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Vinblastine: Drug information

Vinblastine: Drug information
(For additional information see "Vinblastine: Patient drug information" and see "Vinblastine: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Experienced physician:

This preparation should be administered by individuals experienced in the administration of vinblastine sulfate.

Extravasation:

It is extremely important that the intravenous needle or catheter be properly positioned before any vinblastine sulfate is injected. Leakage into surrounding tissue during intravenous administration of vinblastine may cause considerable irritation. If extravasation occurs, the injection should be discontinued immediately, and any remaining portion of the dose should then be introduced into another vein. Local injection of hyaluronidase and the application of moderate heat to the area of leakage help disperse the drug and are thought to minimize discomfort and the possibility of cellulitis.

Appropriate administration:

For intravenous use only - fatal if given by other routes.

Pharmacologic Category
  • Antineoplastic Agent, Antimicrotubular;
  • Antineoplastic Agent, Vinca Alkaloid
Dosing: Adult

Note: For IV use only; fatal if administered by other routes. The Institute for Safe Medication Practices (ISMP) strongly recommends dispensing vinblastine in a minibag and NOT in a syringe (Ref).

Bladder cancer

Bladder cancer (off-label use):

Locally advanced or metastatic disease:

Dose-dense MVAC regimen: IV: 3 mg/m2 on day 2 every 14 days (in combination with methotrexate, doxorubicin, cisplatin, and growth factor support) until disease progression or unacceptable toxicity (Ref).

MVAC regimen: IV: 3 mg/m2 on days 2, 15, and 22 every 28 days (in combination with methotrexate, doxorubicin, and cisplatin) for up to 6 cycles (Ref) or 3 mg/m2 on days 2, 15, and 22 every 28 days (in combination with methotrexate, doxorubicin, and cisplatin) until disease progression or unacceptable toxicity (Ref) or 3 mg/m2 on days 1, 15, and 22 every 28 days (in combination with methotrexate, doxorubicin, cisplatin, and filgrastim) for up to 6 cycles (Ref).

Neoadjuvant treatment:

Note: Patients with non–organ-confined disease at cystectomy who did not receive cisplatin-based neoadjuvant chemotherapy should be offered an adjuvant cisplatin-based chemotherapy regimen (Ref).

Dose-dense MVAC regimen: IV: 3 mg/m2 on day 1 or 2 every 14 days (in combination with methotrexate, doxorubicin, cisplatin, and pegfilgrastim) for 3 to 4 cycles (Ref).

MVAC regimen: IV: 3 mg/m2 on days 2, 15, and 22 every 28 days (in combination with methotrexate, doxorubicin, and cisplatin) for 3 cycles (Ref).

CMV regimen: IV: 4 mg/m2 on days 1 and 8 every 21 days (in combination with methotrexate, cisplatin, and leucovorin) for 3 cycles (Ref).

Hodgkin lymphoma

Hodgkin lymphoma (off-label dosing):

ABVD regimen:

Favorable/early stage disease: IV: 6 mg/m2 on days 1 and 15 of a 28-day cycle (in combination with doxorubicin, bleomycin, dacarbazine, and radiation therapy) for 2 cycles (Ref).

Unfavorable/early stage disease: IV: 6 mg/m2 on days 1 and 15 of a 28-day cycle (in combination with doxorubicin, bleomycin, dacarbazine, and radiation therapy) for 4 cycles (Ref).

Unfavorable/advanced stage disease: IV: 6 mg/m2 on days 1 and 15 of a 28-day cycle (in combination with doxorubicin, bleomycin, dacarbazine, and radiation therapy) for 6 to 8 cycles (Ref).

Stanford V regimen:

Favorable/early stage disease: IV: 6 mg/m2 in weeks 1, 3, 5, and 7 (in combination with doxorubicin, mechlorethamine, vincristine, bleomycin, etoposide, prednisone, and radiation therapy) (Ref).

Unfavorable/advanced stage disease: IV: 6 mg/m2 in weeks 1, 3, 5, 7, 9, and 11 (in combination with doxorubicin, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone) (Ref).

VEPEMB regimen: Adults ≥60 years of age: IV: 6 mg/m2 on day 1 of each 28-day cycle (in combination with cyclophosphamide, prednisone/prednisolone, procarbazine, etoposide, mitoxantrone, and bleomycin, ± radiation therapy) for 3 cycles (stage 1A or IIA disease) or for 6 cycles (stage IIB, III, or IV disease) (Ref).

