Vinblastine


Generic Medicine Info
Indications and Dosage
Intravenous
Advanced mycosis fungoides, Histiocytic lymphoma, Hodgkin's disease, Kaposi's sarcoma, Langerhans cell histiocytosis, Lymphocytic lymphoma, Renal cell carcinoma, Testicular cancer
Adult: Alone or in combination with other antineoplastic agents: Approx 6 mg/m2, administered not more often than once every 7 days. Alternatively, initiate with a single dose of 3.7 mg/m2, then increased at weekly intervals in increments of approx 1.8 mg/m2 based on patient’s WBC count until the desired therapeutic response is reached. Usual dose: 5.5-7.4 mg/m2 once every 7 days. Max: 18.5 mg/m2 once every 7 days. Doses are given not more frequently than once every 7 days via infusion over 5-10 minutes or inj over 1 minute into the tubing of a running IV infusion. Do not increase dose if leucocyte count is reduced to approx 3,000 cells/mm3; administer the Max dose that does not cause leucopenia at weekly intervals for maintenance. Do not administer the next dose, even if 7 days have elapsed unless the WBC count has returned to at least 4,000 cells/mm3. Dosage and treatment protocol recommendations may vary among individual products and between countries (refer to detailed product and local treatment guidelines).
Child: Dose is individualised based on the disease being treated, schedule used, and whether given as a single agent or part of a combination chemotherapy regimen. Usual dose: Approx 6 mg/m2, administered not more often than once every 7 days. Alternatively, initiate with a single dose of 2.5 mg/m2, then increased at weekly intervals in increments of approx 1.25 mg/m2 based on patient’s WBC count until the desired therapeutic response is reached. Max: 12.5 mg/m2 once every 7 days. Doses are given not more frequently than once every 7 days via infusion over 5-10 minutes or inj over 1 minute into the tubing of a running IV infusion. Do not increase dose if leucocyte count is reduced to approx 3,000 cells/mm3; administer the Max dose that does not cause leucopenia at weekly intervals for maintenance. Do not administer the next dose, even if 7 days have elapsed unless the WBC count has returned to at least 4,000 cells/mm3. Dosage and treatment protocol recommendations may vary among individual products and between countries (refer to detailed product and local treatment guidelines).

Intravenous
Choriocarcinoma
Adult: For cases resistant to other chemotherapeutic agents: Alone or in combination with other antineoplastic agents: Approx 6 mg/m2, administered not more often than once every 7 days. Alternatively, initiate with a single dose of 3.7 mg/m2, then increased at weekly intervals in increments of approx 1.8 mg/m2 based on patient’s WBC count until the desired therapeutic response is reached. Usual dose: 5.5-7.4 mg/m2 once every 7 days. Max: 18.5 mg/m2 once every 7 days. Doses are given not more frequently than once every 7 days via infusion over 5-10 minutes or inj over 1 minute into the tubing of a running IV infusion. Do not increase dose if leucocyte count is reduced to approx 3,000 cells/mm3; administer the Max dose that does not cause leucopenia at weekly intervals for maintenance. Do not administer the next dose, even if 7 days have elapsed unless the WBC count has returned to at least 4,000 cells/mm3. Dosage and treatment protocol recommendations may vary among individual products and between countries (refer to detailed product and local treatment guidelines).
Child: Dose is individualised based on the disease being treated, schedule used, and whether given as a single agent or part of a combination chemotherapy regimen. Usual dose: Approx 6 mg/m2, administered not more often than once every 7 days. Alternatively, initiate with a single dose of 2.5 mg/m2, then increased at weekly intervals in increments of approx 1.25 mg/m2 based on patient’s WBC count until the desired therapeutic response is reached. Max: 12.5 mg/m2 once every 7 days. Doses are given not more frequently than once every 7 days via infusion over 5-10 minutes or inj over 1 minute into the tubing of a running IV infusion. Do not increase dose if leucocyte count is reduced to approx 3,000 cells/mm3; administer the Max dose that does not cause leucopenia at weekly intervals for maintenance. Do not administer the next dose, even if 7 days have elapsed unless the WBC count has returned to at least 4,000 cells/mm3. Dosage and treatment protocol recommendations may vary among individual products and between countries (refer to detailed product and local treatment guidelines).

