An alkaloid, C46H56N4O10, obtained from the Madagascar periwinkle and used as an antineoplastic drug for a variety of neoplasms.
[New Latin Vinca, periwinkle genus; see vinca + Latin crista, crest; see crest + -INE2.]
vincristine
Dictionary:
vin·cris·tine (vĭn-krĭs'tēn')  |
| 5min Related Video: vincristine |
| Oncology Encyclopedia: Vincristine |
Key Terms: Alkaloid, Microtubles.
Definition
Vincristine is a drug used to treat certain types of cancer. Vincristine is available under the trade names Oncovin, Vincasar, and Vincrex, and may also be referred to as vincristine sulfate, or VCR. The drug was previously known as leurocristine, or LCR.
Purpose
Vincristine is an antineoplastic agent used to treat leukemia, Hodgkin's disease, malignant lymphomas, neuroblastoma, rhabdomyosarcoma, Wilms' tumor, as well as other cancers.
Description
Vincristine was approved by the Food and Drug Administration (FDA) in 1984.
Vincristine is a naturally occurring compound that is extracted from periwinkle plants. It belongs to a group of chemicals called alkaloids. The chemical structure and biological action of vincristine is similar to vinblastine and vinorelbine.
Vincristine prevents the formation of microtubules in cells. One of the roles of microtubules is to aid in the replication of cells. By disrupting this function, vincristine inhibits cell replication, including the replication of the cancer cells.
Vincristine is used in combination with other drugs to treat leukemia. It is also used in combination with other drugs, such as mechlorethamine, procarbazine and prednisone, to treat Hodgkin's disease. It is also used in combination to treat non-Hodgkin's lymphomas, neuroblastoma, rhabdomyosarcoma, and Wilms' tumor. Vincristine is also used less frequently to treat other types of cancer.
Recommended Dosage
Vincristine is administered by intravenous injection once per week. The initial dose of vincristine may be adjusted upward or downward depending on patient tolerance to the toxic side effects of treatment.
Precautions
Vincristine must only be administered by individuals experienced in the use of this cancer chemotherapeutic agent. Vincristine must only be administered intravenously, that is, directly into a vein. Accidental administration of vincristine into the spinal cord fluid is a medical emergency that may result in death. Vincristine has a low therapeutic index. It is unlikely there will be therapeutic benefit without toxic side effects. Certain complications can only be managed by a physician experienced in the use of cancer chemotherapeutic agents.
Because vincristine is administered intravenously and is extremely irritating, the site of infusion and surrounding tissue should be monitored for signs of inflammation.
Some experts recommend blood tests to ensure that the number of white blood cells is adequate for treatment to continue. Infections should also be controlled before vincristine treatment starts.
Vincristine is not recommended for use in patients with the demyelinating form of Charcot-Marie-Tooth syndrome.
Vincristine is not recommended for patients receiving radiation therapy though a port in the liver.
Vincristine may cause harm to a fetus when administered to pregnant women. Only in life-threatening situations, should this treatment be used during pregnancy. Women of childbearing age are advised not to become pregnant during treatment. Women should stop nursing before beginning treatment, due to the potential for serious adverse side effects in the nursing infants.
Side Effects
The side effects of vincristine treatment are usually related to the dose of drug and are generally reversible. Toxic side effects may be more common in patients with poor liver function.
Toxicity of the nervous system is the principal adverse side effect associated with vincristine treatment. This toxicity may cause numbness, pain, especially of the jaw, tingling, and headaches. Lengthy treatment at high doses may cause even more severe toxicity. Constipation is a common side effect. Laxatives and enemas are typically used to prevent severe constipation. Shortness of breath is a potentially severe side effect that patients should report to their doctor. Additional side effects, including rash, an increase or decrease in blood pressure, dizziness, nausea and vomiting, hearing impairment, and hair loss (alopecia) may occur.
Interactions
Drugs that may alter the metabolism of vincristine, particularly itraconazole, should be used with caution due to the potential for interactions. Hearing impairment may be enhanced when vincristine is used with other drugs that affect the ear. These drugs include platinum-containing antineoplastic agents, such as cisplatin. Seizures have been reported in patients taking vincristine and phenytoin. The doses of vincristine and phenytoin may need to be adjusted to decrease the chance of this problem.
| Drug Info: Vincristine |
Brand names: Oncovin®Vincasar® PFS
Chemical formula:
Vincristine Sulfate Solution for injection
What is this medicine?
VINCRISTINE is a chemotherapy drug. It slows the growth of cancer cells. This medicine is used to treat many types of cancer like Hodgkin's disease, leukemia, non-Hodgkin's lymphoma, neuroblastoma (brain cancer), rhabdomyosarcoma, and Wilms' tumor.
This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.
What should I tell my health care provider before I take this medicine?
They need to know if you have any of these conditions:
•blood disorders
•gout
•infection (especially chickenpox, cold sores, or herpes)
•kidney disease
•liver disease
•lung disease
•nervous system disease like Charcot-Marie-Tooth (CMT)
•recent or ongoing radiation therapy
•an unusual or allergic reaction to vincristine, other chemotherapy agents, other medicines, foods, dyes, or preservatives
•pregnant or trying to get pregnant
•breast-feeding
How should I use this medicine?
