Vincristine Liposome (Intravenous)

Vincristine Liposome is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug that is classified as a plant alkaloid.

Overview

Vincristine Sulfate Liposome, referred to as Vincristine Liposome is a generic cancer medication, or chemotherapy, that interferes with the growth of cancer cells which are then destroyed by the body. It is used in the treatment of Philadelphia chromosome-negative (Ph) acute lymphoblastic leukemia (ALL) for adult patients who have relapsed more than twice or whose disease has progressed after at least two anti-leukemia therapies. It is administered in a hospital or cancer treatment center by a nurse or other trained health professional as an infusion into the vein (intravenous, IV) over a one-hour period every seven days.

Brand:

  • Marqibo

Condition(s) Treated

  • Philadelphia chromosome-negative (Ph) acute lymphoblastic leukemia (ALL)

Therapeutic Class:

  • Antineoplastic Agent

Side Effects

Below is a list of commonly reported side effects. It is important to remember that not all patients will experience every side effect listed and that they are reversible in most cases and usually go away when treatment is completed. Furthermore, there are many options to help prevent or minimize side effects and there is no correlation between the existence or intensity of side effects and the efficacy of the medication. However, if any of these effects persist or worsen, contact your doctor or health care professional immediately.

  • abdominal or stomach pain
  • black, tarry stools
  • bleeding gums
  • blood in the urine or stools
  • blurred vision
  • burning, tingling, numbness or pain in the hands, arms, feet, or legs
  • change in consciousness
  • change in muscle reflexes
  • chest pain
  • chills
  • confusion
  • cough
  • dizziness, faintness, or lightheadedness when rising suddenly from a lying or sitting position
  • fever
  • hair loss
  • increased sensitivity to pain or touch
  • loss of appetite
  • low blood pressure or pulse
  • lower back or side pain
  • nausea and vomiting
  • nerve pain
  • painful or difficult urination
  • pale skin
  • pinpoint red spots on the skin
  • sensation of pins and needles
  • severe constipation
  • severe vomiting
  • shortness of breath
  • sleep problems (insomnia)
  • sneezing
  • sore throat
  • stabbing pain
  • sweating
  • tightness in the chest
  • troubled breathing
  • ulcers, sores, or white spots in the mouth
  • unsteadiness or awkwardness
  • unusual bleeding or bruising
  • unusual tiredness or weakness

Other, less common side effects may include:

  • blue lips, fingernails, or skin
  • irregular, fast or slow, or shallow breathing
  • abdominal or stomach tenderness
  • clay colored stools
  • dark urine
  • headache
  • itching
  • joint pain, stiffness, or swelling
  • skin rash
  • swelling of the feet or lower legs
  • yellow eyes or skin

Alert your doctor immediately if you exhibit serious side effects, including: vision/hearing changes, emotional changes such as depression, hallucinations, confusion or if you experience easy bleeding/bruising or severe tiredness.

Seek medical attention immediately if you exhibit very serious side effects such as seizures, trouble breathing, chest, jaw, or left arm pain, dark urine, persistent nausea, vomiting, stomach or abdominal pain, or yellowing eyes and skin.

Allergic reactions to Vincristine Liposome are rare, but may be serious. Seek medical help immediately if you show symptoms of a serious allergic reaction such as a rash, itching or swelling, especially of the face, tongue or throat, or if you encounter severe dizziness or difficulty breathing.

Vincristine Liposome can cause constipation, which may become serious in some cases. Contact your doctor or pharmacist to learn how to prevent constipation (such as maintaining a high-fiber diet and drinking plenty of water). Ask about regular use of a stool softener, avoiding bulk-forming laxatives, such as Metamucil, and choosing a stimulant laxative. Tell your doctor or pharmacist immediately if you become constipated or have stomach/abdominal pain or bloating.

To reduce the occurrence of moderate dizziness or lightheadedness, rise slowly when getting up from a sitting or lying position.

Temporary hair loss may occur, but regular hair growth should return after treatment is completed.

This is not a complete list of all possible side effects. If you exhibit side effects or symptoms not listed, contact your doctor or healthcare provider.

In the US - Report side effects to the FDA 1-800-FDA-1088 or www.fda.gov/medwatch.

In Canada - Report side effects to Health Canada 1-866-234-2345.

Dosage

This medication is available in the following dosage forms:

  • Solution
  • Suspension

Adult Dosage for Acute Lymphoblastic Leukemia is 2.25 mg/m2 infused intravenously over a one-hour period every seven days.

The amount of Vincristine Liposome that your doctor will prescribe depends on many factors, including your age, height, weight and your overall health or other health concerns. Your doctor will determine your exact dosage and schedule.

