Vinblastine (Velban) - Uses, Dose, Side effects, Mechanism of action

Vinblastine (Velban) is a chemotherapeutic drug that belongs to the class of medicines called vinca alkaloids. It arrests the growth of tumor cells and is cell cycle-specific.

Indications of Vinblastine:

  • Hodgkin Lymphoma:

    • It is indicated for the treatment of Hodgkin lymphoma.
  • Kaposi sarcoma:

    • It is used for the treatment of Kaposi sarcoma.
  • Langerhans cell histiocytosis:

    • It is effective in the treatment of histiocytosis X (Letterer-Siwe disease)
  • Non-Hodgkin lymphomas:

    • Treatment of lymphocytic lymphoma, histiocytic lymphoma, and advanced mycosis fungoides can be done by vinblastine.
  • Testicular cancer:

    • It is helpful in treating testicular malignancy.
    • Has also been used in the treatment of resistant choriocarcinoma.
  • Off Label Use of Vinblastine in Adults:

    • Bladder cancer; Kaposi sarcoma, oral lesions (intralesional);
    • Metastatic Melanoma;
    • Non-small cell lung cancer (NSCLC);
    • Advanced Soft tissue sarcoma (desmoid tumors, aggressive fibromatosis)

Vinblastine dose in adults:

Note:

  • For IV use only;
  • fatal if administered by other routes.
  • The Institute for Safe Medication Practices (ISMP) strongly recommends dispensing vinblastine in a minibag (NOT a syringe).

Vinblastine Treatment dose of Bladder cancer (off-label): 


Vinblastine Treatment dose of Hodgkin lymphoma (off-label dosing):

  • ABVD regimen:

    • Favorable/early-stage disease:

      • 6 mg/m² intravenous on days 1 and 15 of a 28-day cycle (in combination with doxorubicin, bleomycin, dacarbazine, and radiation therapy) for 2 cycles.
    • Unfavorable/early-stage disease:

      • 6 mg/m² intravenous on days 1 and 15 of a 28-day cycle (in combination with doxorubicin, bleomycin, dacarbazine, and radiation therapy) for 4 cycles.
    • Unfavorable/advanced stage disease:

      • 6 mg/m² intravenous on days 1 and 15 of a 28-day cycle (in combination with doxorubicin, bleomycin, dacarbazine, and radiation therapy) for 6 to 8 cycles.
  • Stanford V regimen:

  • VEPEMB regimen:

    • Adults ≥60 years of age:
      • 6 mg/m² intravenous on day 1 of each 28-day cycle (in combination with cyclophosphamide, prednisone/prednisolone, procarbazine, etoposide, mitoxantrone, and bleomycin, ± radiation therapy) for 3 cycles (stage 1A or IIA disease) or for 6 cycles (stage IIB, III, or IV disease).

Vinblastine Treatment dose of Kaposi sarcoma, oral lesions (off-label route; based on limited data):

    • Intralesional:
    • 0.1m per 0.5 cm² lesions injected directly into the lesion (a 0.2 mg/mL vinblastine solution was used).
    • Larger lesions may require multiple injections;
    • The reported range of volume injected: 0.8 to 4 mL.

Vinblastine Treatment dose of Metastatic Melanoma (off-label): 

  • CVD + immunotherapy regimen:


Vinblastine Treatment dose of Non-small cell lung cancer (off-label): 

  • Adjuvant treatment after complete resection:

    • 4 mg/m² I/V on days 1, 8, 15, 22, and 29, then every 2 weeks (in combination with cisplatin) until the last cisplatin dose.
  • Concurrent radiation:

    • 5 mg/m² I/V on days 1, 8, 15, 22, and 29 (in combination with cisplatin and concurrent radiation therapy).

Vinblastine Treatment dose of advanced Soft tissue sarcoma (desmoid tumors, aggressive fibromatosis) (off-label):

    • 6 mg/m² Intravenous every 7 to 10 days (dose usually rounded to 10 mg) in combination with methotrexate for 1 year.

