Vincristine (Intravenous)

Vincristine affects reproduction of cancer cells by modifying telomeres and it is injected into veins in order to treat different cancers as well as blood disorders.

Overview

Vincristine is used in the treatment of solid tumors and certain blood conditions. It is a vesicant, which means that it is administered through injection. The patient receives the medication through an IV over the course of a minute, and it is only injected into a vein and not into the spine or other areas. Vincristine is also known as leurocristine and is sold under the brand name Oncovin, as well as other names.

Chemistry

The chemical formula of Vincristine is C46H56N4O10. Vincristine is a vinca alkaloid that is derived from Catharanthus roseus which is a Madagascar periwinkle. Chemical analysis indicates it has more than 70 active alkaloids.

Vincristine stops cells from dividing properly. This can stop cancer cells from reproducing when injected into the cancer site. It was tested on mice with leukemia and it was shown that it has the effect of decreasing the activity in the bone marrow and that the mice lived longer after using the drug.

In order to make Oncovin, chemists required many periwinkle plants. Every ounce of Vincristine required one ton of leaves. A ranch in Texas grew these for some time and the drug is now artificially synthesized.

The World Health Organization's List of Essential Medicines includes it, indicating it is recognized as a safe medicine in the health system.

One way that it works is that it binds to the tublin protein. This prevents the cell's ability to separate chromosomes during cell division. The microtubules are affected and the cells can't properly undergo mitosis. The cell then dies. By this method, lukocytes maturation and production is inhibited.

Vincristine is shown to work in animals as well. One study indicated it was an effective treatment for venereal tumors in dogs. Almost all oncological treatments for canines, ferrets and felines involve injecting vincristine.

Condition(s) treated

  • Non-Hodgkin's lymphoma
  • Hodgkin's lymphoma
  • Acute Lymphoblastic Leukemia
  • Nephroblastoma
  • Childhood leukemia
  • Wilms tumor (type of kidney cancer in children)
  • Neuroblastoma
  • Rhabdomyosarcoma
  • Brain tumors
  • Certain types of lung cancer
  • Multiple myeloma
  • Chronic lymphocytic leukemia
  • Kaposi's sarcoma (causes abnormal tissue growth)
  • Ewings sarcoma (type of cancer related to bones and muscles
  • Gestational trophoblastic tumors (cancer that forms in the uterus during pregnancy)
  • Thrombotic thrombocytopenic purpura (condition that causes blood clots in the small blood vessels)

Type of Medication

  • Vesicant

Side Effects

The side effects of vincristine are often reversible over time. The side effects are predictable and depend on the duration and dosage. There is not a correlation between the severity of side effects and the effectiveness of the medication.

Alopecia, which is also known as hair loss, occurs in over 70% of patients. Hair may grow back during or shortly after treatment. Many patients are advised to look for wigs.

Digestive Complications

One common side effect is constipation and patients are often prescribed a laxative. There are also effects on the digestive system, this includes vomiting or nausea. Some patients experience loss of appetite and subsequent weight loss. Other patients may develop anorexia.

Immune System

Physicians report reduced red and white blood cell counts. This medication may increase the likelihood of infections because of the suppressed immune system response. The effect on the immune system might result in mouth sores or a pin prick rash. Other possibilities include infections. Because of the compromised immune system, a patient might experience a fever. Call your doctor if your body temperature is over 100.5 F.

Irritation

Some patients experience redness or pain at the site of injection.

There can be adverse effects in patients with recent surgical lesions. Reports have indicated patients had necrotic effects after surgery.

Pulmonary

One reported side effect is pulmonary toxicology. These include different pulmonary conditions like airway obstruction. Swelling, or edema in the lung area or cardiac is also seen. A patient might develop a cough or other symptoms and the alveolars might show damage. Another potential side effect is the patient could develop pneumonia. There are also patients who have symptoms of pulmonary hypertension.

