Vinblastine extravasation

Vinblastine-use 50% of dose for bilirubin > 3.0 vesicant-avoid extravasation watch for neurotoxicity... 

Vinblastine -vinca alkaloid inhibits tubulin polymerization G2 phase specific -bone marrow suppression -vesicant if extravasated -nausea and vomiting -constipation (often secondary to neuropathy induced ileus) -neuropathy (jaw pain, peripheral neuropathy, autonomic neuropathy) -SIADH -tumor pain... 

As opposed to vinblastine, vincristine s hematologic effects are minimal. In fact, thrombocytosis is often seen following vincristine administration (10,25,26). Alopecia occurs in from 13 to 22% of patients given full doses of vincristine. Cutaneous effects are, however, more unusual and are a practical problem only when the drug is extravasated (21,22). The spectrum of vindesine side effects is similar to that seen with vincristine. 

Neurological toxicity is the major dose-limiting toxicity of vincristine, whereas bone marrow toxicity is limiting for vinblastine. Severe neutropenia occurs in approximately half of the patients receiving vinorelbine. Severe leukopenia is the major side effect of vinblastine. These drugs are potent local blistering agents and will produce tissue necrosis if extravasated. 

Among several antidotes for the treatment of vinca alkaloid extravasation, hyaluronidase is the most effective (79). Seven patients with extravasation of vincristine, vinblastine, or vinorelbine received hyaluronidase 250 units diluted in 6 ml of 0.9% saline, through the indwelling needle or, when the needle had been already removed, as six subcutaneous injections around the extravasation site. None developed skin necrosis. Local mild skin warming in order to produce local vasodilatation may have an additional beneficial effect, but should be avoided when simultaneous extravasation of a vinca alkaloid and an anthra-cycline is suspected, because local warming can worsen the anthracycline-associated local reaction, whereas local cooling, which is generally beneficial in anthracycline-related extravasation alone, can worsen skin necrosis due to vinca alkaloids (76). 

Myelosuppression may be delayed and prolonged (up to 8 weeks) mucositis moderately emetogenic extravasation severe vesicant pulmonary toxicity pneumonitis, fibrosis (worse with concurrent vincristine or vinblastine) hemolytic anemia and uremic syndrome... 

The nadir of the leukopenia that follows the administration of vinblastine usually occurs within 7-10 days, after which recovery ensues within 7 days. Other toxic effects of include neurological manifestations as described above. GI disturbances including nausea, vomiting, anorexia, and diarrhea may be encountered. The syndrome of inappropriate secretion of antidiuretic hormone has been reported. Loss of hair, stomatitis, and dermatitis occur infrequently. Extravasation during injection may lead to cellulitis and phlebitis. Local injection of hyaluronidase and application of moderate heat to the area may be of help by dispersing the drug. 

MAINTAINING TISSUE INTEGRITY. Some antineoplastic dni are vesicants (ie, tliey cause tissue necrosis if tliey infiltrate or extravasate out of tlie blood vessel and into tlie soft tissue). If extravasation occurs, underlying tissue is damaged. The damage can be severe, causing physical deforarity or loss of vascularity or tendon function. Examples of vesicant dni are daunorubicin, doxorubicin, and vinblastine... 

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