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Vinblastine: Drug information

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

For abbreviations, symbols, and age group definitions 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 sulfate 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

Dosage guidance:

Safety: 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). Ensure control of infections prior to initiation of treatment with vinblastine.

Clinical considerations: Refer to the protocol or institutional guidance for additional details of off-label dosing.

Bladder cancer

Bladder cancer (off-label use):

Neoadjuvant treatment :

Note: Patients with nonorgan-confined disease (pT3-4 and/or N+) at cystectomy who did not receive cisplatin-based neoadjuvant chemotherapy should be offered an adjuvant cisplatin-based chemotherapy regimen or adjuvant immunotherapy (Ref).

Dose-dense MVAC regimen: IV: 3 mg/m2 on day 1 or 2 of a 14-day treatment cycle (in combination with methotrexate, doxorubicin, cisplatin) for 3 to 4 cycles (Ref) or 3 mg/m2 on day 2 of a 14-day treatment cycle (in combination with methotrexate, doxorubicin, cisplatin) for 6 cycles (Ref). Administer protocol-specific G-CSF prophylaxis following each cycle (Ref).

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

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

Locally advanced or metastatic disease:

Dose-dense MVAC regimen: IV: 3 mg/m2 on day 2 of a 14-day treatment cycle (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 of a 28-day treatment cycle (in combination with methotrexate, doxorubicin, and cisplatin) for up to 6 cycles (Ref) or 3 mg/m2 on days 2, 15, and 22 of a 28-day treatment cycle (in combination with methotrexate, doxorubicin, and cisplatin) until disease progression or unacceptable toxicity (Ref) or 3 mg/m2 on days 1, 15, and 22 of a 28-day treatment cycle (in combination with methotrexate, doxorubicin, cisplatin, and filgrastim) for up to 6 cycles (Ref).

Hodgkin lymphoma

Hodgkin lymphoma (off-label combinations):

A + AVD regimen:

Advanced stage disease : IV: 6 mg/m2 on days 1 and 15 of a 28-day treatment cycle (in combination with brentuximab vedotin, doxorubicin, and dacarbazine) for up to 6 cycles (Ref). Administer primary prophylaxis with G-CSF (filgrastim) beginning with cycle 1 (Ref).

ABVD regimen:

Early stage/favorable disease: IV: 6 mg/m2 on days 1 and 15 of a 28-day treatment cycle (in combination with doxorubicin, bleomycin, dacarbazine [ABVD regimen] ± radiation therapy) for 2 to 4 cycles. Available protocols may utilize interim positron-emission tomography (PET)–adaptation of therapy following 2 cycles of ABVD; refer to individual protocol for details (Ref).

Early stage/unfavorable disease: IV: 6 mg/m2 on days 1 and 15 of a 28-day treatment cycle (in combination with doxorubicin, bleomycin, dacarbazine [ABVD regimen] ± radiation therapy) for 4 to 6 cycles. Available protocols may utilize interim PET-adaptation of therapy following 2 cycles of ABVD; refer to individual protocol for details (Ref).

Advanced stage disease: IV: 6 mg/m2 on days 1 and 15 of a 28-day treatment cycle (in combination with doxorubicin, bleomycin, dacarbazine [ABVD regimen] ± radiation therapy) for 6 to 8 cycles (Ref) or 6 mg/m2 on days 1 and 15 of a 28-day treatment cycle (in combination with doxorubicin, bleomycin, dacarbazine [ABVD regimen]) for 2 cycles, followed by 6 mg/m2 on days 1 and 15 of a 28-day treatment cycle (in combination with doxorubicin and dacarbazine [AVD regimen]) for 4 cycles in patients with negative interim PET-scan (Ref).

Nivolumab + AVD regimen:

Patients ≥60 years of age (any stage) : IV: 6 mg/m2 on days 1 and 15 of a 28-day treatment cycle (in combination with doxorubicin, dacarbazine, and nivolumab) for 6 cycles. Administer primary prophylaxis with G-CSF (filgrastim) beginning with cycle 1 (Ref).

Unfavorable/advanced stage disease (newly diagnosed): IV: 6 mg/m2 on days 1 and 15 of a 28-day treatment cycle (in combination with doxorubicin, dacarbazine, and nivolumab) for 6 cycles (Ref).

Stanford V regimen:

Early stage/favorable 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).

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 a 28-day treatment 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): 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); continue until the last cisplatin dose (Ref).

Concurrent chemoradiation: 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 combination): VeIP regimen: IV: 0.11 mg/kg daily on days 1 and 2 of a 21-day treatment cycle (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 (Ref).

Hemodialysis: No need for dosage adjustment is expected (Ref).

Dosing: Liver Impairment: Adult

Note: Toxicity may be increased in patients with hepatic dysfunction (Ref).

Serum bilirubin 1.5 to 3 mg/dL: Reduce dose by 50% (Ref).

Serum bilirubin >3 mg/dL: Conflicting information exists; some sources recommend to avoid use (Ref), while other sources suggest reducing the dose by 50% (Ref).

Transaminases 2 to 3 times ULN: Administer 50% of dose (Ref).

Transaminases >3 times ULN: Avoid use (Ref).

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: Liver Impairment: Pediatric

Infants, Children, and Adolescents: Toxicity may be increased in patients with hepatic dysfunction (Ref).

Serum bilirubin 1.5 to 3 mg/dL: Reduce dose by 50% (Ref).

Serum bilirubin >3 mg/dL: Conflicting information exists; some sources recommend to avoid use,(Ref) while other sources suggest reducing the dose by 50% (Ref).

Transaminases 2 to 3 times ULN: Administer 50% of dose (Ref).

Transaminases >3 times ULN: Avoid use (Ref).

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 after administration. 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 the bone 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, severe and permanent CNS damage, and death 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. Progressive dyspnea requiring chronic therapy may also occur with vinblastine.

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): $6.45

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 2024 [table 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 2023; NIOSH 2024; 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:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drug classes (chemotherapeutic agent, parenteral and oral) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Acute Care, Community/Ambulatory Care, and Long-Term Care Settings).

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 CYP3A4 (Major with inhibitors), CYP3A4 (Minor with inducers), P-glycoprotein (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 drug interactions program by clicking on the “Launch drug interactions program” link above.

5-Aminosalicylic Acid Derivatives: May increase myelosuppressive effects of Myelosuppressive Agents. Risk C: Monitor

Abrocitinib: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

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

Antithyroid Agents: Myelosuppressive Agents may increase neutropenic effects of Antithyroid Agents. Risk C: Monitor

Baricitinib: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Baricitinib. Risk X: Avoid

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

Brincidofovir: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Brincidofovir. Risk C: Monitor

Brivudine: May increase adverse/toxic effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Chikungunya Vaccine (Live): Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Chikungunya Vaccine (Live). Risk X: Avoid

Chloramphenicol (Ophthalmic): May increase adverse/toxic effects of Myelosuppressive Agents. Risk C: Monitor

Chloramphenicol (Systemic): Myelosuppressive Agents may increase myelosuppressive effects of Chloramphenicol (Systemic). Risk X: Avoid

Cladribine: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Cladribine. Risk X: Avoid

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

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

Coccidioides immitis Skin Test: Coadministration of Immunosuppressants (Cytotoxic Chemotherapy) and Coccidioides immitis Skin Test may alter diagnostic results. 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 (Inactivated Virus): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of COVID-19 Vaccine (Inactivated Virus). Risk C: Monitor

COVID-19 Vaccine (mRNA): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects 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 decrease therapeutic effects of COVID-19 Vaccine (Subunit). Risk C: Monitor

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

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

Deferiprone: Myelosuppressive Agents may increase neutropenic effects 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 decrease therapeutic effects of Dengue Tetravalent Vaccine (Live). Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Dengue Tetravalent Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Denosumab: May increase immunosuppressive effects 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 increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Etrasimod: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Fexinidazole: Myelosuppressive Agents may increase myelosuppressive effects of Fexinidazole. Risk X: Avoid