Vinblastine Treatment dose of Testicular cancer (off-label dosing):

  • VeIP regimen:

    • 11 mg/kg intravenous daily for 2 days every 21 days (in combination with ifosfamide, cisplatin, and mesna) for 4 cycles.
    • Manufacturer's labeling:

      • Hodgkin lymphoma, non-Hodgkin lymphomas (lymphocytic lymphoma, histiocytic lymphoma, advanced mycosis fungoides), testicular cancer, Kaposi sarcoma, Langerhans cell histiocytosis (histiocytosis X, Letterer-Siwe disease):
        • Dosing in the prescribing information may not reflect current clinical practice.
        • 3.7 mg/m² intravenous ;
        • adjust dose every 7 days (based on white blood cell response) up to 5.5 mg/m² (second dose);
        • 7.4 mg/m² (third dose);
        • 9.25 mg/m² (fourth dose); and
        • 11.1 mg/m² (fifth dose).
      • The dose should not be administered more frequently than every 7 days.
      • Usual dosage range: 5.5 to 7.4 mg/m² every 7 days.
      • Maximum dose: 18.5 mg/m²; dosage adjustment goal is to reduce white blood cell count to 3,000/mm³.
      • The frequency and duration of therapy may vary by indication, concomitant combination chemotherapy, and hematologic response.

Vinblastine dose in children:

Note:

  • Dosing and frequency depend on the indication, protocol, and/or treatment phase and hematologic response;
  • refer to the specific protocol. It can be given intravenous only.
  • The Institute for Safe Medication Practices (ISMP) strongly recommends dispensing vinblastine in a mini bag (NOT a syringe) to prevent inadvertent intrathecal administration.

Vinblastine Treatment dose of Hodgkin lymphoma:

  • Infants, Children, and Adolescents:

    • Manufacturer's labeling:

      • Initial dose: 6 mg/m² /dose I/V, do not administer more frequently than every 7 days.
    • ABVD regimen:

      • 6 mg/m² /dose I/V administered on days 1 and 15 of a 28 day cycle in combination with doxorubicin, bleomycin, and dacarbazine.
    • ChlVPP regimen:

      • 6 mg/m²/dose I/V administered on days 1 and 8 of a 28 day cycle in combination with chlorambucil, procarbazine, and prednisolone;
      • The minimum reported age: 7 months.

Vinblastine Treatment dose of Multisystem Langerhans cell histiocytosis (Letterer-Siwe disease; Histiocytosis X):

  • Infants, Children, and Adolescents:

    • Manufacturer's labeling:

      • Initial dose: 6.5 mg/m² /dose I/V; do not administer more frequently than every 7 days
    • Alternate dosing: Limited data available:

      • Induction: 6 mg/m² /dose I/V every 7 days in combination with prednisone for 6 to 12 weeks depending upon clinical response; then begin maintenance therapy of 6 mg/m /dose every 3 weeks in combination with prednisone, continue for a total duration of vinblastine therapy of 12 months.

Vinblastine Treatment dose of Extracranial Germ cell tumors (eg, testicular, ovarian, mediastinal):

  • Infants, Children, and Adolescents:

    • Initial dose: 3 mg/m² /dose intravenous; per the manufacturer, do not administer more frequently than every 7 days; however, in some trials, a single dose was used and others used a daily dose of vinblastine administered over 1 hour for 2 days.

Dose in pregnancy and lactation:

  • Vinblastine can cross the placenta.
  • Guidelines for treatment and follow-up for cancer in pregnancy have been published by the European Society for Medical Oncology.
  • The ESMO guidelines recommend that you refer to a hospital with expertise in the treatment of cancer during pregnancy.
  • They also encourage a multidisciplinary team (obstetrician/neonatalian, oncology team).
  • The first trimester should not receive chemotherapy. It should be withheld after 33 weeks.
  • There should also be a three-week period between the last dose of chemotherapy and the expected delivery.
  • Guidelines for treatment of hematologic malignancies in pregnancy have been published by an international consensus panel. 
  • Vinblastine, which is part of the ABVD regimen is used to treat Hodgkin lymphoma. ABVD can be safely administered in the second stage of pregnancy for early-stage Hodgkin Lymphoma.
  • ABVD may be administered in the second or third trimester to patients with advanced-stage diseases.
  • Vinblastine treatment should not be used if you are pregnant. Combination therapy with vinblastine can cause reversible amenorrhea.
  • Vinblastine therapy can cause permia in males.