Intravenous
Breast carcinoma
Adult: For cases unresponsive to appropriate endocrine surgery and hormonal therapy: Alone or in combination with other antineoplastic agents: Approx 6 mg/m2, administered not more often than once every 7 days. Alternatively, initiate with a single dose of 3.7 mg/m2, then increased at weekly intervals in increments of approx 1.8 mg/m2 based on patient’s WBC count until the desired therapeutic response is reached. Usual dose: 5.5-7.4 mg/m2 once every 7 days. Max: 18.5 mg/m2 once every 7 days. Doses are given not more frequently than once every 7 days via infusion over 5-10 minutes or inj over 1 minute into the tubing of a running IV infusion. Do not increase dose if leucocyte count is reduced to approx 3,000 cells/mm3; administer the Max dose that does not cause leucopenia at weekly intervals for maintenance. Do not administer the next dose, even if 7 days have elapsed unless the WBC count has returned to at least 4,000 cells/mm3. Dosage and treatment protocol recommendations may vary among individual products and between countries (refer to detailed product and local treatment guidelines).
Child: Dose is individualised based on the disease being treated, schedule used, and whether given as a single agent or part of a combination chemotherapy regimen. Usual dose: Approx 6 mg/m2, administered not more often than once every 7 days. Alternatively, initiate with a single dose of 2.5 mg/m2, then increased at weekly intervals in increments of approx 1.25 mg/m2 based on patient’s WBC count until the desired therapeutic response is reached. Max: 12.5 mg/m2 once every 7 days. Doses are given not more frequently than once every 7 days via infusion over 5-10 minutes or inj over 1 minute into the tubing of a running IV infusion. Do not increase dose if leucocyte count is reduced to approx 3,000 cells/mm3; administer the Max dose that does not cause leucopenia at weekly intervals for maintenance. Do not administer the next dose, even if 7 days have elapsed unless the WBC count has returned to at least 4,000 cells/mm3. Dosage and treatment protocol recommendations may vary among individual products and between countries (refer to detailed product and local treatment guidelines).
Hepatic Impairment
Direct serum bilirubin >3 mg/100 mL: Reduce dose by 50%.
Reconstitution
IV infusion: Dilute in 25-50 mL 0.9% NaCl, dextrose 5% in water, or lactated Ringer's solution. Doses should be supplied in a small-volume IV bag (minibag technique) rather than in a syringe. Dilution in large volumes of IV fluids (e.g. 100-250 mL) is not recommended.
Incompatibility
Immediately precipitates with furosemide, particularly when injected sequentially in Y-site without flushing in between or when mixed in syringe.
Contraindications
Presence of bacterial infection; leucopenia or significant granulocytopenia (unless it is a result of the disease being treated). Immunisation with live vaccines. Administration via IM, SC, or intrathecal route.
Special Precautions
Patient with malignant cell infiltration of the bone marrow; pre-existing pulmonary disease, ischaemic heart disease. Avoid use in elderly patients with cachexia or extensive skin ulceration. Not to be injected into an extremity with impaired circulation. Prolonged IV infusion (e.g. from 30-60 minutes or more) is not recommended. Avoid extravasation and eye contamination. Hepatic impairment. Children. Pregnancy and lactation.
Adverse Reactions
Significant: Leucopenia or granulocytopenia (may be severe with higher doses); severe local reactions such as cellulitis, phlebitis, or sloughing in extreme cases (if extravasation occurs); hyperuricaemia. Rarely, stomatitis.
Blood and lymphatic system disorders: Rarely, thrombocytopenia, anaemia.
Ear and labyrinth disorders: Rarely, vestibular and auditory damage to the 8th cranial nerve.
Gastrointestinal disorders: Nausea, vomiting, abdominal pain, constipation, diarrhoea, gastrointestinal bleeding, haemorrhagic enterocolitis, ileus, oral mucosal blistering, rectal bleeding.
General disorders and administration site conditions: Asthenia, malaise.
Metabolism and nutrition disorders: Anorexia; syndrome of inappropriate antidiuretic hormone secretion (SIADH) at high doses.
Musculoskeletal and connective tissue disorders: Bone pain, jaw pain, myalgia.
Neoplasms benign, malignant and unspecified: Tumour pain.
Nervous system disorders: Headache, dizziness, loss of deep tendon reflexes, paraesthesia, peripheral neuritis.
Psychiatric disorders: Depression.
Reproductive system and breast disorders: Aspermia.
Respiratory, thoracic and mediastinal disorders: Pharyngitis.
Skin and subcutaneous tissue disorders: Alopecia, skin blistering.
Vascular disorders: Hypertension.
Potentially Fatal: Neurotoxicity such as seizures and severe or permanent CNS damage (higher and more frequent doses); MI and CVA (usually in combination with bleomycin and cisplatin); acute shortness of breath and severe bronchospasm (often with concomitant use of mitomycin).
IV/Parenteral: D
Monitoring Parameters
Obtain CBC with differential and platelet count, serum uric acid level, and LFTs before starting therapy. Screen for hepatitis B virus (HBV) with hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), total Ig or IgG, and antibody to hepatitis B surface antigen (anti-HBs) before initiating systemic anticancer treatment. If leucopenia with <2,000 cells/mm3 occurs after administration, closely monitor for signs of infection until WBC returns to normal levels.
Overdosage
Symptoms: Myelosuppression, neurotoxicity (e.g. seizures, severe and permanent CNS damage), SIADH, and other exaggerated adverse effects. Management: Supportive and symptomatic treatment. Restrict fluid intake and use a diuretic agent that acts on the loop of Henle and distal tubule function to prevent the effects resulting from SIADH. Administer anticonvulsant agent (e.g. phenobarbital). Initiate prevention of ileus (e.g. use of enema or cathartics). Protect the airway of the patient; support ventilation and perfusion. Monitor CV function and daily blood counts of the patient.
Drug Interactions
Increased plasma concentrations with cisplatin. May cause Raynaud's phenomenon when co-administered with bleomycin, with or without cisplatin. May decrease serum levels of phenytoin. May increase the severity or cause an earlier onset of adverse effects with CYP3A inhibitors (e.g. erythromycin).
Potentially Fatal: May lead to severe infection with live vaccines. May cause vascular events (e.g. MI, CVA) when combined with bleomycin and cisplatin. May result in acute respiratory distress and pulmonary infiltration when used as part of a combination regimen with mitomycin.
Action
Description: Vinblastine is an antineoplastic vinca alkaloid. Its mechanism of action has not been fully established; however, it appears to bind to microtubular proteins and inhibit microtubule formation of the mitotic spindle, leading to the arrest of dividing cells at metaphase stage, specifically for the M phase. It also interferes with the metabolism of amino acids by blocking the cellular utilisation of glutamic acid, thus preventing purine synthesis, citric acid cycle, and urea formation.
Pharmacokinetics:
Distribution: Distributed in the body tissues; concentrated in blood platelets.
Metabolism: Extensively metabolised in the liver by CYP3A isoenzymes into desacetylvinblastine (more active than the parent drug based on weight).
Excretion: Via faeces (10%); urine (14%). Terminal elimination half-life: Approx 25 hours.
Chemical Structure

