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Vinblastine Sulfate

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Overview

What is Vinblastine Sulfate?

Vinblastine sulfate is the salt of an alkaloid extracted from Linn., a common flowering herb known as the periwinkle (more properly known as G. Don). Previously, the generic name was vincaleukoblastine, abbreviated VLB.  It is a stathmokinetic oncolytic agent.  When treated with this preparation, growing cells are arrested in metaphase.

Chemical and physical evidence indicate that vinblastine sulfate is a dimeric alkaloid containing both indole and dihydroindole moieties.  The accompanying structural formula has been proposed.

Each mL contains: Vinblastine sulfate 1 mg; sodium chloride 9 mg; benzyl alcohol 0.9% (v/v) as a preservative; water for injection, q.s. (pH 3.5 to 5.0).



What does Vinblastine Sulfate look like?



What are the available doses of Vinblastine Sulfate?

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What should I talk to my health care provider before I take Vinblastine Sulfate?

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How should I use Vinblastine Sulfate?

Vinblastine Sulfate Injection is indicated in the palliative treatment of the following:

I.

II.

Current principles of chemotherapy for many types of cancer include the concurrent administration of several antineoplastic agents.  For enhanced therapeutic effect without additive toxicity, agents with different dose-limiting clinical toxicities and different mechanisms of action are generally selected.  Therefore, although vinblastine sulfate is effective as a single agent in the aforementioned indications, it is usually administered in combination with other antineoplastic drugs.  Such combination therapy produces a greater percentage of response than does a single-agent regimen.  These principles have been applied, for example, in the chemotherapy of Hodgkin’s disease.

Caution–It is extremely important that the intravenous needle or catheter be properly positioned before any vinblastine sulfate is injected.  Leakage into surrounding tissue during intravenous administration of vinblastine sulfate may cause considerable irritation.  If extravasation occurs, the injection should be discontinued immediately and any remaining portion of the dose should then be introduced into another vein. Local injection of hyaluronidase and the application of moderate heat to the area of leakage will help disperse the drug and may minimize discomfort and the possibility of cellulitis.

There are variations in the depth of the leukopenic response that follows therapy with vinblastine sulfate.  For this reason, it is recommended that the drug be given no more frequently than .


What interacts with Vinblastine Sulfate?

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What are the warnings of Vinblastine Sulfate?

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What are the precautions of Vinblastine Sulfate?

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What are the side effects of Vinblastine Sulfate?

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What should I look out for while using Vinblastine Sulfate?

Vinblastine sulfate is contraindicated in patients who have significant granulocytopenia unless this is a result of the disease being treated.  It should not be used in the presence of bacterial infections.  Such infections must be brought under control prior to the initiation of therapy with vinblastine sulfate.

Caution is necessary with the administration of all oncolytic drugs during pregnancy.  Information on the use of vinblastine sulfate during human pregnancy is very limited.  Animal studies with vinblastine sulfate suggest that teratogenic effects may occur.  Vinblastine sulfate can cause fetal harm when administered to a pregnant woman.  Laboratory animals given this drug early in pregnancy suffer resorption of the conceptus; surviving fetuses demonstrate gross deformities.  There are no adequate and well-controlled studies in pregnant women.  If this drug is used during pregnancy, or if the patient becomes pregnant while receiving this drug, she should be apprised of the potential hazard to the fetus.  Women of childbearing potential should be advised to avoid becoming pregnant.

Aspermia has been reported in man.  Animal studies show metaphase arrest and degenerative changes in germ cells.

Leukopenia (granulocytopenia) may reach dangerously low levels following administration of the higher recommended doses.  It is therefore important to follow the dosage technique recommended under .  Stomatitis and neurologic toxicity, although not common or permanent, can be disabling.


What might happen if I take too much Vinblastine Sulfate?


How should I store and handle Vinblastine Sulfate?

Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F) [see USP Controlled Room Temperature].Store products in refrigerator 2° to 8°C (36° to 46°F) to assure extended stability. PROTECT FROM LIGHT.Store products in refrigerator 2° to 8°C (36° to 46°F) to assure extended stability. PROTECT FROM LIGHT.


