Drug Information

Drug Interaction:

Mitotic inhibitors include-

Etoposide, Vincristine, Vinblastine, Teniposide, Vinorelbine tartarate

Interacting drugs - summary

Vinblastine +

Mitomycin

Acute shortness of breath and severe bronchospasm occured

following use of vinca alkaloids in patients previously

received mitomycin. Onset may be within minutes or several hours

after the vinca alkaloid is injected and occur up to 2 weeks after the

dose of mitomycin

Phenytoin

combination therapy reduce phenytoin plasma levels. Adjust

dosage based on serial blood level monitoring

+ Vinblastine-

Erythromycin

cause toxicity of vinblastine. Severe myalgia, neutripeni and

constipation

Agents that inhibit the cytochrome P-450 pathway

vinblastine is metabolised by the P-450 IIA enzymes. Use caution when coadministering drugs that inhibit P-450 enzymes

Indication:

Mitotic inhibitors include- Etoposide, Vincristine, Vinblastine, Teniposide, Vinorelbine tartarate

Adverse Reaction:

Hematologic- Leucopenia, anemia, thrombocytopenia, mylosuppression Cardiovascular- Hypertension.

GI- Nausea and vomiting, pharyngitis, vesiculation of the mouth, ileus, diarrhea, constipation, anorexia, abdominal pain, rectal bleeding from old peptic ulcer

CNS- Numbness of digits, peresthesiasis, peripheral neuritis, mental depression, loss of deep tendon. reflexes, headache, convulsions

Dermatologic- Alopecia, total epilation (infrequent) hair may regrow during maintenance therapy.

Miscellaneous- malaise, weakness, dizziness, paaain in tumpr site, bone and jaw pain

Contra-Indications:

Leucopenia, presence of bacterial infection, infections must be under control before initiating therapy, significant granulocytopenia.

Special precautions-

Long term use- using small amounts of drug daily for long periods is not advised, even though the resulting total weekly dose may be similar to that recommended. Strict adherence to the recommended dosage schedule is very important. Avoid eye contamination- severe irritation or cvorneal ulceration (if the drug was delivered under pressure ) may result. Throughly wash the eye with water immediately.

Pulmonary reactions- acute shortness of breath and severe bronnchospasm have ocurred following use of vinca alkaloids These raections occur most frequently when vinca alkaloids is used with mitomycin. Onset could be within minutes or several hours after the vinca is injected and may occur up to 2 weeks after trhe dose of mitomycin.

Benzyl alcohol - use in some of these products as preservative has been asociated with a fatal -gasping syndrome -

Warnings- This product is for IV use only- the intrathecal administration of vinblastine has resulted in death. Syringes containing this product should be labelled - vinblastine sulfate for intravenous use only.

Hematologic effects- leukopenia is expected , leukocyte count is an important guide to therapy in general Hepatic impairment- toxicity may be enhanced in the presence of hepatic insufficieny. A dose reduction is recommended.

Fertility impairment- aspermia has been reported. Amonorrhea has occured in some patients treated with a combination of an alkylating agent,procarbazine, predinisolone and vinblastine. Its occurence was related to the total dose of these agents. Recovery of menses was frequent.

Pregnancy- there are no adequate and well controlled studies in pregnant women., but the drug can cause fetal harm.

Lactation- because of the potential for serious adverse reactions in nursing infants, decide whether to control nursing or discontinue nursing taking into account the importance of the drug to the mother.

Dosages/ Overdosage Etc:

Dosage:

Do not administer the more than once weekly. Initiate therapy for adults a single IV dose of 3.7mg/sqm of body surface area.

Overdosage

Symptoms Side effects are dose-related. After an overdose expected exagerrated effects. In addition, neurotoxicity similar to that with vincristine may occur.

Treatment

1. Supportive care should include prevention of side effects that result from the syndrome of inappropriate secretion of antidiuretic hormone(ie restriction of the volume of daily fluid intake to that of the urine output plus insensible loss and perhaps use of a diuretic affecting the function of loop of Henle and distel tube.)