Doctors should use caution when prescribing a dose for elderly patients who are at greater risk of decreased hepatic, renal, or cardiac function and associated disease or drug therapy.

Dose modifications are recommended for peripheral neuropathy related to Vincristine Liposome.

Therapy should be interrupted If patient develops persistent grade 2 or grade 3 peripheral neuropathy and discontinued if neuropathy remains at grade 3 or above. Reduce dose to 2 mg/m2 if the neuropathy recovers to grade 1 or 2.

If grade 2 peripheral neuropathy persists after dose reduction, interrupt therapy for up to 7 days. Discontinue if neuropathy rises to grade 3. Reduce dose to 1.825 mg/m2 if the neuropathy recovers to grade 1.

If grade 2 neuropathy persists following a second dose reduction, interrupt the therapy for up to 7 days. Discontinue if neuropathy increases to grade 3. Reduce dose to 1.825 mg/m2 if the neuropathy recovers to grade 1.

Major Drug Interactions

Taking Vincristine Liposome with other medications may change the way those medications or Vincristine Liposome work and may increase the risk of serious side effects. Inform your doctor know of any medications that you are taking, including non-prescription or over the counter medicines and supplements, including herbal products. Do not begin taking or alter the dosage of any medication without your doctor's knowledge.

There are 352 drugs (1050 brand and generics) known to interact with Vincristine Liposome. The following is a partial list:

  • Amiodarone
  • Asparaginase
  • Atazanavir
  • Azithromycin
  • Boceprevir
  • Captopril
  • Carbamazepine
  • Carvedilol
  • Clarithromycin
  • Cobicistat
  • Cyclosporine
  • Dexamethasone
  • Diltiazem
  • Dronedarone
  • Eliglustat
  • Erythromycin
  • Felodipine
  • Filgrastim
  • Fluconazole
  • Fosphenytoin
  • Indinavir
  • Itraconazole
  • Ketoconazole
  • Lopinavir
  • Nefazodone
  • Nelfinavir
  • Nifedipine
  • Nilotinib
  • Phenytoin
  • Posaconazole
  • Quercetin
  • Quinidine
  • Quinupristin
  • Ranolazine
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Ritonavir
  • Saquinavir
  • Sargramostim
  • Simeprevir
  • St. John's Wort
  • Telaprevir
  • Telithromycin
  • Ticagrelor
  • Tolvaptan
  • Valspodar
  • Verapamil
  • Voriconazole
  • Warfarin
  • Zidovudine

Self-Care Suggestions

There are a number of things you can do to avoid side effects and complications:

  • Drink 2 to 3 quarts of fluid every day, unless told otherwise by your doctor, and maintain good nutrition. This will help avoid constipation and prevent dehydration.
  • Avoid crowds or people who have cold or flu symptoms. And tell your doctor or health care provider immediately if you have a fever or show signs of infection.
  • Wash your hands frequently.
  • Wear gloves, long pants and other protective clothing when doing yard work.
  • Do not clean litter boxes or otherwise handle pet waste.
  • Keep all cuts and scrapes covered and clean.
  • Bathe daily and maintain proper oral hygiene.
  • Do not trim cuticles or ingrown finger or toe nails. Nail polish use is acceptable, but avoid wearing false nails.
  • Contact your doctor or health care provider before scheduling any dental visits or procedures.
  • Contact your doctor or health care provider before you, or someone you will be in close proximity to, receives any vaccinations.
  • Shave with an electric razor and use a soft toothbrush to minimize bleeding.
  • Do not play contact sports or participate in any activities that may cause injury.
  • If you experience nausea, take anti-nausea medicines prescribed by your doctor. Eat small portions often. Sucking on sugar-free hard candy or chewing sugar-free gum may further reduce nausea.
  • If you experience constipation, drink plenty of fluids, exercise and add fiber to your diet. Consult your doctor or pharmacist about non-bulking stool softeners or laxatives.
  • Avoid exposure to the sun, apply SPF 15 (or higher) sunscreen frequently and wear protective clothing.
  • Avoid drinking alcoholic beverages.
  • Maintain a healthy sleep schedule and get plenty of rest.
  • Maintain good nutrition and a balanced diet.
  • Discuss any symptoms or side effects with your doctor or health care providers. They may prescribe medicine or make suggestions on how to manage any problems.
  • Report flu-like symptoms to your doctor or health care providers. Stay warm with blankets and stay hydrated. Your doctor may prescribe medication to ease the discomfort related to chills.
  • Acetaminophen and ibuprofen may reduce discomfort related to fever, headache and other aches and pains. Contact your doctor or health care provider before taking any medication.
  • Rinse your mouth often with baking soda and salt water. Mix half a teaspoon of baking soda or half to a full teaspoon of salt in a cup of water an rinse often to avoid and treat mouth sores.

