Vincristine is a drug that has a cytostatic effect. It is based on the eponymous alkaloid vinca pink. The remedy is on the List of Vital Drugs.
Composition, Form and Packing
Vincristine is manufactured as a lyophysiate from which a solution for parenteral administration is to be prepared.
The main substance is vincristine sulfate, lactose is used as an auxiliary. Solvent is a mixture of isotonic sodium chloride solution, water for injection and benzyl alcohol.
Manufacturer
Vincristine is manufactured by Pharmachemie B.V.(Netherlands).
Indications for use
The drug is used for therapy:
- Acute leukemia;
- Osteogenic sarcoma;
- Malignant neoplasms in the genital organs of girls;
- Idiopathic thrombocytopenic purpura;
- Lymphogranulomatosis;
- of myeloma;
- Acute lymphoblastic leukemia in pediatric practice;
- Cervical cancer and organ sarcoma;
- Ependymiomas;
- Non-Hodgkin's Malignant Lymphoma;
- Soft tissue sarcomas;
- Germinogenic tumor of the ovaries and testes;
- Kaposi's sarcomas;
- Intercellular lung cancer;
- Breast Cancer;
- Chorionepithelioma of the uterus;
- Pleurisy, which has a tumor etiology;
- Bladder cancer;
- Mushroomed mycosis;
- Melanomas;
- Cancer of the pelvis of the kidney and ureter;
- Neuroblastoma;
- Meningioma.
Contraindications
Vincristine is not recommended for use with:
- Neurodystrophic pathologies;
- Acute infectious diseases;
- Hypersensitivity;
- With simultaneous use of radiation therapy, when the liver region is involved;
- Pregnancy or during lactation.
With caution, prescribe the drug at:
- Liver disorders;
- Presence of a history of neuropathy;
- Decreased rate of bone marrow hematopoiesis;
- Gout;
- In the elderly;
- After a course of radiotherapy on the liver area.
Pharmacological action of
The cytostatic selectively acts on cells, blocking exclusively the DNA of cancer cells.
The action is based on the ability of the drug to bind to the cellular protein-tubulin. As a result, the microtubule apparatus is damaged and the mitotic spindle is torn.
The use of cytostatic leads to inhibition of metaphase of mitosis, interferes with the repair mechanism of DNA in tumor cells.
The greatest sensitivity to the effect of cytotoxic is observed in malignant cells, which quickly divide.
Healthy cells of the skin, mucous membranes and bone marrow, for which rapid division also is characteristic, are practically not subject to cytostatic action.
Instructions for use Vincristine: dosage
The cytotoxic is administered intravenously for at least 60 seconds. The interval between doses is 7 days. The dose of the drug is determined only individually.
Adult patients need to administer 1.0 to 1.4 mg per 1 m2 of body surface .At the same time, not more than 2 g. The course duration is 1.5 months, after which a break is necessary.
In pediatrics, the cytostatic is used at a rate of 1.5 to 2 mg per 1 m2 of body surface area. If the weight is less than 10 kg, then the therapeutic dosage should first be a maximum of 0.05 mg / kg once every 7 days.
Before injections, a fresh solution should be prepared. For this, the dry substance is dissolved with the solvent contained in the kit.
Side effect of
Vincristine is capable of leading to the development of such pathologies:
- Nervous system disorders: headaches, convulsive state against increased BP, peripheral nerve nerves, muscle paralysis, deafness, paresthesia, stopping of the feet, unconsciousness, isolated paresis,neuralgia, ataxia, dizziness, nystagmus, depressive state, hallucinations, ptosis, diplopia. The appearance of such symptoms should be an excuse for reducing dosage;
- Pathology of the genitourinary system: amenorrhea, urination disorder, bladder atony, azoospermia, uric acid nephropathy;
- Allergic reactions ( anaphylactic shock, urticaria, Quincke's edema);
- GI disorders: nausea, stomatitis, vomiting, stool disorders( constipation or diarrhea), intestinal paralysis that causes obstruction( especially in children), abdominal pain, necrotic lesions of the small intestine, accompanied by perforation;
- Pathology of the cardiovascular system: lability of blood pressure. If the mediastinum has been irradiated, the use of a cytostatic may provoke the development of angina and infarction;
- Respiratory system disorders: development of acute respiratory failure, dyspnea, bronchospasm;
- Pathologies of the hematopoiesis are rare;
- Endocrine disorders: hyponatremia, polyuria in the absence of signs of damage to the kidneys, adrenal glands;
- Local reactions: accidental ingestion on the skin may lead to inflammation of the subcutaneous fat and skin vessels, necrosis.