Other symptoms affecting the lung symptoms are pulmonary hemorrhaging. Another side effect is respiratory paralysis or muscle weakness. Another reason is that phospholipids are deposited in the cells. The injury could also be due to the decreased potency of the immune system. Some patients might experience trouble breathing especially when it is taken with mitomycin-C. Other cardiological effects include high blood pressure and low blood pressure.

Axonal Neuropathy

Almost every patient reports axonal neuropathy. Many patients also report feeling numbness and this can affect different body systems. This is attributed to the fact exoplasmic transport is inhibited. A patient might experience hoarseness or difficulty talking. Other ways axonal neuropathy could manifest includes paralysis of different degrees. A patient might experience jaw pain, parotid gland pain, back pain, bone pain, pain in the limbs and myalgia.

Cranial system

Cranial nerve damage may occur such as auditory or vestibular damage. They also might experience vertigo or loss of balance. This affects motor and sensory fibers. Patients might experience changes in vision. The eyes can potentially be affected and the results may last after treatment. This includes cortical blindness, ptosis, diplopia, photophobia and optic atrophy with blindness. Some patients experience total or partial deafness that may or may not be permanent.

Because of the axonal neuropathy effect, a patient might experience difficulty walking. Another symptom could be weakness or fatigue. Other indications of neuropathy are drooping eyelids. Some patients might experience other pains in the cranial area like jaw pain or headaches.

The ones that are particularly affected are the small fibers. In clinical studies, this is seen as different symptoms. One is foot and fingertip paresthesia. Another is wrist and foot drop or numbness in the joints. Sensory neuropathy is experienced as pain or a burning sensation. Patients with neuropathic disorders or genetic disposition to it have experienced life-threatening neuropathy. This damage is caused because of a few reasons. The drug itself is directly toxic and it depresses the CNS system. As a result, motor functions are affected. It doesn't affect the blood-brain barrier but it does impact the nerves. Another reason for the effect on the pulmonary system is injury due to oxidants and the body lacks the resources to fully recover from the intense oxidative damage caused by chemotherapy.

Adrenals

Other symptoms include kidney or adrenal diseases.

Urogenital

Side effects like urinary retention because of bladder atony, dysuria, polyuria have been measured. Males who receive treatment before the age of 18 have a five times higher chance of azoospermia. There might be bed wetting or loss of other genital functions like diarrhea. Other symptoms related to this area are painful urination or difficulty urinating as well as changes in the volume of urine.

Some women experience amenorrhea. Women might go through menopause-like symptoms. There can be potentially harmful effects to a fetus if the women is pregnant.

Hematologic

There are also different hematologic effects. These include leukopenia, anemia, thrombocytopenia and leukemia in the central nervous system.

Endocrine

Some side effects have been noted in the endocrine systems. This includes rarely pancreatitis and a syndrome that affects the antidiuretic hormone. This is characterized by high sodium excretion content alongside hyponatremia.

Allergies

There is a possibility of an allergic reaction. This is indicated by swelling, itching (especially of the tongue/face/throat), extreme dizziness, rash or trouble breathing. Hypersensitive patients are more at risk of experiencing anaphylaxis or other allergic reactions.

Liver Complications

There have been reports of fatal hepatitis in combined radiation treatment. Because of this, the drug is counterindicated for patients receiving liver radiation.

More severe side effects include seizures or yellowing of the eyes or skin. Symptoms of a seizure include blacking out, confusion, loss of hearing or vision, unusual tastes or smells, difficulty speaking, shaking or tremors, repetitive body moments, muscles that won't relax and loss of control of bowels and urine. Patients should be alert for severe pain in the left side or the liver area and any changes in the color of the urine such as darkening.

Other side effects include depression, hallucinations or difficulty sleeping.

Dosage

Vincristine is administered to the veins. It is almost always fatal when given in the spine.