Kaposi sarcoma, oral lesions

Kaposi sarcoma, oral lesions (off-label route; based on limited data): Intralesional: 0.1 mL per 0.5 cm2 lesion injected directly into the lesion (a 0.2 mg/mL vinblastine solution was used). Larger lesions may require multiple injections; reported range of volume injected: 0.8 to 4 mL (Ref).

Non–small cell lung cancer

Non–small cell lung cancer (off-label use):

Adjuvant treatment after complete resection: IV: 4 mg/m2 on days 1, 8, 15, 22, and 29, then every 2 weeks (in combination with cisplatin) until last cisplatin dose (Ref).

Concurrent radiation: IV: 5 mg/m2 on days 1, 8, 15, 22, and 29 (in combination with cisplatin and concurrent radiation therapy) (Ref).

Soft tissue sarcoma, advanced

Soft tissue sarcoma (desmoid tumors, aggressive fibromatosis), advanced (off-label use): IV: 6 mg/m2 every 7 to 10 days (dose usually rounded to 10 mg) in combination with methotrexate for 1 year (Ref).

Testicular cancer

Testicular cancer (off-label dosing): VeIP regimen: IV: 0.11 mg/kg daily for 2 days every 21 days (in combination with ifosfamide, cisplatin, and mesna) for 4 cycles (Ref).

Manufacturer's labeling: Hodgkin lymphoma, non-Hodgkin lymphomas (lymphocytic lymphoma, histiocytic lymphoma, advanced mycosis fungoides), testicular cancer, Kaposi sarcoma, Langerhans cell histiocytosis (histiocytosis X, Letterer-Siwe disease): Dosing in the prescribing information may not reflect current clinical practice. IV: 3.7 mg/m2; adjust dose every 7 days (based on white blood cell response) up to 5.5 mg/m2 (second dose); 7.4 mg/m2 (third dose); 9.25 mg/m2 (fourth dose); and 11.1 mg/m2 (fifth dose); do not administer more frequently than every 7 days. Usual dosage range: 5.5 to 7.4 mg/m2 every 7 days; Maximum dose: 18.5 mg/m2; dosage adjustment goal is to reduce white blood cell count to ~3,000/mm3. Frequency and duration of therapy may vary by indication, concomitant combination chemotherapy and hematologic response.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

No dosage adjustment necessary.

Dosing: Hepatic Impairment: Adult

Toxicity may be increased in patients with hepatic dysfunction. The manufacturer's labeling recommends the following adjustment: Serum bilirubin >3 mg/dL: Administer 50% of dose

The following adjustments have also been recommended (Ref):

Serum bilirubin 1.5 to 3 mg/dL or transaminases 2 to 3 times ULN: Administer 50% of dose

Serum bilirubin >3 times ULN: Avoid use.

Dosing: Obesity: Adult

American Society of Clinical Oncology guidelines for appropriate systemic therapy dosing in adults with cancer with a BMI ≥30 kg/m2 : Utilize patient's actual body weight for calculation of BSA- or weight-based dosing; manage regimen-related toxicities in the same manner as for patients with a BMI <30 kg/m2; if a dose reduction is utilized due to toxicity, may consider resumption of full weight-based dosing (or previously tolerated dose level) with subsequent cycles only if dose escalations are allowed in the prescribing information, if contributing underlying factors (eg, hepatic or kidney impairment) are sufficiently resolved, AND if performance status has markedly improved or is considered adequate (Ref).

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Vinblastine: Pediatric drug information")

Note: For IV use only; fatal if administered by other routes. In order to prevent inadvertent intrathecal administration, the Institute for Safe Medication Practices (ISMP) strongly recommends dispensing vinblastine in a minibag (NOT a syringe) (Ref). Dosing and frequency may vary by indication, protocol, and/or treatment phase and hematologic response; refer to specific protocol.

Glioma, low-grade

Glioma, low-grade: Limited data available: Infants ≥8 months, Children, and Adolescents: IV: 6 mg/m2/dose every 7 days for 70 doses (Ref).

Hodgkin lymphoma

Hodgkin lymphoma: Infants, Children, and Adolescents: IV:

ABVD regimen: 6 mg/m2/dose administered on days 1 and 15 of a 28-day cycle in combination with doxorubicin, bleomycin, and dacarbazine (Ref).

ChIVPP regimen: 6 mg/m2/dose administered on days 1 and 8 of a 28-day cycle in combination with chlorambucil, procarbazine, and prednisolone; minimum reported age: 7 months (Ref).