Among other side effects noted: loss of appetite and weight loss, alopecia, fever.
Overdose of
Accidental excess of the therapeutic dose of the drug may lead to increased side effects of Vincristine.
Patient in this case will need symptomatic therapy:
- Diuretic medication and limited fluid intake to prevent the syndrome of increased production of antidiuretic hormone;
- Use of laxatives to prevent intestinal obstruction;
- Phenobarbital. The drug will prevent the development of seizures;
- Leucovorin intravenously by 100 mg every 3 hours during the day.
Special instructions
Therapy should be carried out under the constant supervision of an oncologist who has sufficient experience in the use of the drug.
During treatment, you need to monitor the clinical picture of blood, adjust the dose for any violations of the liver.
- If Vincristine is treated with constipation, then laxatives or the use of cleansing enemas will be required.
- If during the introduction of a cytotoxic the medical worker accidentally damages the vein, then the injection should be stopped immediately. Continue the injection through another vein. And the puncture site must be cut off with hyaluronidase.
- Vincristine is used with caution in elderly patients, because the risk of developing pathological processes from the side of the nervous system is increased. In such cases, constant monitoring of the general condition of the patient and the work of internal organs is necessary.
- Women who have undergone Vincristine therapy and plan pregnancy in the future, it is necessary to use reliable contraceptives within 6 months.
- The cytostatic is characterized by increased neurotoxicity, which negatively affects the activity of the central nervous system, the rate of reactions. It is important to consider patients who manage complex processes or drive cars.
Drug Interaction
When combined with drugs that inhibit CYP3A4( Erythromycin, Nefazodone, Itraconazole), the concentration of the cytostatic in the bloodstream can increase.
- Simultaneous reception with Itraconazole results in neuromuscular disorders. Specialists attribute this to the inhibition of the metabolism of the cytostatic.
- Simultaneous use with Phenytoin can lead to a decrease in the concentration of the latter in the blood. This significantly reduces the anticonvulsant effect of the drug.
- Joint use of Vincristine with Prednisolone will cause suppression of hematopoiesis in the bone marrow.
- Simultaneous prescription with drugs( Itraconazole, Isoniazid, Nifedipine), which have a neurotoxic and ototoxic effect, will cause increased side effects from the CNS and hearing.
- Vincristine is able to reduce the effectiveness of Digoxin, a means for treating gout.
- When combined with Verapamil, the toxic effect of vincristine is increased. A combination with mitomycin C leads to the development of severe bronchospasm.
- If a patient requires simultaneous therapy with Vincristine and L-asparaginase, then the cytotoxic must be administered one day before the use of another drug. Otherwise, hepatic clearance may be impaired.
Reviews
Marina, 47 years, Moscow:
The doctor prescribed to use Vincristine for the treatment of breast cancer. Has transferred or carried therapy is serious. Almost all side effects appeared! My stomach was very sick, so there was nothing I could do. Refused to take the drug, a few weeks later it all passed.
Oleg, 56, Moscow:
I was given bladder cancer and I was prescribed Vincristine. After the first course of treatment, the doctor noted a positive dynamics, a decrease in the size of the tumor. During the treatment, nausea and abdominal pain appeared, which disappeared after the drug was discontinued.
Price Vincristine in Moscow
The cost of cytostatic varies from 120 to 550 rubles per 1 bottle depending on the manufacturer.
Analogues
The following products are used for analogues:
- Vinelbine;
- Maverex;
- Velbin;
- Vinicarbine;
- Javlor;
- Vinblastine;
- Winkater;
- Navelbin;
- Tsitwin.
Synonyms for
There are the following synonyms:
- Vincristin-Richter;
- Vero-Vincristine;
- Vincristine-Teva.
Storage conditions
Cytostatics can be purchased at the pharmacy only on prescription. Shelf life - 3 years with full observance of storage conditions. It is necessary to keep in the refrigerator, where the temperature regime does not exceed 80 C.