Use of vinblastine during breastfeeding

  • It is unknown if breast milk secretes vinblastine.
  • Comparing to healthy untreated women, the ABVD regimen caused changes in breast milk's bacterial and metabolic compositions. 
  • This regimen may make it difficult for women to breastfeed after giving birth if they are pregnant.
  • Consider the possibility of serious adverse reactions in breastfed infants.
  • The decision to stop taking vinblastine or stop breastfeeding should be made based on the importance to the mother.

Dose adjustment in renal disease:

  • No dosage adjustment is necessary.

Vinblastine Dose adjustment in liver disease:

The manufacturer's labeling recommends the following adjustment:

  • Serum bilirubin >3 mg/dl:

    • A 50% dose reduction is required.
  • The following adjustments have also been recommended:

    • Serum bilirubin 1.5 to 3 mg/dL or transaminases 2 to 3 times ULN:
      • 50% dose reduction is needed.
    • Serum bilirubin >3 times ULN:
      • Use is not recommended.

Side effects of Vinblastine:

  • Cardiovascular:

    • Angina Pectoris
    • Cerebrovascular Accident
    • ECG Abnormality
    • Hypertension
    • Ischemic Heart Disease
    • Limb Ischemia
    • Myocardial Infarction
    • Raynaud's Phenomenon
  • Central Nervous System:

    • Decreased Deep Tendon Reflex
    • Depression
    • Dizziness
    • Headache
    • Malaise
    • Metallic Taste
    • Neurotoxicity
    • Paresthesia
    • Peripheral Neuritis
    • Seizure
    • Tumor Pain
    • Vertigo
  • Dermatologic:

    • Alopecia
    • Dermatitis
    • Skin Blister
    • Skin Photosensitivity
    • Skin Rash
  • Endocrine & Metabolic:

    • Hyperuricemia
    • SIADH
  • Gastrointestinal:

    • Abdominal Pain
    • Anorexia
    • Constipation
    • Diarrhea
    • Enterocolitis
    • Gastrointestinal Hemorrhage
    • Intestinal Obstruction
    • Nausea
    • Paralytic Ileus
    • Stomatitis
    • Toxic Megacolon
    • Vomiting
  • Genitourinary:

    • Azoospermia
    • Urinary Retention
  • Hematologic & Oncologic:

    • Anemia
    • Bone Marrow Depression
    • Granulocytopenia
    • Hemolytic Uremic Syndrome
    • Leukopenia
    • Rectal Hemorrhage
    • Thrombocytopenia
    • Thrombotic Thrombocytopenic Purpura
  • Local:

    • Local Irritation
  • Neuromuscular & Skeletal:

    • Jaw Pain
    • Myalgia
    • Ostealgia
    • Weakness
  • Ophthalmic:

    • Nystagmus
  • Otic:

    • Auditory Disturbance
    • Deafness
    • Vestibular Disturbance
  • Respiratory:

    • Bronchospasm
    • Dyspnea
    • Pharyngitis
  • Miscellaneous:

    • Radiation Recall Phenomenon

Contraindications to Vinblastine:

  • Bacterial infection
  • Significant granulocytopenia

Canadian labeling: Additional contraindications that are not found in the US labeling

  • Pregnancy
  • There is not much evidence of cross-reactivity between drugs within this class and allergenic substances. 
  • Cross-sensitivity is possible due to similarities in chemical structure or pharmacologic activities.

Warnings and precautions

  • Suppression of bone marrow

    • You can usually see bone marrow suppression, including leukopenia or granulocytopenia, within five to ten days of administration.
    • The recovery process takes 2 weeks, or more.
    • If WBC is less than 2,000/mm, monitor for infection.
    • Leukopenia can be more severe in patients with cachectic conditions and skin ulceration than it is milder when taken at lower doses.
    • Therapy should be stopped if the marrow becomes infected with malignant cells. Anemia is rare.
  • Extravasation: [US Boxed Warning]

