Side effects of the drug Vincristine
Possible convulsions, loss of sensitivity with the appearance of constantly progressive paresthesia and with continued treatment of neurotic pain with possible motor disorders, constipation, paralytic intestinal obstruction, abdominal pain, vomiting, diarrhea, ulcerative necrotic lesions of the digestive tract, polyuria and dysuria, granulocytopenia, anemia and thrombocytopenia, acute attack of dyspnea, bronchospasm, weight loss, fever, headache, optic atrophy with blindness, temporary loss of vision of cortical origin, inappropriate antidiuretic hormone secretion syndrome with increased urinary sodium excretion in the presence of hyponatremia, reversible alopecia, amenorrhea, azoospermia .
Vincristine solution for intravenous administration, 2 ml bottles in Domodedovo
The incidence of side effects is given in accordance with the following gradation: very often (≥ 1/10), often (≥ 1/100, <1/10), infrequently (≥ 1/1000, <1/100), rarely (≥ 1 /10000, <1/1000), very rare (<1/10000).
From the nervous system: often - peripheral sensorimotor neuropathy (paresthesia, loss of deep tendon reflexes, foot drop, muscle weakness, ataxia, paralysis), neuralgia (including pain in the jaws, pharynx, parotid glands, back, bones, muscles and male gonads), dysfunction of the cranial nerves (hoarseness, vocal cord paresis, ptosis, optic neuropathy and other neuropathies), transient cortical blindness, nystagmus, diplopia, optic nerve atrophy. Sometimes - convulsions with increased blood pressure, headache, dizziness, depression, agitation, increased drowsiness, confusion, psychosis, hallucinations, sleep disturbance, hearing loss. Neurotoxicity is the dose-limiting factor.
From the gastrointestinal tract: often - constipation, abdominal pain; sometimes - anorexia, weight loss, nausea, vomiting, diarrhea, paralytic intestinal obstruction (especially common in children); rarely - stomatitis, necrosis of the small intestine and/or perforation.
From the hepatobiliary system: primary thrombosis of the hepatic veins (especially in children).
From the urinary system: sometimes - polyuria, dysuria, urinary retention due to bladder atony, hyperuricemia, urate nephropathy; rarely - syndrome of inadequate secretion of antidiuretic hormone (hyponatremia in combination with a high level of sodium excretion in the urine without signs of renal and adrenal dysfunction, hypotension, dehydration, azotemia or edema).
From the cardiovascular system: sometimes - coronary heart disease, myocardial infarction (in patients who have previously received radiotherapy in the mediastinum, when using combination therapy including vincristine); rarely - increase or decrease in blood pressure.
From the immune system: often - acute respiratory failure and bronchospasm, sometimes severe and life-threatening (observed when using vincristine with mitomycin C); rarely - anaphylactic shock, skin rash and swelling.
From the skin and skin appendages: very often - alopecia.
From the reproductive system: very often - azoospermia, amenorrhea.
From the hematopoietic system: often - transient thrombocytosis; sometimes - pronounced depression of bone marrow function, anemia, leukopenia and thrombocytopenia. Typically, vincristine does not have a significant effect on hematopoiesis.
Local reactions: often - irritation at the injection site; sometimes - when the drug gets under the skin, inflammation of the subcutaneous fat, phlebitis, pain, necrosis of surrounding tissues.
Other: myalgia, arthralgia, fever
Special instructions for the use of Vincristine
Do not inject into the spinal canal (risk of death). Before starting the injection of vincristine, you must ensure that the needle is inserted strictly intravenously. Penetration of vincristine into surrounding tissues during administration can cause a pronounced inflammatory reaction, including necrosis. In this case, it is necessary to immediately stop the injection and inject the remaining dose into another vein; hyaluronidase can be injected into the site of extravasation of vincristine and a warm compress can be applied, which will improve the absorption of vincristine, reduce discomfort and reduce the risk of an inflammatory reaction from the subcutaneous tissue and connective tissue. Vincristine can cause kidney damage due to the formation of uric acid during massive tumor decay. To prevent such cases, it is recommended to alkalize urine, control the content of uric acid and, if necessary, prescribe inhibitors of its synthesis. Particular attention must be paid to the dosage of vincristine, and also to carefully identify its neurological side effects when prescribed to patients with pre-existing neuropathies or when vincristine is combined with other drugs that have a neurotoxic effect. When combining chemotherapy and radiation therapy with radiation fields that include the liver, the use of vincristine should be delayed until the course of radiation therapy is stopped. Contact of the drug with the eyes should be carefully avoided as it may cause severe irritation and ulceration of the cornea.
Vincristine-Teva
Vincoalkoloids are metabolized by the cytochrome P-450 isoenzyme -CYP3A4 and are a substrate for P-glycoprotein. In this regard, with the simultaneous use of inhibitors of CYP3A4 and P-glycoprotein, such as ritonavir, nelfinavir, ketoconazole, itraconazole, erythromycin, fluoxetine, nefazodone, cyclosporine and nifedipine, an increase in the concentration of vincristine in the blood plasma may be observed.
With the simultaneous administration of itraconazole and vincristine, side effects from the nervous system developed more quickly and/or were more pronounced, which appears to be associated with inhibition of the metabolism of vincristine.