Langerhans cell histiocytosis; multisystem

Langerhans cell histiocytosis; multisystem (Letterer-Siwe disease; Histiocytosis X): Limited data available:

Infants, Children, and Adolescents: IV: Induction: 6 mg/m2/dose every 7 days in combination with prednisone for 6 to 12 weeks depending upon clinical response; then begin maintenance therapy of 6 mg/m2/dose every 3 weeks in combination with prednisone, continue for a total duration of vinblastine therapy of 12 months (Ref).

Neuroblastoma, recurrent or refractory

Neuroblastoma, recurrent or refractory: Limited data available: Children and Adolescents: IV: 3 mg/m2/dose every 14 days; as metronomic therapy in combination with celecoxib, cyclophosphamide, and etoposide for up to 24 months of therapy (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

No dosage adjustment necessary.

Dosing: Hepatic Impairment: Pediatric

All patients: The manufacturer's labeling recommends the following adjustment: Serum bilirubin >3 mg/dL: Administer 50% of dose.

The following adjustments have also been recommended (Ref):

Serum bilirubin 1.5 to 3 mg/dL or transaminases 2 to 3 times ULN: Administer 50% of dose.

Serum bilirubin >3 times ULN: Avoid use.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined.

Cardiovascular: Angina pectoris, cerebrovascular accident, ECG abnormality, hypertension (common), ischemic heart disease, limb ischemia, myocardial infarction, Raynaud's phenomenon

Central nervous system: Decreased deep tendon reflex, depression, dizziness, headache, malaise (common), metallic taste, neurotoxicity (duration: >24 hours), paresthesia, peripheral neuritis, seizure, tumor pain (common), vertigo

Dermatologic: Alopecia (common), dermatitis, skin blister, skin photosensitivity (rare), skin rash

Endocrine & metabolic: Hyperuricemia, SIADH (syndrome of inappropriate antidiuretic hormone secretion)

Gastrointestinal: Abdominal pain, anorexia, constipation (common), diarrhea, enterocolitis (hemorrhagic), gastrointestinal hemorrhage, intestinal obstruction, nausea (mild), paralytic ileus, stomatitis, toxic megacolon, vomiting (mild)

Genitourinary: Azoospermia, urinary retention

Hematologic & oncologic: Anemia, bone marrow depression (common), granulocytopenia (common; nadir: 5 to 10 days; recovery: 7 to 14 days; dose-limiting toxicity), hemolytic uremic syndrome, leukopenia (common; nadir: 5 to 10 days; recovery: 7 to 14 days; dose-limiting toxicity), rectal hemorrhage, thrombocytopenia (recovery within a few days), thrombotic thrombocytopenic purpura

Local: Local irritation

Neuromuscular & skeletal: Jaw pain (common), myalgia, ostealgia (common), weakness

Ophthalmic: Nystagmus

Otic: Auditory disturbance, deafness, vestibular disturbance

Respiratory: Bronchospasm, dyspnea, pharyngitis

Miscellaneous: Radiation recall phenomenon

Contraindications

Significant granulocytopenia (unless as a result of condition being treated); presence of bacterial infection

Canadian labeling: Additional contraindications not in the US labeling: Pregnancy

Warnings/Precautions

Concerns related to adverse effects:

• Bone marrow suppression: Leukopenia commonly occurs; granulocytopenia may be severe with higher doses. The leukocyte nadir generally occurs 5 to 10 days after administration; recovery typically occurs 7 to 14 days later. Leukopenia may be more pronounced in cachectic patients and patients with skin ulceration and may be less pronounced with lower doses used for maintenance therapy. Leukocytes and platelets may fall considerably with moderate doses when marrow is infiltrated with malignant cells (further use in this situation is not recommended). Thrombocytopenia and anemia may occur rarely.

• Extravasation: Vinblastine is a vesicant; ensure proper needle or catheter placement prior to and during infusion. Avoid extravasation. Extravasation may cause significant irritation. Individuals administering should be experienced in vinblastine administration.

• Gastrointestinal toxicity: Stomatitis may occur (rare); may be disabling, but is usually reversible.

• Neurotoxicity: May rarely cause disabling neurotoxicity; usually reversible. Seizures and severe and permanent CNS damage have occurred with higher than recommended doses and/or when administered more frequently than recommended.

• Pulmonary toxicity: Acute shortness of breath and severe bronchospasm have been reported, most often in association with concurrent administration of mitomycin; may occur within minutes to several hours following vinblastine administration or up to 14 days following mitomycin administration; use caution in patients with preexisting pulmonary disease.

Disease-related concerns:

• Ischemic heart disease: Use with caution in patients with ischemic heart disease.

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.

Other warnings/precautions:

• NOT for intrathecal use: For IV use only. Administration by other routes may result in death. To prevent administration errors, the Institute for Safe Medication Practices (ISMP) Targeted Medication Safety Best Practices for Hospitals initiative strongly recommends dispensing vinblastine diluted in a minibag (ISMP 2020). Vinblastine should NOT be prepared during the preparation of any medications intended for CNS administration. After preparation, keep vinblastine in a location away from the separate storage location recommended for medications intended for CNS administration. Vinblastine should NOT be delivered to the patient at the same time with any medications intended for CNS administration (ASCO/ONS [Neuss 2016]). Refer to vinblastine manufacturer labeling for information regarding management of inadvertent intrathecal vinblastine exposure.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous, as sulfate:

Generic: 1 mg/mL (10 mL)

Generic Equivalent Available: US

Yes

Pricing: US

Solution (vinBLAStine Sulfate Intravenous)

1 mg/mL (per mL): $5.66

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous, as sulfate:

Generic: 1 mg/mL (10 mL, 13.5 mL)

Solution Reconstituted, Intravenous, as sulfate:

Generic: 10 mg (1 ea)

Administration: Adult

IV: The Institute for Safe Medication Practices (ISMP) strongly recommends dispensing vinblastine in a minibag and NOT in a syringe (Ref). For IV administration only. Fatal if administered by other routes. The preferred administration is as a short infusion in a 25 to 50 mL minibag. Prolonged administration times (≥30 to 60 minutes) and/or increased administration volumes may increase the risk of vein irritation and extravasation.

Vesicant; ensure proper needle or catheter placement prior to and during infusion. Avoid extravasation.

Extravasation management: If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase antidote; remove needle/cannula; apply dry warm compresses for 20 minutes 4 times a day for 1 to 2 days; elevate extremity (Ref). Remaining portion of the vinblastine dose should be infused through a separate vein.

Hyaluronidase: If needle/cannula still in place, administer 1 to 6 mL hyaluronidase (150 units/mL) into the existing IV line; the usual dose is 1 mL hyaluronidase for each 1 mL of extravasated drug (Ref). If needle/cannula was removed, inject 1 to 6 mL (150 units/mL) subcutaneously in a clockwise manner using 1 mL for each 1 mL of drug extravasated (Ref) or administer 1 mL (150 units/mL) as 5 separate 0.2 mL injections (using a 25-gauge needle) subcutaneously into the extravasation site (Ref).

Intralesional (off-label route): Administer local anesthesia prior to vinblastine intralesional injections; analgesia may be required for 1 to 2 days following vinblastine administration (Ref).

Administration: Pediatric

In order to prevent inadvertent intrathecal administration, the Institute for Safe Medication Practices (ISMP) strongly recommends dispensing vinblastine in a minibag (NOT in a syringe) (Ref).

IV infusion: For IV administration only. Fatal if given intrathecally. The preferred administration is as a short infusion in a minibag. If administration via a minibag is not possible, vinblastine may also be administered undiluted (1 mg/mL) over 1 minute into a free flowing IV line to prevent venous irritation/extravasation. Prolonged administration times (≥30 to 60 minutes) and/or increased administration volumes may increase the risk of vein irritation and extravasation.

Vesicant; ensure proper needle or catheter placement prior to and during infusion. Avoid extravasation. If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase antidote (see Management of Drug Extravasations for more details); remove needle/cannula; apply dry warm compresses for 20 minutes 4 times a day for 1 to 2 days; elevate extremity (Ref). Remaining portion of the vinblastine dose should be infused through a separate vein.

Hazardous Drugs Handling Considerations

Hazardous agent (NIOSH 2016 [group 1]).

Use appropriate precautions for receiving, handling, storage, preparation, dispensing, transporting, administration, and disposal. Follow NIOSH and USP 800 recommendations and institution-specific policies/procedures for appropriate containment strategy (NIOSH 2016; USP-NF 2020).

