Vinca alkaloid, microtubule assembly inhibitor
ATC code: L01CA02 (Vincristine)
Brand names
Oncovin, Vincasar, Marqibo (liposomal)
Binds tubulin and blocks mitotic spindle microtubule assembly – cells arrest at metaphase and undergo apoptosis. Selective for rapidly dividing tumour cells but also affects neurons (neurotoxicity is the main dose-limiting adverse effect). Metabolised by CYP3A4, excreted via P-glycoprotein. Combination with CYP3A4 inhibitors causes fatal neurotoxicity.
First line
Vincristine is a first-line chemotherapy component in acute lymphoblastic leukaemia in children and adults, non-Hodgkin lymphoma and neuroblastoma. ESMO and SEHH include vincristine in CHOP, COP, ABVD regimens and ALL induction. Strictly IV administration (intrathecal route is FATAL). Dose capped at 2 mg to avoid neurotoxicity.
3 pairs found. Sorted from critical to minor.
Mechanism
Itraconazole inhibits CYP3A4 and P-gp. Vincristine rises 5+ fold – fatal neurotoxicity with motor deficit and autonomic neuropathy.
Symptoms
Severe peripheral neuropathy, paralytic ileus, autonomic disorders.
Management
Combination contraindicated. Alternative antifungal – micafungin or caspofungin.
Mechanism
Same CYP3A4 + P-gp pharmacodynamics. Fatal neurotoxicity.
Symptoms
Severe neuropathy.
Management
Combination contraindicated.
Mechanism
Strong CYP3A4 inhibitor. Fatal neurotoxicity.
Symptoms
Severe neuropathy.
Management
Combination contraindicated.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Contraindicated in first trimester. In second and third trimesters use only by multidisciplinary decision for pregnancy-associated cancer.
Breastfeeding contraindicated.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Vincristine is evaluated for the following indications with varying evidence strength: Acute leukemia (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Vincristine (≥ 1 in 100): Peripheral neuropathy, Constipation (may be severe), Alopecia, Myalgia. See the Safety section for uncommon and serious reactions.
FDA category D. Contraindicated in first trimester. In second and third trimesters use only by multidisciplinary decision for pregnancy-associated cancer.
Breastfeeding contraindicated.
Vincristine is contraindicated in: Intrathecal administration (FATAL); Itraconazole, posaconazole, voriconazole, ritonavir, cobicistat (fatal neurotoxicity); Demyelinating Charcot-Marie-Tooth syndrome; Pregnancy (first trimester). Full list in the Safety section.