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

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

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.

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.

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

Not available

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.