Warnings

Go directly to the Emergency Room (ER) if you have signs of a very bad reaction to the drug, such as wheezing, chest tightness, fever of 100.4º F (38º C), itching skin, bad cough, blue or grey skin, seizures, or swelling in the face, lips, tongue or throat.

Vincristine Liposome is for intravenous use only. Fatalities have occurred when given by other routes, including spinal injection. Vincristine Sulfate Liposome (intravenous) has different dosage recommendations than Vincristine Sulfate. Verify medication and proper dosage prior to administering.

This medicine may cause Tumor Lysis Syndrome (TLS), a serious reaction. Contact your doctor if you experience changes in the frequency or volume of urination, a change in your heart rate, rapid weight-gain, muscle or joint pain, swelling of the feet or lower legs, or tiredness.

Vincristine Liposome is a vesicant, a chemical that causes extensive tissue damage and blistering if it escapes from the vein. If you experience pain, redness or swelling at the injection site while you are receiving Vincristine Liposome, alert your health care professional immediately.

Vincristine Liposome may lessen your body's ability to fight infection and increase your chances of contracting a serious, although rarely fatal, infection or worsen an infection you may already have. Contact your doctor immediately if you show any signs of infection such as fever, chills, persistent sore throat or cough.

Vincristine Liposome regularly affects nerves and muscles. These side effects may improve if treatment is temporarily stopped and then restarted at a lower dose. However, these side effects may worsen and persist, requiring and end to treatment altogether.

Alert your doctor immediately if you experience any of the following: painful, difficult or decreased urination, joint, back or muscle pain, numbness, tingling or burning foot pain, muscle weakness, difficulty walking, loss of coordination, loss of balance, muscle stiffening, drooping eyelids, hoarseness or trouble speaking.

Pregnancy: The FDA lists Vincristine Liposome in pregnancy category D - There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans. Use vincristine liposome only if clearly needed and the benefits outweigh the potential risk. Women of childbearing age should use effective contraception during treatment.

Male reproduction/fertility: Animal studies indicate that vincristine liposome can impair male fertility, and can cause testicular degeneration and atrophy and epididymal aspermia.

Breastfeeding: It is unknown whether Vincristine Liposome is excreted into human milk. A decision should be made to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Overdose: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center immediately. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

Vincristine Liposome may impair your thinking or reactions. Be careful if you drive, operate heavy machinery or do anything that requires you to be alert.

Avoid people who show symptoms of cold, flu or other contagious illnesses. Contact your doctor immediately if you develop any signs of infection.

Do not receive a "live" vaccine while using Vincristine Liposome, including varicella (chickenpox), zoster (shingles), mumps, measles, rubella, typhoid, rotavirus, yellow fever and flu (influenza).

Vincristine Liposome can be passed via bodily fluids such as urine, feces and vomit. Avoid allowing bodily fluids to contact hands or surfaces for 48 hours after receiving a dose. Caregivers must wear rubber gloves if contacting patient's bodily fluids or handling contaminated trash, laundry or changing diapers. Wash hands prior to and after removing gloves and wash soiled clothing and linens separately.

Storage

Vincristine Liposome should be refrigerated between 36 degrees to 46 degrees Fahrenheit (2 degrees to 8 degrees Celsius) and should not be frozen.

The manufacturer's product information should be consulted for complete reconstitution and dilution recommendations.

Summary

Vincristine Sulfate Liposome, also called Vincristine Liposome and by the brand name Marqibo, presents some potentially serious side effects, including seizures and may result in death if administered incorrectly. However, it represents a life-saving possibility for adult patients suffering from Philadelphia chromosome-negative (Ph) acute lymphoblastic leukemia (ALL) who have relapsed twice or whose disease has progressed after two previous anti-leukemia therapies.

Vincristine Liposome interacts with more than 1050 brand and generic drugs, so be sure to let your doctor know of any medications that you are using, including non-prescription, over-the-counter, vitamins, supplements and herbal products. Do not begin taking or alter the dosage of any medication without your doctor's approval. And notify your doctor or health care provider immediately if you show any symptoms of infection or develop serious side effects.

Furthermore, The FDA lists Vincristine Liposome in pregnancy category D and should be prescribed to pregnant women only if the benefits outweigh the potential risks.

Resources
Last Reviewed:
December 23, 2017
Last Updated:
April 27, 2018
Content Source: