Vincristine-Teva solution for injection 1mg / ml, 2ml — Made in Czech Republic — Free Delivery
Antineoplastic preparation, an alkaloid derived from pink periwinkle (vinca rosea l.). the antiblastoma and cytotoxic effect of vincristine is due to a violation of the formation of microtubules and mitotic spindle, as well as a violation of the synthesis of DNA and RNA in cells.
In 15-30 minutes after intravenous administration, more than 90% of the preparation is redistributed from the blood to the tissues with which it is firmly but reversibly bound. The preparation poorly penetrates the BBB. The kinetics of the preparation after intravenous jet injection is three-phase. The half-life in the first and second phases is 5 minutes and 2.3 hours, respectively; the duration of the half-life in the terminal phase is subject to significant fluctuations (from 19 to 155 hours), averaging 85 hours. The preparation is excreted mainly in the feces (about 80%), a smaller part in the urine (10–20%). The pharmacokinetics of vincristine may change in the presence of impaired liver function.
Acute leukemias, lymphogranulomatosis, non-Hodgkin's lymphomas, reticulosarcoma, lymphosarcoma, rhabdomyosarcoma, neuroblastoma, Wilms tumor.
Vincristine is administered intravenously only. ampouled solution of vincristine can be additionally diluted with water for injection or isotonic solution of sodium chloride. when administered, extravasation of the preparation should be avoided. the preparation is administered at intervals of 1 week. adults are usually prescribed at the rate of 1.4 mg per 1 m2 of body surface, the maximum dose is 2 mg / m2. in case of leukemia, it is prescribed at a dose of 0.025–0.075 mg / kg once a week. in the treatment of other malignant tumors, the recommended dose is 0.025 mg / kg once a week. for maintenance therapy, the preparation can be administered weekly at a dose of 0.005–0.01 mg / kg. Vincristine can be used in combination with other anticancer preparations.
Children are prescribed at the rate of 2 mg per 1 m2 of body surface. The dose of the preparation for infants is calculated taking into account body weight: for the induction of remission in acute leukemia, a dose of 0.05–0.15 mg / kg is prescribed once a week. In acute leukemia in children, the following scheme is used: the first dose is 0.05 mg / kg, the second dose is 0.075 mg / kg, the third dose is 0.1 mg / kg, and the fourth dose is 0.125 mg / kg. The maximum dose is 0.15 mg / kg once a week. After achieving remission, the preparation is prescribed in a maintenance dose of 0.05–0.075 mg / kg once a week.
In patients with serum bilirubin levels above 0.03 mg / ml, the dose of vincristine is halved. Patients receiving radiation therapy to the liver area are not prescribed vincristine.
When vincristine is combined with L-asparaginase, it is administered 12-24 hours before enzyme administration; the introduction of L-asparaginase before the introduction of vincristine can reduce its elimination in the bile.
Hypersensitivity to the preparation, diseases of the central nervous system and peripheral nerves.
Possible headache, neuropathy, peripheral neuritis, sensory disturbances, damage to the cranial nerves, transient blindness and optic nerve atrophy, gait disturbances, loss of deep tendon reflexes, muscle weakness, convulsions, pain in the jaws, pharynx, parotid salivary glands, bones, back, spine and muscles; anemia, leukopenia, thrombocytopenia (less pronounced than when using other antineoplastic agents); constipation, bowel cramps, weight loss, anorexia, nausea, vomiting, aphthous stomatitis, diarrhea, paralytic ileus, small intestinal necrosis and / or its perforation; decreased blood pressure, angina pectoris and myocardial infarction (in patients with previously irradiated mediastinum), polyuria, dysuria and urinary retention due to atony of the bladder, allergic reactions (rash, angioedema, anaphylactic shock), shortness of breath, bronchospasm, fever, alopecia, rarely caused by impaired secretion of antidiuretic hormone (hyponatremia due to increased sodium excretion in the urine), azoospermia, menstrual irregularities.
Treatment with the preparation can only be carried out by an experienced chemotherapist in a specialized hospital. vincristine is administered intravenously only; endolumbar administration is categorically contraindicated (it can be fatal).
With extravasation, soft tissue necrosis may develop; to prevent it, it is recommended to inject the extravasate zone with hyaluronidase or hydrocortisone at a dose of 20–25 mg, and prescribe warming compresses on the affected area. Vincristine is prescribed with caution in the early postoperative period, since a significant part of the intravenous preparation administered can enter the postoperative wound, causing edema, inflammation and local tissue necrosis.
To prevent constipation during treatment with the preparation, appropriate treatment is prescribed (cleansing enemas, laxatives). In some patients (especially in children), during treatment with vincristine, paralytic ileus may develop, which in some cases is masked by the clinic of an acute abdomen; it usually disappears when the administration of vincristine is discontinued and symptomatic treatment is carried out.
The neuro- and hepatotoxic effect of the preparation is more pronounced in infants.
The preparation is a potential teratogenic and carcinogenic agent. The use of vincristine can adversely affect reproductive function. Breastfeeding should be discontinued during preparation treatment.
During treatment, patients need to regularly conduct a study of the fundus and visual fields; at the slightest suspicion of damage to the optic nerve, treatment is stopped. Any complaints of eye pain or decreased visual acuity require a thorough ophthalmologic examination.
To reduce the degree of alopecia during chemotherapy, local hypothermia of the scalp or a tourniquet (pressure helmet) can be used. A pressure bandage on the scalp is not applied in case of leukemia and lymphomas, as well as in the presence of metastases or infiltrates on the scalp.
With the development of leukopenia, further preparation treatment should be approached with caution.
Dyspnea and bronchospasm most often occur when the preparation is combined with mitomycin-C and may require intensive treatment, especially in the presence of initial respiratory failure. These reactions may appear within minutes or hours after administration of vincristine and within 2 weeks after administration of mitomycin. Progressive dyspnea requires discontinuation of vincristine therapy.
Before each administration of vincristine, a study of the composition of the peripheral blood should be carried out. During the induction of remission in the treatment of acute leukemia, the level of uric acid in the blood may increase; this indicator should be monitored during the first 3-4 weeks of treatment and appropriate measures should be taken to prevent neuropathy caused by uric acid diathesis. Laboratory studies are repeated until the indicator normalizes. During treatment with vincristine, the concentration of sodium ions in the blood serum is periodically determined. Hyponatremia develops as a result of a violation of the secretion of antidiuretic hormone and should be corrected by the introduction of isotonic sodium chloride solution.
During treatment with vincristine, systematic ECG monitoring should be performed. In the process of treating children with malignant tumors, it is necessary to monitor their intellectual, emotional state, speech and neurophysiological status.
When working with the preparation, medical personnel should use protective clothing (gloves, gown), as well as glasses and a mask. Pregnant women are not allowed to work with the preparation. If the preparation gets into the eyes, rinse them with plenty of water or isotonic sodium chloride solution.
Intravenous administration of phenytoin or taking it orally during treatment with vincristine reduces the anticonvulsant activity of the preparation and may cause an increase in the number of epileptic seizures. the neurotoxicity of isoniazid increases when it is combined with other neurotoxic preparations (asparaginase, isoniazid, etc.). Vincristine may increase blood uric acid levels and reduce the effectiveness of anti-gout preparations. the simultaneous use of vincristine with other myelodepressant preparations (doxorubicin in combination with prednisolone, etc.) can enhance the myelotoxic effect of the preparation. when vincristine is combined with mitomycin-c, acute respiratory disorders may occur (see above). vincristine can reduce the effectiveness of vaccination when using vaccines from live and inactivated viruses and increase the incidence of side effects of live viral vaccines. regional radiation therapy may increase the peripheral neurotoxicity of vincristine.
In children under the age of 13, a tenfold excess of the dose of the preparation can be fatal. the introduction to children under the age of 13 years of the preparation at a dose of 3-4 mg / m2, and adults - a single dose of 3 mg / m2 or more can cause a serious general condition of the patient. there is no specific antidote. carry out symptomatic and supportive treatment under the control of indicators of water-salt balance, ecg, peripheral blood composition. with the development of generalized seizures, anticonvulsants are used. if necessary, blood transfusions, transfusion of erythrocyte and platelet mass are carried out. calcium folinate is injected intravenously at a dose of 100 mg every 3 hours for 24 hours, and then every 6 hours for at least 48 hours. Hemodialysis is ineffective. in the case of taking vincristine by mouth, gastric lavage is performed, laxatives and activated charcoal are prescribed.
Store in a dark place at a temperature of 2-8 ° C in tightly sealed containers. vincristine sulfate in the form of an injection solution is intended for repeated administration. after using part of the contents of the bottle, the remaining solution can be stored in the refrigerator at a temperature of 2–8 ° C for 14 days.
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