This drug is given as an infusion into a vein. It is administered in a hospital or clinic by a specially trained health care professional. If you have pain, swelling, burning, or any unusual feeling around the site of your injection, tell your health care professional right away.
Talk to your pediatrician regarding the use of this medicine in children. While this drug may be prescribed for selected conditions, precautions do apply.
Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.
What may interact with this medicine?
Do not take this medicine with any of the following medications:
•itraconazole
•mibefradil
•voriconazole
This medicine may also interact with the following medications:
•cyclosporine
•erythromycin
•fluconazole
•ketoconazole
•medicines for HIV like delavirdine, efavirenz, nevirapine
•medicines for seizures like ethotoin, fosphenotoin, phenytoin
•medicines to increase blood counts like filgrastim, pegfilgrastim, sargramostim
•other chemotherapy drugs like cisplatin, L-asparaginase, methotrexate, mitomycin, paclitaxel
•pegaspargase
•vaccines
•zalcitabine, ddC
Talk to your doctor or health care professional before taking any of these medicines:
•acetaminophen
•aspirin
•ibuprofen
•ketoprofen
•naproxen
This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.
What should I watch for while using this medicine?
Your condition will be monitored carefully while you are receiving this medicine. You will need important blood work done while you are taking this medicine.
This drug may make you feel generally unwell. This is not uncommon, as chemotherapy can affect healthy cells as well as cancer cells. Report any side effects. Continue your course of treatment even though you feel ill unless your doctor tells you to stop.
In some cases, you may be given additional medicines to help with side effects. Follow all directions for their use.
Call your doctor or health care professional for advice if you get a fever, chills or sore throat, or other symptoms of a cold or flu. Do not treat yourself.
Avoid taking products that contain aspirin, acetaminophen, ibuprofen, naproxen, or ketoprofen unless instructed by your doctor. These medicines may hide a fever.
Do not become pregnant while taking this medicine. Women should inform their doctor if they wish to become pregnant or think they might be pregnant. There is a potential for serious side effects to an unborn child. Talk to your health care professional or pharmacist for more information. Do not breast-feed an infant while taking this medicine.
Men may have a lower sperm count while taking this medicine. Talk to your doctor if you plan to father a child.
What side effects may I notice from receiving this medicine?
Side effects that you should report to your doctor or health care professional as soon as possible:
•allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
•breathing problems
•confusion or changes in emotions or moods
•constipation
•cough
•mouth sores
•muscle weakness
•nausea and vomiting
•pain, swelling, redness or irritation at the injection site
•pain, tingling, numbness in the hands or feet
•problems with balance, talking, walking
•seizures
•stomach pain
•trouble passing urine or change in the amount of urine
Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
•diarrhea
•hair loss
•jaw pain
•loss of appetite
This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Where should I keep my medicine?
This drug is given in a hospital or clinic and will not be stored at home.
Last updated: 7/1/2002
Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.
| Veterinary Dictionary: vincristine |
A vinca alkaloid; the sulfate is used as an antineoplastic usually in combination with other antineoplastic agents.
| Wikipedia: Vincristine |
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Vincristine
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| Systematic (IUPAC) name | |
| methyl (1R,9R,10S,11R,12R,19R)-11-(acetyloxy)-12-ethyl-4-
[(13S,15S,17S)-17-ethyl-17-hydroxy-13-(methoxycarbonyl)-1,11-diazatetracyclo[13.3.1.0 4,12.05,10]nonadeca-4(12),5,7,9-tetraen-13-yl]-8-formyl-10-hydroxy-5-methoxy-8, 16-diazapentacyclo[10.6.1.01,9.02,7. 016,19]nonadeca-2,4,6,13-tetraene-10-carboxylate |
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| Identifiers | |
| CAS number | 57-22-7 |
| ATC code | L01CA02 |
| PubChem | 5978 |
| DrugBank | APRD00495 |
| ChemSpider | 5758 |
| Chemical data | |
| Formula | C46H56N4O10 |
| Mol. mass | 824.958 g/mol |
| Pharmacokinetic data | |
| Bioavailability | n/a |
| Protein binding | ~75% |
| Metabolism | Hepatic |
| Half life | 19 to 155 hours |
| Excretion | Mostly biliary, 10% in urine |
| Therapeutic considerations | |
| Pregnancy cat. | |
| Legal status |
℞ Prescription only |
| Routes | Exclusively intravenous |
Vincristine (brand name, Oncovin), also known as leurocristine, is a vinca alkaloid from the Catharanthus roseus (Madagascar periwinkle), formerly Vinca rosea and hence its name. It is a mitotic inhibitor, and is used in cancer chemotherapy.
Contents |
Mode of action
Tubulin is a structural protein which polymerizes to form microtubules. The cell cytoskeleton and mitotic spindle, amongst other things, are made of microtubules. Vincristine binds to tubulin dimers, inhibiting assembly of microtubule structures. Disruption of the microtubules arrests mitosis in metaphase. The vinca alkaloids therefore affect all rapidly dividing cell types including cancer cells, but also intestinal epithelium and bone marrow.