Chemical Structure Image
Vinblastine

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 13342, Vinblastine. https://pubchem.ncbi.nlm.nih.gov/compound/Vinblastine. Accessed Oct. 26, 2021.

Storage
Store between 2-8°C. Do not freeze. Protect from light. This is a cytotoxic drug. Follow applicable procedures for receiving, handling, administration, and disposal.
MIMS Class
Cytotoxic Chemotherapy
ATC Classification
L01CA01 - vinblastine ; Belongs to the class of plant alkaloids and other natural products, vinca alkaloids and analogues. Used in the treatment of cancer.
References
Anon. Vinblastine Sulfate. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 20/09/2021.

Anon. Vinblastine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 08/09/2021.

Buckingham R (ed). Vinblastine Sulfate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 08/09/2021.

DBL Vinblastine Injection (Zuellig Pharma Sdn Bhd). MIMS Malaysia. http://www.mims.com/malaysia. Accessed 08/09/2021.

Joint Formulary Committee. Vinblastine Sulfate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 08/09/2021.

Pfizer New Zealand Limited. DBL Vinblastine Injection data sheet 19 August 2021. Medsafe. http://www.medsafe.govt.nz. Accessed 20/09/2021.

Velbastine 10 mg Powder for IV Injection (Qualimed Pharma Inc.). MIMS Philippines. http://www.mims.com/philippines. Accessed 08/09/2021.

Vinblastine Sulfate 1 mg/mL Solution for Injection (Hospira UK Limited). MHRA. https://products.mhra.gov.uk. Accessed 08/09/2021.

Vinblastine Sulfate Injection (Fresenius Kabi USA, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 08/09/2021.

Disclaimer: This information is independently developed by MIMS based on Vinblastine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2021 MIMS. All rights reserved. Powered by MIMS.com
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