Filgotinib: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Fusidic Acid (Systemic): May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Consider avoiding this combination if possible. If required, monitor patients closely for increased adverse effects of the CYP3A4 substrate. Risk D: Consider Therapy Modification

Inebilizumab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Inebilizumab. Risk C: Monitor

Influenza Virus Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects 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 increase immunosuppressive effects 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 decrease therapeutic effects 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

Linezolid: May increase myelosuppressive effects of Myelosuppressive Agents. Risk C: Monitor

Lipegfilgrastim: Antineoplastic Agents may decrease therapeutic effects 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 increase adverse/toxic effects of MitoMYcin (Systemic). Specifically, the risk of pulmonary toxicity may be increased. Risk C: Monitor

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

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

Natalizumab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Natalizumab. Risk X: Avoid

Ocrelizumab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Ocrelizumab. Risk C: Monitor

Ofatumumab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Ofatumumab. Risk C: Monitor

Olaparib: Myelosuppressive Agents may increase myelosuppressive effects of Olaparib. Risk C: Monitor

Palifermin: May increase adverse/toxic effects 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 serum concentration of Phenytoin. Risk C: Monitor

Pidotimod: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Pidotimod. Risk C: Monitor

Pimecrolimus: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid

Piperacillin: May increase hypokalemic effects of Antineoplastic Agents. Risk C: Monitor

Pneumococcal Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Pneumococcal Vaccines. Risk C: Monitor

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

Polymethylmethacrylate: Immunosuppressants (Cytotoxic Chemotherapy) may increase hypersensitivity effects of 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 increase myelosuppressive effects of Myelosuppressive Agents. Risk C: Monitor

Rabies Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects 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 increase immunosuppressive effects of Ritlecitinib. Risk X: Avoid

Ropeginterferon Alfa-2b: Myelosuppressive Agents may increase myelosuppressive effects 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 increase immunosuppressive effects of Ruxolitinib (Topical). Risk X: Avoid

Sipuleucel-T: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects 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 Modulators: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk C: Monitor

Tacrolimus (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Tacrolimus (Topical). Risk X: Avoid

Talimogene Laherparepvec: Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects 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

Tertomotide: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Tertomotide. Risk X: Avoid

Tofacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Tofacitinib. Risk X: Avoid

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

Ublituximab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Ublituximab. Risk C: Monitor

Upadacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Upadacitinib. Risk X: Avoid

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

Vaccines (Non-Live/Inactivated/Non-Replicating): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Give non-live/inactivated/non-replicating vaccines at least 2 weeks prior to starting chemotherapy when possible. Patients vaccinated less than 14 days before or during chemotherapy should be revaccinated at least 3 months after therapy is complete. Risk D: Consider Therapy Modification

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

Zoster Vaccine (Live/Attenuated): Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Zoster Vaccine (Live/Attenuated). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Zoster Vaccine (Live/Attenuated). Risk X: Avoid

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), neurotoxicity (with higher than recommended doses), pulmonary toxicity (particularly when used in combination with mitomycin-C). 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;
  • (CH) Switzerland: Velbe;
  • (CL) Chile: Lemblastine;
  • (CN) China: Vinblastine | Vinblastine sulphate;
  • (CO) Colombia: Lemblastine | Velbe | Vinblastina | Vinblastina sulfato | Vincablas;
  • (CZ) Czech Republic: Velbe | Vinblastin;
  • (DE) Germany: Velbe | Vinblastin | Vinblastinsulfat Teva;
  • (DO) Dominican Republic: Cytoblastin;
  • (EC) Ecuador: Vinblastina | Vinblastina sulfato;
  • (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: Myoblastin | 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 | Vblaast | Velbe | Vinblastine | Vinko;
  • (PR) Puerto Rico: Velban;
  • (PT) Portugal: Solblastin | Velbe;
  • (PY) Paraguay: Vinblastina kemex;
  • (QA) Qatar: Vinko;
  • (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 | Vinblastine sulfate teva;
  • (UY) Uruguay: Vinblastina;
  • (ZA) South Africa: Cytoblastin aqueous | Periblastine | Velbe | Vinblastine
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