Use: Labeled Indications

Hodgkin Lymphoma: Treatment of Hodgkin lymphoma

Kaposi sarcoma: Treatment of Kaposi sarcoma

Langerhans cell histiocytosis: Treatment of histiocytosis X (Letterer-Siwe disease)

Non-Hodgkin lymphomas: Treatment of lymphocytic lymphoma, histiocytic lymphoma, and advanced mycosis fungoides

Testicular cancer: Treatment of testicular cancer

Has also been used in the treatment of resistant choriocarcinoma

Use: Off-Label: Adult

Bladder cancer; Kaposi sarcoma, oral lesions (intralesional); Non-small cell lung cancer; Soft tissue sarcoma (desmoid tumors, aggressive fibromatosis), advanced

Medication Safety Issues
Sound-alike/look-alike issues:

VinBLAStine may be confused with vinCRIStine, vinorelbine

High alert medication:

This medication is in a class the Institute for Safe Medication Practices (ISMP) includes among its list of drug classes which have a heightened risk of causing significant patient harm when used in error.

Administration issues:

Vinblastine is for IV administration only. Fatal if administered by other routes. To prevent fatal inadvertent intrathecal injection, the ISMP strongly recommends that vinblastine doses be dispensed in a small minibag (25 to 50 mL of a compatible solution), and NOT a syringe (ISMP 2020). Vinblastine should NOT be prepared during the preparation of any medications intended for CNS administration. After preparation, keep vinblastine in a location away from the separate storage location recommended for medications intended for CNS administration. Vinblastine should NOT be delivered to the patient at the same time with any medications intended for CNS administration.

Metabolism/Transport Effects

Substrate of CYP2D6 (minor), CYP3A4 (major), P-glycoprotein/ABCB1 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

5-Aminosalicylic Acid Derivatives: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk C: Monitor therapy

Abrocitinib: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination

Antithymocyte Globulin (Equine): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Antithymocyte Globulin (Equine). Specifically, these effects may be unmasked if the dose of cytotoxic chemotherapy is reduced. Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Antithymocyte Globulin (Equine). Specifically, infections may occur with greater severity and/or atypical presentations. Risk C: Monitor therapy

Baricitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Baricitinib. Risk X: Avoid combination

BCG (Intravesical): Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

BCG Products: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of BCG Products. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of BCG Products. Risk X: Avoid combination

Brincidofovir: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Brincidofovir. Risk C: Monitor therapy

Brivudine: May enhance the adverse/toxic effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination

Chloramphenicol (Ophthalmic): May enhance the adverse/toxic effect of Myelosuppressive Agents. Risk C: Monitor therapy

Cladribine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk X: Avoid combination

Cladribine: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Cladribine. Risk X: Avoid combination

Clofazimine: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor therapy

CloZAPine: Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased. Risk C: Monitor therapy

Coccidioides immitis Skin Test: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the diagnostic effect of Coccidioides immitis Skin Test. Management: Consider discontinuing cytotoxic chemotherapy several weeks prior to coccidioides immitis skin antigen testing to increase the likelihood of accurate diagnostic results. Risk D: Consider therapy modification

COVID-19 Vaccine (Adenovirus Vector): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Adenovirus Vector). Management: Administer a 2nd dose using an mRNA COVID-19 vaccine (at least 4 weeks after the primary vaccine dose) and a bivalent booster dose (at least 2 months after the additional mRNA dose or any other boosters). Risk D: Consider therapy modification

COVID-19 Vaccine (Inactivated Virus): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Inactivated Virus). Risk C: Monitor therapy

COVID-19 Vaccine (mRNA): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (mRNA). Management: Give a 3-dose primary series for all patients aged 6 months and older taking immunosuppressive medications or therapies. Booster doses are recommended for certain age groups. See CDC guidance for details. Risk D: Consider therapy modification

COVID-19 Vaccine (Subunit): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Subunit). Risk C: Monitor therapy

COVID-19 Vaccine (Virus-like Particles): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Virus-like Particles). Risk C: Monitor therapy

CYP3A4 Inhibitors (Moderate): May increase the serum concentration of VinBLAStine. Risk C: Monitor therapy

CYP3A4 Inhibitors (Strong): May increase the serum concentration of VinBLAStine. Risk C: Monitor therapy

Deferiprone: Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone. Management: Avoid the concomitant use of deferiprone and myelosuppressive agents whenever possible. If this combination cannot be avoided, monitor the absolute neutrophil count more closely. Risk D: Consider therapy modification

Dengue Tetravalent Vaccine (Live): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Dengue Tetravalent Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Dengue Tetravalent Vaccine (Live). Risk X: Avoid combination

Denosumab: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Management: Consider the risk of serious infections versus the potential benefits of coadministration of denosumab and cytotoxic chemotherapy. If combined, monitor patients for signs/symptoms of serious infections. Risk D: Consider therapy modification

Deucravacitinib: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination

Dipyrone: May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased Risk X: Avoid combination

Fexinidazole: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination

Fexinidazole: Myelosuppressive Agents may enhance the myelosuppressive effect of Fexinidazole. Risk X: Avoid combination

Filgotinib: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination

Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination

Inebilizumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Inebilizumab. Risk C: Monitor therapy

Influenza Virus Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Influenza Virus Vaccines. Management: Administer influenza vaccines at least 2 weeks prior to initiating chemotherapy if possible. If vaccination occurs less than 2 weeks prior to or during chemotherapy, revaccinate at least 3 months after therapy discontinued if immune competence restored. Risk D: Consider therapy modification

Leflunomide: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Leflunomide. Management: Increase the frequency of chronic monitoring of platelet, white blood cell count, and hemoglobin or hematocrit to monthly, instead of every 6 to 8 weeks, if leflunomide is coadministered with immunosuppressive agents, such as cytotoxic chemotherapy. Risk D: Consider therapy modification

Lenograstim: Antineoplastic Agents may diminish the therapeutic effect of Lenograstim. Management: Avoid the use of lenograstim 24 hours before until 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Risk D: Consider therapy modification

Lipegfilgrastim: Antineoplastic Agents may diminish the therapeutic effect of Lipegfilgrastim. Management: Avoid concomitant use of lipegfilgrastim and myelosuppressive cytotoxic chemotherapy. Lipegfilgrastim should be administered at least 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Risk D: Consider therapy modification

MitoMYcin (Systemic): Antineoplastic Agents (Vinca Alkaloids) may enhance the adverse/toxic effect of MitoMYcin (Systemic). Specifically, the risk of pulmonary toxicity may be increased. Risk C: Monitor therapy

Mumps- Rubella- or Varicella-Containing Live Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination

Nadofaragene Firadenovec: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Nadofaragene Firadenovec. Specifically, the risk of disseminated adenovirus infection may be increased. Risk X: Avoid combination

Natalizumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Natalizumab. Risk X: Avoid combination

Ocrelizumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ocrelizumab. Risk C: Monitor therapy

Ofatumumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ofatumumab. Risk C: Monitor therapy

Olaparib: Myelosuppressive Agents may enhance the myelosuppressive effect of Olaparib. Risk C: Monitor therapy

Palifermin: May enhance the adverse/toxic effect of Antineoplastic Agents. Specifically, the duration and severity of oral mucositis may be increased. Management: Do not administer palifermin within 24 hours before, during infusion of, or within 24 hours after administration of myelotoxic chemotherapy. Risk D: Consider therapy modification

Phenytoin: VinBLAStine may decrease the serum concentration of Phenytoin. Risk C: Monitor therapy

Pidotimod: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Pidotimod. Risk C: Monitor therapy

Pimecrolimus: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination

Pneumococcal Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy

Poliovirus Vaccine (Live/Trivalent/Oral): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Risk X: Avoid combination

Polymethylmethacrylate: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the potential for allergic or hypersensitivity reactions to Polymethylmethacrylate. Management: Use caution when considering use of bovine collagen-containing implants such as the polymethylmethacrylate-based Bellafill brand implant in patients who are receiving immunosuppressants. Consider use of additional skin tests prior to administration. Risk D: Consider therapy modification

Promazine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk C: Monitor therapy

Rabies Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Rabies Vaccine. Management: Complete rabies vaccination at least 2 weeks before initiation of immunosuppressant therapy if possible. If combined, check for rabies antibody titers, and if vaccination is for post exposure prophylaxis, administer a 5th dose of the vaccine. Risk D: Consider therapy modification

Ritlecitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ritlecitinib. Risk X: Avoid combination

Ropeginterferon Alfa-2b: Myelosuppressive Agents may enhance the myelosuppressive effect of Ropeginterferon Alfa-2b. Management: Avoid coadministration of ropeginterferon alfa-2b and other myelosuppressive agents. If this combination cannot be avoided, monitor patients for excessive myelosuppressive effects. Risk D: Consider therapy modification

Ruxolitinib (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ruxolitinib (Topical). Risk X: Avoid combination

Sipuleucel-T: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Sipuleucel-T. Management: Consider reducing the dose or discontinuing the use of immunosuppressants, such as cytotoxic chemotherapy, prior to initiating sipuleucel-T therapy. Risk D: Consider therapy modification

