Oncovin

Dosage Forms & Strengths

injectable solution

• 1mg/mL

Acute Leukemia

1.4 mg/m² IV qWeek 

Combination Therapy

Cancers

• Hodgkin's Disease, Non Hodgkin's Malignant Lymphomas, Rhabdomyosarcoma, Neuroblastoma, and Wilm's Tumor
• Consult dose modifications in multi-drug regimens

Uveal Melanoma (Orphan)

Indicated for metastatic uveal melanoma

Orphan indication sponsor

• Hana Biosciences, Inc; 7000 Shoreline Court; Suite 370; South San Francisco, CA 94080

Renal Impairment

Dose adjustment not necessary

Hepatic Impairment

Decrease dose 50% if direct bilirubin >3 mg/dL [51 umol/L]

Monitor: CBC

Other Indications & Uses

ALL, AML, CML, Hodgkin's disease, NHL, neuroblastoma, sarcomas, small cell lung cancer, Wilms' tumor, brain tumors

Off-label: breast cancer, idiopathic thrombocytopenic purpura, Kaposi's sarcoma, bladder cancer

Dosage Forms & Strengths

injectable solution

• 1mg/mL

Acute Leukemia

2 mg/m² IV qWeek 

<10 kg: 0.05 mg/kg/dose IV qWeek

>10 kg: 1.5-2 mg/m²/dose

Combination Therapy

Cancers

• Hodgkin's Disease, Non Hodgkin's Malignant Lymphomas, Rhabdomyosarcoma, Neuroblastoma, and Wilm's Tumor
• Consult dose modifications in multi-drug regimens

Administration

Stool softeners or stimulant laxatives may ease severe constipation

APAP or opioid may ease jaw pain

Other Information

Hepatic Impairment

• Decr. dose 50% if direct bilirubin >3 mg/dL [51 umol/L]

Monitor: CBC

Before using vincristine, tell your doctor or pharmacist if you are allergic to it or to vincristine liposomal; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: nerve/muscle problems (such as numbness/tingling/pain due to neuropathy, demyelinating conditions including Charcot-Marie-Tooth syndrome), liver disease, radiation treatment to the liver, decreased bone marrow function, blood disorders, current infection.This medication can make you more likely to get infections or may worsen any current infections. Therefore, wash your hands well to prevent the spread of infection. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Consult your doctor if you have been exposed to an infection or for more details.Do not have immunizations/vaccinations without the consent of your doctor. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.This drug may make you dizzy or tired or cause numbness in your hands/feet. Do not drive, use machinery, or do any activity that requires alertness or a sense of touch until you are sure you can perform such activities safely. Limit alcoholic beverages.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Children may be more sensitive to the effects of this drug, especially slowed movement of the gut that may cause vomiting and constipation.Elderly patients who also take drugs that may cause difficult urination as a side effect may be more sensitive to the effects of this drug on the kidneys (urinary retention). Consult your doctor for more details. See also Drug Interactions.This medication may reduce fertility in men and women. Consult your doctor for more details.This medication is not recommended for use during pregnancy. It may harm an unborn baby. Consult your doctor for more details and to discuss reliable forms of birth control. It is recommended that men and women use 2 effective forms of birth control (e.g., condoms, birth control pills) while using this medication and for some time afterwards. If you become pregnant or think you may be pregnant, tell your doctor immediately.It is not known whether this drug passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• medications that block a protein in the body (CYP3A4) such as some macrolide antibiotics (clarithromycin, telithromycin), some HIV protease inhibitors (indinavir, nelfinavir, ritonavir, saquinavir), some HCV protease inhibitors (boceprevir, telaprevir), some azole antifungals (ketoconazole, itraconazole, posaconazole, voriconazole), conivaptan (Vaprisol), delavirdine (Rescriptor), and nefazodone
• vinca alkaloids such as vinblastine, vinorelbine, vincristine, and vindesine

This is not a complete list of Oncovin drug interactions. Ask your doctor or pharmacist for more information.

Before receiving this medication, tell your doctor about all of your medical conditions. Especially tell your doctor if:

• you are allergic to any ingredient in Oncovin
• you suffer from any diseases affecting the nerves or muscles
• you are pregnant or breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Since this medication is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

Vincristine is injected into a vein through an IV. A healthcare provider will give you this injection.

Vincristine is usually given once per week. Follow your doctor's instructions.

Tell your caregivers if you feel any burning, pain, or swelling around the IV needle when the medicine is injected.

Vincristine can cause severe constipation. You may be given medication to prevent constipation while you are receiving this medicine. Use all medications as directed by your doctor.

You may need frequent medical tests to be sure this medication is not causing harmful effects. Your cancer treatments may be delayed based on the results of these tests.

Antineoplastic agent; vinca alkaloid.a 135 140

Distribution

Extent

Distribution of vincristine and its metabolites not fully characterized; following IV administration, the drug is rapidly and widely distributed.100 101 102 103 104

Following rapid IV injection, rapidly and extensively distributed into bile.103

Following rapid IV injection, vincristine and its metabolites (and/or decomposition products) cross the blood-brain barrier poorly, generally do not appear in the CSF in cytotoxic concentrations.102

Not known whether vincristine and its metabolites are distributed into milk.a

Elimination

Metabolism

Not clearly determined; apparently extensively metabolized, probably in the liver by CYP microsomal enzymes, including CYP3A,131 but extent of metabolism is not clear because vincristine also apparently undergoes decomposition in vivo.100 103

Elimination Route

Vincristine and its metabolites (and/or decomposition products) are excreted principally in feces via biliary elimination (30% within 24 hours and 70% within 72 hours) and to lesser extent in urine (about 10% within 24 hours).100 103 104

Half-life

19–155 hours.131

Special Populations

In patients with hepatic impairment, metabolism of vincristine may be decreased.102 103 131 Only small amounts of vincristine are removed by hemodialysis.131

Storage

Parenteral

Injection

2–8°C;131 protect from light.a

Doses of 0.5, 1, 2, or 3 mg of vincristine sulfate diluted in 25 or 50 mL of 0.9% sodium chloride injection in small-volume IV bags (i.e., minibags) or in 20 mL of 0.9% sodium chloride injection in a 30-mL syringe remained stable when stored for 7 days at 4°C followed by 2 days at 23°C.199

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Manufacturers state that injection should not be diluted in solutions that alter pH outside range of 3.5–5.5 and do not recommend mixing with solutions other than 0.9% sodium chloride injection or 5% dextrose injection.131

Solution CompatibilityHID

Compatible
Dextrose 5% in water
Ringer’s injection, lactated
Sodium chloride 0.9%

Drug Compatibility Admixture CompatibilityHID

Compatible
Bleomycin sulfate
Cytarabine
Doxorubicin HCl
Doxorubicin HCl with etoposide phosphate
Doxorubicin HCl with ondansetron HCl
Fluorouracil
Methotrexate sodium
Variable
Doxorubicin HCl with etoposide

Y-Site CompatibilityHID

Compatible
Allopurinol sodium
Amifostine
Amphotericin B cholesteryl sulfate complex
Anidulafungin
Aztreonam
Bleomycin sulfate
Caspofungin acetate
Cisplatin
Cladribine
Cyclophosphamide
Doxorubicin HCl
Doxorubicin HCl liposome injection
Droperidol
Etoposide phosphate
Filgrastim
Fludarabine phosphate
Fluorouracil
Gemcitabine HCl
Granisetron HCl
Heparin sodium
Leucovorin calcium
Linezolid
Melphalan HCl
Methotrexate sodium
Metoclopramide HCl
Mitomycin
Ondansetron HCl
Oxaliplatin
Paclitaxel
Pemetrexed disodium
Piperacillin sodium–tazobactam sodium
Sargramostim
Teniposide
Thiotepa
Topotecan HCl
Vinblastine sulfate
Vinorelbine tartrate
Incompatible
Furosemide
Idarubicin HCl
Sodium bicarbonate