    • Vinblastine can be used as a vesicant. To avoid extravasation, it is important to place the catheter or needle correctly before and during infusion.
    • Extravasation can cause severe irritation. Vinblastine should only be administered by trained personnel.
    • Extravasation should be treated immediately. Hyaluronidase injections and heat should be administered to the affected areas.
    • To complete the administration, a separate vein should also be used.
  • Gastrointestinal toxicities:

    • Stomatitis can be treated with therapy, which is often reversible.
  • Neurotoxicity:

    • Vinblastine is known for its neurotoxicity, which can be reversed. 
    • Seizures and severe CNS damage can be caused by higher doses or more frequent use.
  • Toxicity in the lungs:

    • Combination therapy with mitomycin may result in severe bronchospasm and acute dyspnoea within minutes to several hours following vinblastine therapy, or up to 14-days after mitomycin administration.
    • It should not be used in patients suffering from preexisting pulmonary diseases.
  • Hepatic impairment

    • Vinblastine can cause increased toxicity in patients with hepatic impairment. Therefore, dose adjustment is necessary.
  • Ischemic heart disease

    • Vinblastine should not be given to patients suffering from ischemic heart disease.

Vinblastine: Drug Interaction

Risk Factor C (Monitor therapy)

Aprepitant

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

Bosentan

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).

Chloramphenicol (Ophthalmic)

May enhance the adverse/toxic effect of Myelosuppressive Agents.

Clofazimine

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

CloZAPine

Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased.

Coccidioides immitis Skin Test

Immunosuppressants may diminish the diagnostic effect of Coccidioides immitis Skin Test.

CYP3A4 Inducers (Moderate)

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).

CYP3A4 Inhibitors (Moderate)

May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors).

Deferasirox

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).

Denosumab

May enhance the adverse/toxic effect of Immunosuppressants. Specifically, the risk for serious infections may be increased.

Duvelisib

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

Erdafitinib

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).

Erdafitinib

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

Erdafitinib

May increase the serum concentration of P-glycoprotein/ABCB1 Substrates.

Fosaprepitant

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

Fosnetupitant

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

Itraconazole

May increase the serum concentration of VinBLAStine.

Ivosidenib

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).

Larotrectinib

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

Mesalamine

May enhance the myelosuppressive effect of Myelosuppressive Agents.

MitoMYcin (Systemic)

Antineoplastic Agents (Vinca Alkaloids) may enhance the adverse/toxic effect of MitoMYcin (Systemic). Specifically, the risk of pulmonary toxicity may be increased.

Netupitant

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

Ocrelizumab

May enhance the immunosuppressive effect of Immunosuppressants.

Palbociclib

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

P-glycoprotein/ABCB1 Inhibitors

May increase the serum concentration of Pglycoprotein/ABCB1 Substrates. P-glycoprotein inhibitors may also enhance the distribution of pglycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.).

Pidotimod

Immunosuppressants may diminish the therapeutic effect of Pidotimod.

Promazine

May enhance the myelosuppressive effect of Myelosuppressive Agents.

Ranolazine

May increase the serum concentration of P-glycoprotein/ABCB1 Substrates.

Sarilumab

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).

Siltuximab

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).

Simeprevir

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

Siponimod

Immunosuppressants may enhance the immunosuppressive effect of Siponimod.

Tertomotide

Immunosuppressants may diminish the therapeutic effect of Tertomotide.

Tocilizumab

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).

Trastuzumab

May enhance the neutropenic effect of Immunosuppressants.

Risk Factor D (Consider therapy modification)

Baricitinib

Immunosuppressants may enhance the immunosuppressive effect of Baricitinib. Management: Use of baricitinib in combination with potent immunosuppressants such as azathioprine or cyclosporine is not recommended. Concurrent use with antirheumatic doses of methotrexate or nonbiologic disease modifying antirheumatic drugs (DMARDs) is permitted.

CYP3A4 Inducers (Strong)

May increase the metabolism of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling.

CYP3A4 Inhibitors (Strong)

May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors).

Dabrafenib

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects).

Echinacea

May diminish the therapeutic effect of Immunosuppressants.

Enzalutamide

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring.

