine
  • Meloxicam
  • Mephobarbital
  • Methohexital
  • Methotrexate
  • Mifepristone
  • Mitomycin
  • Mitotane
  • Modafinil
  • Nabumetone
  • Nafcillin
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Nelfinavir
  • Neratinib
  • Netupitant, Fosnetupitant; Palonosetron
  • Nifedipine
  • Nilotinib
  • Octreotide
  • Ombitasvir; Paritaprevir; Ritonavir
  • Omeprazole; Amoxicillin; Rifabutin
  • Oritavancin
  • Osimertinib
  • Oxaprozin
  • Oxcarbazepine
  • Palifermin
  • Pazopanib
  • Pegaspargase
  • Pegfilgrastim
  • Peginterferon Alfa-2a
  • Peginterferon Alfa-2b
  • Penicillamine
  • Pentobarbital
  • Pentosan
  • Perampanel
  • Phenobarbital
  • Phenytoin
  • Piroxicam
  • Posaconazole
  • Primidone
  • Propafenone
  • Protease inhibitors
  • Quinidine
  • Quinine
  • Ribociclib
  • Ribociclib; Letrozole
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Rifaximin
  • Ritonavir
  • Rivaroxaban
  • Rolapitant
  • Saquinavir
  • Secobarbital
  • Segesterone Acetate; Ethinyl Estradiol
  • Simeprevir
  • Sorafenib
  • St. John’s Wort, Hypericum perforatum
  • Sulindac
  • Tbo-Filgrastim
  • Telaprevir
  • Telithromycin
  • Telotristat Ethyl
  • Temsirolimus
  • Teniposide
  • Testosterone
  • Thalidomide
  • Thiopental
  • Ticagrelor
  • Tinzaparin
  • Tipranavir
  • Tolmetin
  • Trandolapril; Verapamil
  • Trifluoperazine
  • Tuberculin Purified Protein Derivative, PPD
  • Tucatinib
  • Valganciclovir
  • Valproic Acid, Divalproex Sodium
  • Vasopressin, ADH
  • Vemurafenib
  • Verapamil
  • Voriconazole
  • Warfarin
  • Zafirlukast
  • Zalcitabine, ddC
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