Uses
Vincristine is delivered via intravenous infusion for use in various types of chemotherapy regimens. Its main uses are in non-Hodgkin's lymphoma as part of the chemotherapy regimen CHOP, Hodgkin's lymphoma as part of MOPP, COPP, BEACOPP, or the less popular Stanford V chemotherapy regimen, in acute lymphoblastic leukemia, and in treatment for nephroblastoma (Wilms tumor, a kidney tumor common in children). Vincristine is occasionally used as an immunosuppressant, for example, in treating thrombotic thrombocytopenic purpura (TTP) or chronic idiopathic thrombocytopenic purpura (ITP). It is used in combination with prednisone to treat childhood leukemia.
Side effects
The main side-effects of vincristine are peripheral neuropathy, hyponatremia, constipation and hair loss.
Peripheral neuropathy can be severe, and hence a reason to avoid, reduce, or stop the use of vincristine. One of the first symptoms of peripheral neuropathy is foot drop: a person with a family history of foot drop and/or Charcot-Marie-Tooth disease (CMT) may benefit from genetic testing for CMT before taking vincristine.[1]
Accidental injection of vinca alkaloids into the spinal canal (intrathecal administration) is highly dangerous, with a mortality rate approaching 100%. The medical literature documents cases of ascending paralysis due to massive encephalopathy and spinal nerve demyelination, accompanied by intractable pain, almost uniformly leading to death; a handful of survivors were left with devastating neurological damage with no hope of recovery. Rescue treatments consist of washout of the cerebrospinal fluid and administration of protective medications.[2] A significant series of inadvertent intrathecal vincristine administration occurred in China in 2007 when batches of cytarabine and methotrexate (both often used intrathecally) manufactured by the company Shanghai Hualian were found to be contaminated with vincristine.[3]
History
Having been used as a folk remedy for centuries, studies in the 1950s revealed that C. roseus contained 70 alkaloids, many of which are biologically active. While initial studies for its use in diabetes mellitus were disappointing, the discovery that it caused myelosuppression (decreased activity of the bone marrow) led to its study in mice with leukemia, whose lifespan was prolonged by the use of a vinca preparation. Treatment of the ground plant with Skelly-B defatting agent and an acid benzene extract led to a fraction termed "fraction A". This fraction was further treated with aluminium oxide, chromatography, trichloromethane, benz-dichloromethane and separation by pH to yield vincristine.[4]
Vincristine was approved by the United States Food and Drug Administration (FDA) in July 1963 as Oncovin. The drug was initially discovered by a team lead by Dr. J.G. Armstrong; it was then marketed by Eli Lilly and Company.
Suppliers
Three generic drug makers supply vincristine in the United States - APP, Mayne, and Sicor (Teva).
See also
References
- ^ Graf WD, Chance PF, Lensch MW, Eng LJ, Lipe HP, Bird TD (1996). "Severe vincristine neuropathy in Charcot-Marie-Tooth disease type 1A". Cancer 77 (7): 1356–62. doi:. PMID 8608515.
- ^ Qweider M, Gilsbach JM, Rohde V (2007). "Inadvertent intrathecal vincristine administration: a neurosurgical emergency. Case report". J Neurosurg Spine 6 (3): 280–3. doi:. PMID 17355029.
- ^ Jake Hooker and Walt Bogdanich, Tainted Drugs Tied to Maker of Abortion Pill, New York Times, January 31, 2008
- ^ Johnson IS, Armstrong JG, Gorman M, Burnett JP (01 Sep 1963). "The vinca alkaloids: a new class of oncolytic agents". Cancer Res 23 (8 Part 1): 1390–427. PMID 14070392. http://cancerres.aacrjournals.org/cgi/reprint/23/8_Part_1/1390.
External links
- Vincristine chemotherapy
- Vincristine and vinblastine
- Description and Natural History of the Periwinkle
- The Boger Route to (-)-Vindoline
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 | Dictionary. The American Heritage® Dictionary of the English Language, Fourth Edition Copyright © 2007, 2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company. All rights reserved. Read more |
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| Oncology Encyclopedia. Gale Encyclopedia of Cancer. Copyright © 2006 by The Gale Group, Inc. All rights reserved. Read more |
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| Drug Info. Gold Standard. Copyright © 2008 by Gold Standard. All rights reserved. Read more |
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| Veterinary Dictionary. Saunders Comprehensive Veterinary Dictionary 3rd Edition. Copyright © 2007 by D.C. Blood, V.P. Studdert and C.C. Gay, Elsevier. All rights reserved. Read more |
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Mentioned in
- VAC
- VMC
- MOPP
- Catharanthus roseus (botany)
- antimitotic drug (pharmacology)
- Induction therapy (in medicine)
- cytotoxic
- vinca alkaloids
- Wilms' Tumor: Treatment
- Ototoxicity: Causes and symptoms
- Uric Acid Tests: Precautions
- Doxorubicin
- dogbane (plant, herb)
- antineoplastic