Sphingosine 1-Phosphate (S1P) Receptor Modulator: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk C: Monitor therapy

Tacrolimus (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Tacrolimus (Topical). Risk X: Avoid combination

Talimogene Laherparepvec: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Talimogene Laherparepvec. Specifically, the risk of infection from the live, attenuated herpes simplex virus contained in talimogene laherparepvec may be increased. Risk X: Avoid combination

Tertomotide: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Tertomotide. Risk X: Avoid combination

Tofacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Tofacitinib. Risk X: Avoid combination

Typhoid Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Typhoid Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Typhoid Vaccine. Risk X: Avoid combination

Ublituximab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ublituximab. Risk C: Monitor therapy

Upadacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Upadacitinib. Risk X: Avoid combination

Vaccines (Inactivated/Non-Replicating): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of chemotherapy when possible. Patients vaccinated less than 14 days before initiating or during chemotherapy should be revaccinated at least 3 months after therapy is complete. Risk D: Consider therapy modification

Vaccines (Live): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Vaccines (Live) may diminish the therapeutic effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination

Yellow Fever Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Yellow Fever Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Yellow Fever Vaccine. Risk X: Avoid combination

Reproductive Considerations

Patients who could become pregnant should avoid becoming pregnant during vinblastine treatment. Reversible amenorrhea may occur when vinblastine is used in some combination regimens (dose related). Aspermia has been reported in males who have received treatment with vinblastine.

Pregnancy Considerations

Based on placental perfusion studies, vinblastine is expected to cross the placenta (Sudhakaran 2008). Outcome information following maternal use of vinblastine as a single agent or as part of combination therapy during pregnancy is available (Avilés 2018; Eyre 2015).

The European Society for Medical Oncology (ESMO) has published guidelines for diagnosis, treatment, and follow-up of cancer during pregnancy. The ESMO guidelines recommend referral to a facility with expertise in cancer during pregnancy and encourage a multidisciplinary team (obstetrician, neonatologist, oncology team). In general, if chemotherapy is indicated, it should be avoided during in the first trimester, there should be a 3-week time period between the last chemotherapy dose and anticipated delivery, and chemotherapy should not be administered beyond week 33 of gestation (ESMO [Peccatori 2013]). An international consensus panel has published guidelines for hematologic malignancies during pregnancy. Vinblastine is a component of the ABVD regimen, which is used for the treatment of Hodgkin lymphoma. If treatment cannot be deferred until after delivery in patients with early stage Hodgkin lymphoma, ABVD may be administered safely and effectively in the latter phase of pregnancy (based on limited data); for patients with advanced-stage disease, ABVD can be administered in the second and third trimesters (Lishner 2016).

A pregnancy registry is available for all cancers diagnosed during pregnancy at Cooper Health (877-635-4499).

Breastfeeding Considerations

It is not known if vinblastine is present in breast milk.

Samples from a lactating patient treated with the ABVD regimen for Hodgkin lymphoma demonstrated changes in the bacterial and metabolic composition of breast milk when compared to untreated healthy patients (Urbaniak 2014). Patients using this regimen during pregnancy may have difficulty initiating breastfeeding postpartum (Stopenski 2017).

Due to the potential for serious adverse reactions in the breastfed infant, a decision should be made to discontinue vinblastine or to discontinue breastfeeding, taking into account the importance of treatment to the mother.

Monitoring Parameters

CBC with differential and platelet count, serum uric acid, hepatic function tests. Monitor for signs/symptoms of infections (particularly if WBC <2,000/mm3). Monitor infusion site.

The American Society of Clinical Oncology hepatitis B virus (HBV) screening and management provisional clinical opinion (ASCO [Hwang 2020]) recommends HBV screening with hepatitis B surface antigen, hepatitis B core antibody, total Ig or IgG, and antibody to hepatitis B surface antigen prior to beginning (or at the beginning of) systemic anticancer therapy; do not delay treatment for screening/results. Detection of chronic or past HBV infection requires a risk assessment to determine antiviral prophylaxis requirements, monitoring, and follow-up.

Mechanism of Action

Vinblastine binds to tubulin and inhibits microtubule formation, therefore, arresting the cell at metaphase by disrupting the formation of the mitotic spindle; it is specific for the M and S phases. Vinblastine may also interfere with nucleic acid and protein synthesis by blocking glutamic acid utilization.

