Vinblastine

Leukopenia commonly occurs; granulocytopenia may be severe with higher doses. The leukocyte nadir generally occurs 5 to 10 days after administration; recovery typically occurs 7 to 14 days later. Monitor for infections if WBC 3. Leukopenia may be more pronounced in cachectic patients and patients with skin ulceration and may be less pronounced with lower doses used for maintenance therapy. Leukocytes and platelets may fall considerably with moderate doses when marrow is infiltrated with malignant cells (further use in this situation is not recommended). Thrombocytopenia and anemia may occur rarely.

Vinblastine is a vesicant; ensure proper needle or catheter placement prior to and during infusion. Avoid extravasation. Extravasation may cause significant irritation. Individuals administering should be experienced in vinblastine administration. If extravasation occurs, discontinue immediately and initiate appropriate extravasation management, including local injection of hyaluronidase and moderate heat application to the affected area. Use a separate vein to complete administration.

Stomatitis may occur (rare); may be disabling, but is usually reversible.

May rarely cause disabling neurotoxicity; usually reversible. Seizures and severe and permanent CNS damage has occurred with higher then recommended doses and/or when administered more frequently than recommended.

Acute shortness of breath and severe bronchospasm have been reported, most often in association with concurrent administration of mitomycin; may occur within minutes to several hours following vinblastine administration or up to 14 days following mitomycin administration; use caution in patients with preexisting pulmonary disease. Disease-related concerns:

Use with caution in patients with hepatic impairment; toxicity may be increased; may require dosage modification.

Use with caution in patients with ischemic heart disease. Concurrent drug therapy issues:

Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Dosage form specific issues:

Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer’s labeling. Special handling:

Avoid eye contamination (exposure may cause severe irritation). Other warnings/precautions:

Should be administered under the supervision of an experienced cancer chemotherapy physician.

For IV use only. Intrathecal administration may result in death. To prevent administration errors, the Institute for Safe Medication Practices (ISMP) Targeted Medication Safety Best Practices for Hospitals initiative strongly recommends dispensing vinblastine diluted in a minibag (ISMP 2014). If not dispensed in a minibag, affix an auxiliary label stating "For intravenous use only - fatal if given by other routes" and also place in an overwrap labeled "Do not remove covering until moment of injection." Vinblastine should NOT be prepared during the preparation of any intrathecal medications. After preparation, keep vinblastine in a location away from the separate storage location recommended for intrathecal medications. Vinblastine should NOT be delivered to the patient at the same time with any medications intended for central nervous system administration.