Vincristine emetogenicity

Aprepitant (Emend) [Centrally Acting Antiemetic] Uses Pre-vents N/V assoc w/ emetogenic CA chemo (eg, cisplatin) (use in combo w/ other antiemetics) Action Substance P/neurokinin l(NKi) receptor antagonist Dose 125 mg PO day 1, 1 h before chemo, then 80 mg PO qAM days 2 3 Caution [B, /-] Contra Use w/ pimozide, Disp Caps SE Fatigue, asthenia, hiccups Interactions T Effects W/ clarithromycin, diltiazem, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, troleandomycin T effects OF alprazolam, astem-izole, cisapride, dexamethasone, methylprednisolone, midazolam, pimozide, terfe-nadine, triazolam, chemo agents, eg, docetaxel, etoposide, ifosfamide, imatinib, irinotecan, paclitaxel, vinblastine, vincristine, vinorelbine i effects W/ paroxetine,... 

Lomustine (CCNU) is used to treat lymphomas and some solid tumors, particularly brain tumors, often in combination with procarbazine and vincristine (2). Nimustine (ACNU) is used to treat mahgnant glioma (3). Streptozocin (streptozotocin) is produced by Streptomyces achromogenes. It is used to treat metastatic islet cell carcinoma of the pancreas, but because of its high nephrotoxic and emetogenic potential should be reserved for patients with symptomatic or progressive disease. 

Compared with vincristine, vinblastine and vinorelbine are more likely to cause myelosuppression (considered to be the dose-limiting toxicity of these agents). In addition, vincristine has very low emetogenic potential compared with vinblastine and vinorelbine, which present a more moderate risk. 

Myelosuppression (neutropenia) neurotoxicity peripheral neuropathy (less common than with vincristine) constipation low back pain mild emetogen vesciant causes painful phlebitis with administration alopecia is uncommon... 

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... 

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