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Clinical Information

Chemical Structure

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Clinical Pharmacology

Experimental data indicate that the action of vinblastine sulfate is different from that of other recognized antineoplastic agents.  Tissue-culture studies suggest an interference with metabolic pathways of amino acids leading from glutamic acid to the citric acid cycle and to urea.  experiments tend to confirm the results.  A number of studies and have demonstrated that vinblastine sulfate produces a stathmokinetic effect and various atypical mitotic figures.  The therapeutic responses, however, are not fully explained by the cytologic changes, since these changes are sometimes observed clinically and experimentally in the absence of any oncolytic effects.

Reversal of the antitumor effect of vinblastine sulfate by glutamic acid or tryptophan has been observed.  In addition, glutamic acid and aspartic acid have protected mice from lethal doses of vinblastine sulfate. Aspartic acid was relatively ineffective in reversing the antitumor effect.

Other studies indicate that vinblastine sulfate has an effect on cell-energy production required for mitosis and interferes with nucleic acid synthesis.  The mechanism of action of vinblastine has been related to the inhibition of microtubule formation in the mitotic spindle, resulting in an arrest of dividing cells at the metaphase stage.

Pharmacokinetic studies in patients with cancer have shown a triphasic serum decay pattern following rapid intravenous injection.  The initial, middle and terminal half-lives are 3.7 minutes, 1.6 hours and 24.8 hours, respectively.  The volume of the central compartment is 70% of body weight, probably reflecting very rapid tissue binding to formed elements of the blood. Extensive reversible tissue binding occurs.  Low body stores are present at 48 and 72 hours after injection.  Since the major route of excretion may be through the biliary system, toxicity from this drug may be increased when there is hepatic excretory insufficiency.  The metabolism of vinca alkaloids has been shown to be mediated by hepatic cytochrome P450 isoenzymes in the CYP 3A subfamily.  This metabolic pathway may be impaired in patients with hepatic dysfunction or who are taking concomitant potent inhibitors of these isoenzymes such as erythromycin. Enhanced toxicity has been reported in patients receiving concomitant erythromycin (see ).  Following injection of tritiated vinblastine in the human cancer patient, 10% of the radioactivity was found in the feces and 14% in the urine; the remaining activity was not accounted for.  Similar studies in dogs demonstrated that, over nine days, 30 to 36% of radioactivity was found in the bile and 12 to 17% in the urine.  A similar study in the rat demonstrated that the highest concentrations of radioactivity were found in the lung, liver, spleen and kidney two hours after injection.

Non-Clinical Toxicology
Vinblastine sulfate is contraindicated in patients who have significant granulocytopenia unless this is a result of the disease being treated.  It should not be used in the presence of bacterial infections.  Such infections must be brought under control prior to the initiation of therapy with vinblastine sulfate.

Caution is necessary with the administration of all oncolytic drugs during pregnancy.  Information on the use of vinblastine sulfate during human pregnancy is very limited.  Animal studies with vinblastine sulfate suggest that teratogenic effects may occur.  Vinblastine sulfate can cause fetal harm when administered to a pregnant woman.  Laboratory animals given this drug early in pregnancy suffer resorption of the conceptus; surviving fetuses demonstrate gross deformities.  There are no adequate and well-controlled studies in pregnant women.  If this drug is used during pregnancy, or if the patient becomes pregnant while receiving this drug, she should be apprised of the potential hazard to the fetus.  Women of childbearing potential should be advised to avoid becoming pregnant.

Aspermia has been reported in man.  Animal studies show metaphase arrest and degenerative changes in germ cells.

Leukopenia (granulocytopenia) may reach dangerously low levels following administration of the higher recommended doses.  It is therefore important to follow the dosage technique recommended under .  Stomatitis and neurologic toxicity, although not common or permanent, can be disabling.

See Table 2 for clinically significant drug interactions with diclofenac.

Toxicity may be enhanced in the presence of hepatic insufficiency.