The administration of phenytoin in combination with antitumor treatment, including vincristine, led to a decrease in the content of phenytoin in the blood and, accordingly, to a decrease in its anticonvulsant effect.
Concomitant use of vincristine with other myelosuppressive drugs and prednisolone may increase the suppression of bone marrow hematopoiesis.
When used simultaneously with neurotoxic drugs (isoniazid, asparaginase, cyclosporine) and ototoxic drugs, increased side effects from the nervous system and auditory system are observed, respectively.
Vincristine reduces the effectiveness of digoxin and ciprofloxacin.
Verapamil increases the toxicity of vincristine.
When used simultaneously, vincristine weakens the effect of drugs used in the treatment of gout.
When used simultaneously with uricosuric drugs, the risk of nephropathy increases.
When vincristine is used in combination with mitomycin, the likelihood of developing respiratory depression and bronchospasm increases.
If it is necessary to use the drug in combination with asparaginase, vincristine should be administered 12-24 hours before using asparaginase. Administration of asparaginase before administration of vincristine may interfere with its elimination from the liver.
Due to the possible suppression of immune system function caused by treatment with vincristine, the production of antibodies in response to the vaccine may be reduced. When taken simultaneously with live viral vaccines, it is possible to intensify the replication process of the vaccine virus, increase its side/adverse effects and/or reduce the production of antibodies in the patient’s body in response to the vaccine. Patients with leukemia in remission should not receive live viral vaccine for at least 3 months after the last chemotherapy treatment.
The pharmacodynamic interaction of vincristine with other cytostatics can enhance the therapeutic and toxic effects. Concomitant use of vincristine and other bone marrow-suppressing drugs such as doxorubicin (especially in combination with prednisone) may enhance the depressive effects on the bone marrow.
Radiotherapy may result in increased peripheral neurotoxicity of vincristine.
During the use of cyclosporine and tacrolimus, excessive immunosuppression with the risk of lymphoproliferation may develop.
In combination with bleomycin, depending on the dose, vincristine can cause Raynaud's syndrome. During concomitant administration of vincristine and colony-stimulating factors (G-CSF, GM-CSF), atypical neuropathies with a tingling or burning sensation in the distal extremities were more often reported.
Vincristine should not be mixed with other drugs in the same syringe.
Glucocorticosteroids, androgens, estrogens and progestins enhance the effect of vincristine.
Pharmaceutically incompatible with furosemide solution (precipitate formation).
Vincristine overdose, symptoms and treatment
The above side effects are observed, but much more pronounced. Treatment of overdose: prevention of complications in the event of disturbances in the secretion of antidiuretic hormone - limiting fluid intake, prescribing diuretics that affect the function of the loop of Henle and distal tubules; prevention of seizures - administration of phenobarbital or other anticonvulsants in sufficient doses; prevention of intestinal obstruction - use of enemas and laxatives; constant monitoring of the state of the cardiovascular system; daily determination of peripheral blood parameters for timely blood transfusions.
List of pharmacies where you can buy Vincristine:
- Moscow
- Saint Petersburg
Vincristine
Allergic reactions: anaphylaxis, rash, angioedema.
From the nervous system: headache, convulsions with increased blood pressure, paresthesia, neuralgia, neuropathy, neuritis of peripheral nerves, impaired motor function, decreased deep tendon reflexes, foot drop, ataxia, isolated paresis, muscle paralysis, dysfunction of cranial nerves ( especially VIII pairs: deafness, dizziness, nystagmus), ataxia, decreased muscle strength, depression, hallucinations, sleep disturbances, diplopia, ptosis, transient loss of vision, optic nerve atrophy (neurotoxicity is a dose-limiting factor).
From the digestive system: nausea, vomiting, stomatitis, constipation or diarrhea, paralytic ileus (especially in children), abdominal pain, necrosis of the small intestinal wall and/or perforation, spasm of the smooth muscles of the gastrointestinal tract.
From the genitourinary system: dysuria, urinary retention due to bladder atony, acute uric acid nephropathy, azoospermia, amenorrhea.
From the cardiovascular system: blood pressure lability. In patients with previously irradiated mediastinum, when using polychemotherapy with the inclusion of the drug, angina pectoris and myocardial infarction may occur.
From the respiratory system: acute respiratory failure, shortness of breath, bronchospasm (especially when combined with mitomycin C).
From the endocrine system: rarely - hyponatremia or syndrome of inappropriate ADH secretion, polyuria. There are no signs of damage to the kidneys, adrenal glands or dehydration.
From the hematopoietic organs and hemostasis system: rarely - anemia, leukopenia, thrombocytopenia.
Local reactions: if the drug gets under the skin, inflammation of the subcutaneous fat, phlebitis and necrosis may develop.
Other: alopecia, fever, weight loss, loss of appetite. Overdose. Symptoms: increased side effects.
Treatment: symptomatic - limiting fluid intake, prescribing hydrochlorothiazide (prevention of the syndrome of inappropriate ADH secretion), phenobarbital (to prevent seizures), enemas and laxatives (prevention of intestinal obstruction), monitoring the activity of the cardiovascular system and hematological control. A specific antidote is unknown. Hemodialysis is ineffective. If necessary, leucovorin 100 mg IV every 3 hours for 24 hours and then every 6 hours for at least 2 days can be prescribed.
