Vincristine extravasation

Vincristine—vesicant-avoid extravasation cumulative neurotoxicity—may produce severe constipation -maximum 2 mg per administration... 

Doxorubicin—monitor cumulative dose for cardiac toxicity (not to exceed 550 mg/M2 or 450 mg/M2 with prior chest radiotherapy) vesicant—avoid extravasation use 50% for bilirubin 1.5-3.0 use 25% for bilirubin >3.0 Vincristine—vesicant—avoid extravasation cumulative neurotoxicity—may produce severe constipation maximum 2 mg per administration ... 

Vincristine -vinca alkaloid inhibits tubulin polymerization G2 phase specific -neurotoxicity—peripheral neuropathy -vesicant if extravasated -nausea and vomiting -bone marrow suppression—mild -transient transaminase elevation -constipation (often secondary to neuropathy induced ileus) —intrathecal injection is ALWAYS FATAL... 

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. 

Vincristine Tissue damage with extravasation Peripheral neuropathy alopecia mild bone marrow depression constipation paralytic ileus jaw pain inappropriate ADH secretion optic atrophy... 

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... 

Precautions also should be used to avoid extravasation during intravenous administration of vincristine. 

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