2. Administration of an anticonvulsant

3. Monitor the cardiovascular system.

Missed dose-

1. If you miss a dose of this medicine, take it as soon as possible.

2. However, if it is almost time for next dose, skip the missed dose and go back to your regular dosing schedule.

]3. Do not double doses.

Patient Information:

Mitotic inhibitors include-

Etoposide, Vincristine, Vinblastine, Teniposide, Vinorelbine tartarate

1. Immediately report sore throat, fever, chills, or sore mouth to the physician

2. The folowing may occur- alopecia, jaw pain, pain in the organs containing

tumor tissue ,nausea and vomiting.

3. Scalp hair will regrow to its pretreatment extent, even with continued treatment.

4. Report any other serious medical event to the physician.

5. Avoid constipation.

Ref - USP PDI Vol II 17th Edition (1997)

VINBLASTINE - SYSTEMIC

1.Allergies-

Tell your doctor if you have ever had any unusual or allergic reaction to

Vinblastine.

2.Pregnancy-

Tell your doctor if you are pregnant or intend to have children. There is a chance

that this medicine may cause birth defects if either the male or female is taking it

at the time of conception or it is taken during pregnancy. In addition, many cancer

medicines may cause sterility.

Although sterility has not been reported with this medicine, vinblastine may interfere

with the production of sperm and this possibility should be kept in mind.

Tell your doctor right away if you think you become pregnant while receiving it

3. Breast-feeding-

Because vinblastine may cause serious side effects, breast feeding is not

recommended while you are receiving it.

4.Children-

This medicine has been tested in children and has not been shown to cause

different side effects or problems than it does in adults.

5.Older adults-

There is no specific information about the use of vinblastine in the elderly

6. Other medicines-

When you receiving vinblastine, it is especially important that your doctor know

if you are using any of the following medicines-

Amphotericin B by njection or

Antithyroid agents or

Azathioprine or

Chloramphenicol or

Cochicine or

Flucytosine or

Interferon or

Pilcamycin or

Zidovudine -

If you have been treated with x-rays or cancer medicines - Vinblastine

increase the effects of these medicines or radiation therapy on the blood.

7. Other medical problems-

The presence of other medical problems may affect the use of vinblastine.

Make sure you tell your doctor if you have any other medical problems

especially-

Chicken pox or

Herpes zoyster - risk of severe disease affecting other parts of the body.

Gout or

Kidney stones - vinblastine may increase levels of uric acid in the body ,

which can cause gout or kidney stones

Infection- vinblastine can reduce immunity to infection

Liver disease - effects may be increased because of slower removal of

vinblastine from the body.

Pharmacology/ Pharmacokinetics:

Pharmacology:

Vinblastine sulfate an alkaloid extracted from vinca rosea Linn, interferes with metabolic pathways of amino acids leading from glutamic acid to the citric acid cycle and urea.

Pharmacokinetics:

Similar to vincristine , vinblastine unddergoes rapid distribution and extensive tissue binding following IV injection. Vinblastine is partially metabolised to deacetyl vinblastine which is more effective than the parent drug. The initial, middle and terminal half lives are 3.7 minutes, 1.6 hours, and 24.8 hours repy. Toxicity may be increased if liver disease is present

Interaction with Food:

Not available

Pregnancy and lactation:

Refer Etoposide-Mitotic inhibitors

Pregnancy- There are no adequate and well controlled studies in pregnant women., but the drug can cause fetal harm.

Lactation- Because of the potential for serious adverse reactions in nursing infants, decide whether to control nursing or discontinue nursing taking into account the importance of the drug to the mother.

Vinblastine ( * )-@Mitotic inhibitors

Drug Interaction

Indication

Adverse Reaction

Contra-Indications

Dosages/ Overdosage Etc

Patient Information

Pharmacology/ Pharmacokinetics

Interaction with Food

Pregnancy and lactation