Fingolimod

Immunosuppressants may enhance the immunosuppressive effect of Fingolimod. Management: Avoid the concomitant use of fingolimod and other immunosuppressants when possible. If combined, monitor patients closely for additive immunosuppressant effects (eg, infections).

Leflunomide

Immunosuppressants may enhance the adverse/toxic effect of Leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Management: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Patients receiving both leflunomide and another immunosuppressant should be monitored for bone marrow suppression at least monthly.

Lenograstim

Antineoplastic Agents may diminish the therapeutic effect of Lenograstim. Management: Avoid the use of lenograstim 24 hours before until 24 hours after the completion of myelosuppressive cytotoxic chemotherapy.

Lipegfilgrastim

Antineoplastic Agents may diminish the therapeutic effect of Lipegfilgrastim. Management: Avoid concomitant use of lipegfilgrastim and myelosuppressive cytotoxic chemotherapy. Lipegfilgrastim should be administered at least 24 hours after the completion of myelosuppressive cytotoxic chemotherapy.

Lopinavir

May increase the serum concentration of VinBLAStine. Management: Monitor closely for signs and symptoms of vinblastine toxicity; consider temporary interruption of lopinavir/ritonavir antiviral therapy if patients develop significant toxicity with concurrent use.

Lorlatinib

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Avoid concurrent use of lorlatinib with any CYP3A4 substrates for which a minimal decrease in serum concentrations of the CYP3A4 substrate could lead to therapeutic failure and serious clinical consequences.

Macrolide Antibiotics

May increase the serum concentration of Antineoplastic Agents (Vinca Alkaloids). Macrolides may also increase the distribution of Vinca Alkaloids into certain cells and/or tissues. Management: Consider an alternative to using a macrolide antibiotic when possible in order to avoid the potential for increased vinca alkaloid toxicity. Exceptions: Azithromycin (Systemic); Fidaxomicin; Roxithromycin; Spiramycin.

MiFEPRIStone

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. Avoid cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus.

Mitotane

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane.

Nivolumab

Immunosuppressants may diminish the therapeutic effect of Nivolumab.

Palifermin

May enhance the adverse/toxic effect of Antineoplastic Agents. Specifically, the duration and severity of oral mucositis may be increased. Management: Do not administer palifermin within 24 hours before, during infusion of, or within 24 hours after administration of myelotoxic chemotherapy.

Pitolisant

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Combined use of pitolisant with a CYP3A4 substrate that has a narrow therapeutic index should be avoided. Other CYP3A4 substrates should be monitored more closely when used with pitolisant.

Posaconazole

May enhance the adverse/toxic effect of Antineoplastic Agents (Vinca Alkaloids). Posaconazole may increase the serum concentration of Antineoplastic Agents (Vinca Alkaloids). Management: Avoid the concomitant use of posaconazole and vinca alkaloids when possible. If combined, monitor for increased vinca alkaloid toxicities (eg, neurotoxicity, gastrointestinal toxicity).

Ritonavir

May increase the serum concentration of VinBLAStine. Management: Monitor closely for signs and symptoms of vinblastine toxicity; consider temporary interruption of ritonavir antiviral therapy if patients develop significant toxicity with concurrent use.

Roflumilast

May enhance the immunosuppressive effect of Immunosuppressants.

Sipuleucel-T

Immunosuppressants may diminish the therapeutic effect of Sipuleucel-T. Management: Evaluate patients to see if it is medically appropriate to reduce or discontinue therapy with immunosuppressants prior to initiating sipuleucel-T therapy.

St John's Wort

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling.

Stiripentol

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Use of stiripentol with CYP3A4 substrates that are considered to have a narrow therapeutic index should be avoided due to the increased risk for adverse effects and toxicity. Any CYP3A4 substrate used with stiripentol requires closer monitoring.

Tofacitinib

Immunosuppressants may enhance the immunosuppressive effect of Tofacitinib. Management: Concurrent use with antirheumatic doses of methotrexate or nonbiologic disease modifying antirheumatic drugs (DMARDs) is permitted, and this warning seems particularly focused on more potent immunosuppressants.

Tolterodine

VinBLAStine may increase the serum concentration of Tolterodine. Management: Reduce tolterodine dose to 1 mg twice daily (regular release formulation) or 2 mg daily (extended release formulation) (adult doses) and monitor for increased levels/effects of tolterodine with initiation of vinblastine therapy.