Pharmacokinetics (Adult Data Unless Noted)

Metabolism: Hepatic (via CYP3A) to active metabolite

Half-life elimination: Terminal: ~25 hours

Excretion: Feces (10%); urine (14%)

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Velbe;
  • (AR) Argentina: Blastovin | Vinblastina filaxis | Vinblastina gobbi | Vinblastina kemex;
  • (AT) Austria: Velbe;
  • (AU) Australia: Velbe | Vinblastin | Vinblastine comp;
  • (BD) Bangladesh: Vinblastin;
  • (BE) Belgium: Velbe | Vinblasin | Vinblastine teva | Vinblastine wyeth pharmaceutic;
  • (BG) Bulgaria: Cytoblastin | Velbe | Vinblastin;
  • (BR) Brazil: Faulblastina | Rabinefil | Velban | Vinatin;
  • (CL) Chile: Lemblastine;
  • (CN) China: Vinblastine | Vinblastine sulphate;
  • (CO) Colombia: Lemblastine | Velbe | Vinblastina;
  • (CZ) Czech Republic: Velbe | Vinblastin;
  • (DE) Germany: Velbe | Vinblastin | Vinblastinsulfat Teva;
  • (DO) Dominican Republic: Cytoblastin;
  • (EE) Estonia: Velbe | Vinblastin | Vinblastine teva;
  • (EG) Egypt: Velbastine;
  • (ES) Spain: Vinblastina;
  • (ET) Ethiopia: Velbastine;
  • (FI) Finland: Velbe;
  • (FR) France: Velbe;
  • (GB) United Kingdom: Trav vinblastine | Velbe | Vinblastine | Vinblastine tillot;
  • (GR) Greece: Velbe | Vinblastine sulphate;
  • (HU) Hungary: Vinblastin;
  • (ID) Indonesia: Erbablas | Velbe | Vinblastine;
  • (IE) Ireland: Vinblastine;
  • (IN) India: Chemoblast | Cytoblastin | Uniblastin;
  • (IT) Italy: Velbe | Vinblastina teva;
  • (JO) Jordan: Cytoblastin | Velbe;
  • (JP) Japan: Exal | Vinblastin kyorin;
  • (KR) Korea, Republic of: Velbastine | Vinblastin | Vinblastine sulfate pch;
  • (KW) Kuwait: Vinblastine sulphate;
  • (LB) Lebanon: Cytoblastin | Uniblastin | Velbe | Vinblastine;
  • (LT) Lithuania: Velbe | Vinblastin | Vinblastin-Teva | Vinblastine teva;
  • (LU) Luxembourg: Velbe;
  • (LV) Latvia: Velbe | Vinblastin;
  • (MA) Morocco: Okanavinblastin | Velbe;
  • (MX) Mexico: Blestinib | Diranovyl | Lemblastine | Velbe | Vinblastina;
  • (MY) Malaysia: Cytoblastin aqueous | Velbastine | Velbe | Vinblastine | Vinblastine sulphate;
  • (NL) Netherlands: Blastivin | Velbe | Vinblastine | Vinblastinesulfaat PCH;
  • (NO) Norway: Velbe;
  • (NZ) New Zealand: Vinblastin | Vinblastine;
  • (PE) Peru: Velbe;
  • (PH) Philippines: Oncostin | Velbastine | Velbe;
  • (PL) Poland: Uniblastin | Velbe | Vinblastine | Vinko;
  • (PR) Puerto Rico: Velban;
  • (PT) Portugal: Solblastin | Velbe;
  • (PY) Paraguay: Vinblastina kemex;
  • (RO) Romania: Cytoblastin | Vinblastina teva;
  • (RU) Russian Federation: Cytoblastine | Vinblastin | Vinblastine lens | Vinblastine richter | Vinblastine teva;
  • (SA) Saudi Arabia: Velbe | Vinblastine sulphate;
  • (SE) Sweden: Velbe;
  • (SI) Slovenia: Velbe | Vinblastine teva;
  • (SK) Slovakia: Vinblastin;
  • (TH) Thailand: Velbe | Vinblastin;
  • (TN) Tunisia: Velbe | Velvin | Vinblastine;
  • (TR) Turkey: Velbe | Vinblastin | Vinko;
  • (TW) Taiwan: Velbe;
  • (UA) Ukraine: Vinblastin;
  • (UY) Uruguay: Vinblastina;
  • (ZA) South Africa: Cytoblastin aqueous | Periblastine | Velbe | Vinblastine
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