If leukopenia with less than 2,000 white blood cells/mm occurs following a dose of vinblastine sulfate, the patient should be watched carefully for evidence of infection until the white blood cell count has returned to a safe level.

When cachexia or ulcerated areas of the skin surface are present, there may be a more profound leukopenic response to the drug; therefore, its use should be avoided in older persons suffering from either of these conditions.

In patients with malignant-cell infiltration of the bone marrow, the leukocyte and platelet counts have sometimes fallen precipitously after moderate doses of vinblastine sulfate.  Further use of the drug in such patients is inadvisable.

Acute shortness of breath and severe bronchospasm have been reported following the administration of vinca alkaloids.  These reactions have been encountered most frequently when the vinca alkaloid was used in combination with mitomycin-C and may require aggressive treatment, particularly when there is pre-existing pulmonary dysfunction.  The onset may be within minutes or several hours after the vinca is injected and may occur up to two weeks following a dose of mitomycin.  Progressive dyspnea requiring chronic therapy may occur.  Vinblastine should not be readministered.

Care should be recommended in patients with ischemic cardiac disease.

Care must be taken to avoid contamination of the eye with concentrations of vinblastine sulfate used clinically.  If accidental contamination occurs, severe irritation (or, if the drug was delivered under pressure, even corneal ulceration) may result.  The eye should be washed with water immediately and thoroughly.

Prior to the use of the drug, patients should be advised of the possibility of untoward symptoms

In general, the incidence of adverse reactions attending the use of vinblastine sulfate appears to be related to the size of the dose employed.  With the exception of epilation, leukopenia and neurologic side effects, adverse reactions generally have not persisted for longer than 24 hours.  Neurologic side effects are not common; but when they do occur, they often last for more than 24 hours.  Leukopenia, the most common adverse reaction, is usually the dose-limiting factor.

The following are manifestations that have been reported as adverse reactions, in decreasing order of frequency.  The most common adverse reactions are underlined:

Leukopenia

Alopecia

Constipation

Treatment with vinca alkaloids has resulted rarely in both vestibular and auditory damage to the eighth cranial nerve.  Manifestations include partial or total deafness which may be temporary or permanent, and difficulties with balance including dizziness, nystagmus and vertigo.  Particular caution is warranted when vinblastine sulfate is used in combination with other agents known to be ototoxic such as the platinum-containing oncolytics.

Hypertension

Malaise, bone pain,

pain in tumor-containing tissue

jaw pain

Nausea and vomiting usually may be controlled with ease by antiemetic agents.  When epilation develops, it frequently is not total; and, in some cases, hair regrows while maintenance therapy continues.

Extravasation during intravenous injection may lead to cellulitis and phlebitis.  If the amount of extravasation is great, sloughing may occur.

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Reference

This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"

While we update our database periodically, we cannot guarantee it is always updated to the latest version.

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Professional

Clonazepam Description Each single-scored tablet, for oral administration, contains 0.5 mg, 1 mg, or 2 mg Clonazepam, USP, a benzodiazepine. Each tablet also contains corn starch, lactose monohydrate, magnesium stearate, microcrystalline cellulose, and povidone. Clonazepam tablets USP 0.5 mg contain Yellow D&C No. 10 Aluminum Lake. Clonazepam tablets USP 1 mg contain Yellow D&C No. 10 Aluminum Lake, as well as FD&C Blue No. 1 Aluminum Lake. Chemically, Clonazepam, USP is 5-(o-chlorophenyl)-1,3-dihydro-7-nitro-2H-1,4-benzodiazepin-2-one. It is a light yellow crystalline powder. It has the following structural formula: C15H10ClN3O3 M.W. 315.72
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Tips

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Interactions

Interactions

A total of 440 drugs (1549 brand and generic names) are known to interact with Imbruvica (ibrutinib). 228 major drug interactions (854 brand and generic names) 210 moderate drug interactions (691 brand and generic names) 2 minor drug interactions (4 brand and generic names) Show all medications in the database that may interact with Imbruvica (ibrutinib).