Vaccines (Inactivated)

Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting an immunosuppressant. If vaccinated during immunosuppressant therapy, revaccinate at least 3 months after immunosuppressant discontinuation.

Voriconazole

May enhance the adverse/toxic effect of Antineoplastic Agents (Vinca Alkaloids). Voriconazole may increase the serum concentration of Antineoplastic Agents (Vinca Alkaloids).

Risk Factor X (Avoid combination)

BCG (Intravesical)

Immunosuppressants may diminish the therapeutic effect of BCG (Intravesical).

BCG (Intravesical)

Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical).

Cladribine

May enhance the immunosuppressive effect of Immunosuppressants.

Cladribine

May enhance the myelosuppressive effect of Myelosuppressive Agents.

Conivaptan

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

Deferiprone

Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone.

Dipyrone

May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased

Fusidic Acid (Systemic)

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

Idelalisib

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

Natalizumab

Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased.

Pimecrolimus

May enhance the adverse/toxic effect of Immunosuppressants.

Tacrolimus (Topical)

May enhance the adverse/toxic effect of Immunosuppressants.

Vaccines (Live)

Immunosuppressants may enhance the adverse/toxic effect of Vaccines (Live). Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live organism vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants.

Monitoring parameters:

  • CBC with differential and platelet count
  • LFTs
  • serum uric acid.

How to administer Vinblastine?

  • You should only give it intravenously. It is fatal to try other routes.
  • The Institute for Safe Medication Practices recommends that vinblastine be administered in a small bag, and not in a syringe.
  • It is preferable to infuse the liquid in a mini bag of 25-50 mL.
  • Extended administration times (>=30-60 minutes) and/or higher administration volumes increase the risk of vein irritation or extravasation.

Vesicant

  • To avoid extravasation, it is important to properly place the needles or catheters before and during infusion.

Extravasation management

  • Extravasation can be prevented by stopping infusion immediately.
  • Extravasated solution should be gently aspirated (do not flush the line).
  • Start hyaluronidase Antidote; Remove needle/cannula
  • Apply dry, warm compresses for 20 mins four times per day for up to two days.
  • Elevate extremity (Perez Fidalgo 2012). Infuse the remaining vinblastine dose through a separate vein.

Hyaluronidase

  • If the cannula has been in place, 1 to 6 mL Hyaluronidase (150 Units/mL) should then be administered. The usual dosage is 1 mL Hyaluronidase per 1 mL extravasated drug.
  • Subcutaneous injections of 1 to 6mL (150 units/mL), should be done in a clockwise fashion, using 1mL for every 1mL extravasated drug.
  • If the cannula has been removed, administer 5 separate 0.2mL injections subcutaneously into extravasation site (using a 25 gauge needle).

Intralesional (offer-label route).

  • Vinblastine intralesional injections should be administered under local anesthesia.
  • Vinblastine administration may require analgesics for up to two days.

Mechanism of action of Vinblastine:

  • Vinblastine stops the cell in metaphase by disrupting formation of the mitotic spindle.
  • It also inhibits the formation and formation of microtubules by binding to tubulin that is specific for the M or S phases.
  • Vinblastine blocks glutamic acid utilization, which results in interference with protein synthesis and nucleic acid.

Metabolism:

  • Occur in the liver (via CYP3A) to the active metabolite.

Half-life elimination:

  • Terminal: 25 hours.

Excretion:

  • Feces (10%);
  • urine (14%)

International Brands of Vinblastine:

  • Blastovin
  • Blastovin PF
  • Blestinib
  • Cytoblastin
  • Lemblastine
  • Oncoblastin
  • Oncostin
  • Velbastine
  • Velbe
  • Vilban
  • Vinatin
  • Vinblastin
  • Vinblastina
  • Vinblastine Sulfate Injection
  • Xintoprost

Vinblastine Brand Names in Pakistan:

Vinblastine Sulphate Injection 10 mg

Velbastine Al-Habib Pharmaceuticals.
Vinblas Pharmedic (Pvt) Ltd.

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