The standard dose for adults with neuroblastoma is 1.4 mg/m2 IV one time over one minute. It is normally administered once a week. Different doses have been used varying from .4 to 1.4 mg/m2 IV, and the maximum dosage is 2 mg.

The dosage for Hodgkin's lymphoma is 1.4 mg/m2 IV over one minute one time a week. Other dosages include 0.4 to 1.4 mg/m2 IV one time a week.

This dosage schedule applies to rhabdomyosarcoma, Acute Lymphocytic Leukemia, Wilms' Tumor and acute myeloid leukemia.

For children, the recommended dosage is 0.05 mg/kg administered as a weekly intravenous injection.

The recommended dosage for the elderly is the same as the adult dosage.

Patients with liver disease or hepatitis get a half dosage.

Interactions

Certain drugs increase the prevalence of different side effects. Mitomycin increases the risk of shortness of breath.

Caution is to be used with drugs that are ototoxic such as oncolytics which contain platinum.

If vincristine is used with L-asparaginase it needs to be administered 12 to 24 hours beforehand. This is in order to minimize toxicity.

Vincristine is additionally toxic when combined with drugs such as isoniazid.

It is known that if administered with phenytoin it increases the risks of seizures.

Vincristine taken with itraconazole, which inhibits the metabolic pathway, causes earlier and more severe neuromuscular onsets.

When taken with dactinomycin it causes hepatoxicity.

Do not take aspirin and vincristine at the same time.

Warnings

Risk factors include advanced age, concurrent lung treatments, genetic factors, radiation therapy, combination therapy. It should not be given to adults with ports for radiation therapy for liver.

White blood cell counts need to be conducted before and after treatment. It is very important not to exceed the dosage of 2ML as it could be potentially fatal.

Extra fluid should not be added to the vial before removal.

It is recommended to infuse it over 5 to 10 minutes after it is diluted in a 50 ml infusion bag with sodium chloride. After it is injected, the vein needs to be flushed.

Before a patient starts using vincristine, they must tell their doctor about any over the counter or pharmaceutical drugs they are taking. St. John's Wort is known to affect and interact with Vincristine.

It is not to be taken by pregnant women or women who are breastfeeding. It could potentially harm a fetus or infant. Men and women taking vincristine are told not to conceive a child and to use contraception.

If these side effects are present then contact the doctor immediately: dark-colored stools, unusual bleeding or bruising, severe vomiting, blood in urine or stools, painful urination, severe stomach pain.

Drug toxicity is measured by tingling in fingers or toes. If this happens, then alert your doctor and then dosages will be altered.

Alert the doctor or nurse if you get pain at the injection site.

Vincristine should not be given to patients with Charcot-Marie-Tooth syndrome.

As it contains alcohol, it should not be given to babies or infants.

Patients and doctors need to be careful to keep the area sterile. Patients need to be extra vigilant about washing their hands and resting after treatment.

Storage

To maintain potency, store vincristine at 2-8°C. It will degrade if it is exposed to life. The shelf life is 18 months. It is distributed in 5 mL glass vials.

Summary

Vincristine works as an antitumor agent. It is normally administered through an IV. It is part of a chemotherapy regiment. It works to prevent microtubules to replicate and prevents the synthesis of cells of RNA and DNA. This is shown in clinical trials with mice to affect leukemia. Vincristnie is a type of medication called an antimitotic because it is shown to affect the mitosis stage of cell division and s a sulfate that has other nonactive agents. Used alongside other medications or by itself, in clinical studies it's shown to affect leukemia. It is for intravenous use only.

It treats human neoplastic diseases and is also used in veterinary care. It's an alkaloid derived from a flower and is no longer being distributed under the name vincristine.

Vincristine is adapted for certain types of cancers and blood disorders. Synonyms for Vincristine include kyocristine, VCR, Leurocristine, Novopharm, Lilly 37231, Oncovin and NSC 67574.

Resources
Last Reviewed:
December 24, 2017
Last Updated:
April 05, 2018
Content Source: