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ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS › ANTINEOPLASTIC AGENTS › PLANT ALKALOIDS AND OTHER NATURAL PRODUCTS › Vinca alkaloids and analogues
vincristine
L01CA02
Forms & Strengths
- Intravenous Solution: 1 mg/mL
Adult Dosing
- Conventional: 1.4 mg/m² (maximum 2 mg per dose) IV once weekly
- Liposomal (Marqibo): 2.25 mg/m² IV once every 7 days (no maximum cap)
Pediatric Dosing
- Conventional (>10 kg or >1 m²): 1.5 to 2 mg/m² IV once weekly
- Conventional (≤10 kg or ≤1 m²): 0.05 mg/kg IV once weekly
- Maximum single dose: 2 mg
Indications
- Acute lymphoblastic leukemia (ALL)
- Hodgkin and non-Hodgkin lymphomas
- Wilms tumor
- Neuroblastoma
- Rhabdomyosarcoma
Mechanism of Action
- Binds to tubulin dimers, inhibiting assembly of microtubules
- Arrests cell division in metaphase by disrupting the mitotic spindle
- Causes metaphase arrest and cell death
Contraindications
- Intrathecal administration (fatal)
- Demyelinating form of Charcot-Marie-Tooth syndrome
- Severe hypersensitivity to vincristine
Adverse Reactions
- Peripheral neuropathy (sensory-motor, dose-limiting)
- Autonomic neuropathy (constipation, paralytic ileus, urinary retention)
- SIADH (hyponatremia)
- Myelosuppression (mild to moderate)
- Severe local tissue necrosis upon extravasation
Drug Interactions
- CYP3A4 inhibitors (e.g., azole antifungals, macrolides) increase toxicity
- CYP3A4 inducers (e.g., phenytoin, rifampin) decrease efficacy
- L-asparaginase reduces hepatic clearance, increasing neurotoxicity
- Concomitant neurotoxic agents increase peripheral neuropathy risk
Curated Content: Needs Vetting Before Put to Clinical Use