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VCR IV Injection (vincristine sulfate) is used to treat acute leukemia. It has also been shown to be useful alongside other oncolytic agents in Hodgkin's disease, non-Hodgkin's malignant lymphomas (lymphocytic, mixed-cell, histiocytic, undifferentiated, nodular and diffuse types), rhabdomyosarcoma, neuroblastoma and Wilms' tumor.
Pharmacology
Vincristine Sulfate is the salt of an alkaloid obtained from the periwinkle plant (Vinca rasea Linn). It is a white or slightly yellow powder, hygroscopic, either amorphous or crystalline, and it dissolves freely in water but only slightly in alcohol.
In patients with cancer, pharmacokinetic studies have shown a triphasic serum decay pattern after a rapid intravenous injection. The initial, middle and terminal half-lives are 5 minutes, 2.3 hours and 85 hours respectively, though the terminal half-life in humans can range from 19 to 155 hours. Vincristine sulfate leaves the body mainly through the liver, which is the major excretory organ in humans and animals. About 80% of an injected dose appears in the faeces and 10% to 20% can be found in the urine. Within 15 to 30 minutes after injection, over 90% of the drug moves from the blood into the tissue, where it stays tightly bound, but not irreversibly.
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Detailed dosing reference is not available yet. Please follow your prescription and consult your pharmacist.
Side Effects
Before VCR is used, patients and/or their parents or guardians should be told that unwanted symptoms are possible. In general the adverse reactions are reversible and depend on the dose. Hair loss is the most common one, but the most troublesome are neuromuscular in origin. These adverse reactions have been reported. Hypersensitivity: Rare allergic-type reactions have been reported in patients who received vincristine as part of multidrug chemotherapy regimens. These include anaphylaxis, rash and oedema, and they were temporally related to vincristine therapy. Gastrointestinal: Autonomic toxicity such as constipation and paralytic ileus is not uncommon, and it often comes with abdominal cramps. Stool softeners, mild laxatives and enemas may help. A routine preventive regimen of laxatives and enemas is usually recommended for patients receiving vincristine. Constipation can take the form of upper colon impaction, and on physical examination the rectum may be empty. Colicky abdominal pain together with an empty rectum may mislead the physician. Genitourinary, hyperuricaemia: It may occur in some patients receiving vincristine, especially those with non-Hodgkin's lymphomas or leukaemia. In some patients uric acid nephropathy may result. Adequate hydration, alkalinisation of the urine and/or allopurinol can minimise these effects. Polyuria, dysuria and urinary retention due to bladder atony have occurred. Cardiovascular: Hypertension and hypotension have occurred. Chemotherapy combinations that included VCR, when given to patients previously treated with mediastinal radiation, have been associated with coronary artery disease and myocardial infarction. Causality has not been established. Neurologic: The neuromuscular side effects often develop in a sequence. At first there may be only sensory impairment and paraesthesiae. With continued treatment, neuritic pain may follow, and later motor difficulties. No agent has been reported that can reverse the neuromuscular manifestations that may accompany vincristine therapy. Other: Fever and headache have occurred. Other side effects include defective sweating, myoclonic jerks, abnormal Vasalva response, impotence and diminished libido. Weight loss has been reported at high doses.
Cautions & Contraindications
Warnings & Precautions
Before any vincristine is injected, be completely sure the needle is properly placed in the vein. If the drug leaks into the surrounding tissue during i.v. administration, it may cause considerable irritation. Stop the injection immediately and give the rest of the dose into another vein. Local injection of hyaluronidase and moderate heat applied to the area of leakage help disperse the drug, and they are thought to reduce discomfort and the chance of cellulitis. VCR should be used only by physicians experienced in cytotoxic chemotherapy. The drug is very irritating and should not be given intramuscularly, subcutaneously or intrathecally. Intrathecal administration of vincristine is usually fatal. Patients who received it intrathecally by accident have been treated with immediate removal of spinal fluid and flushing with Lactated Ringer's solution, as well as other solutions, but this has not prevented ascending paralysis and death. In one case, progressive paralysis in an adult was arrested by the following treatment, started immediately after the intrathecal injection. VCR is a vesicant and may cause a severe local reaction if it extravasates. If it leaks into the surrounding tissue during intravenous administration, stop the injection immediately and give the remaining dose into another vein. Local injection of hyaluronidase with heat has been used to disperse the drug, to reduce discomfort and the chance of tissue damage. Leucopenia is less likely with vincristine than with other oncolytic agents. The risk/benefit should be considered in patients with a history of gout or urate renal stones, because acute uric acid nephropathy, which may occur after oncolytic agents are given, has also been reported with vincristine. Vincristine penetrates the blood-brain barrier poorly, so additional agents and routes of administration may be required for central nervous system leukaemia. Its neurotoxic effect may add to that of other neurotoxic agents, and it may be increased by spinal cord irradiation and neurological disease. Pay particular attention to the dose and to neurologic side effects if vincristine is given to patients who have had previous cytotoxic drug therapy or irradiation, and to those with pre-existing neuromuscular disease (including sensory peripheral neuropathy and steroid-induced myopathy). The same care applies when other drugs with neurotoxic potential are being used. Acute shortness of breath and severe bronchospasm have been reported after vinca alkaloids were given. These reactions have been seen most often when the vinca alkaloid was used together with mitomycin, and they may need aggressive treatment, particularly when there is pre-existing pulmonary dysfunction. VCR should not be readministered.
Contraindications
Vincristine sulfate must not be given to people with the demyelinating form of Charcot-Marie-Tooth Syndrome. It should also not be given while a patient is having radiation therapy through ports that include the liver. And anyone with known hypersensitivity to vinca alkaloids or mannitol should not receive vincristine.
Pregnancy & Breastfeeding
Vincristine Sulfate is Pregnancy Category D. There are no adequate and well controlled studies in pregnant women. Vincristine has been reported to be found in human milk, so a patient who receives Vincristine should not breastfeed.
⚠️ Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
Storage
Keep Vincristine Sulfate in a refrigerator at 2°C - 8°C. Don't freeze it, and protect it from light. Keep it out of the reach of children.
Drug Interactions
Common questions about VCR 2 mg/2 ml
What is VCR 2 mg/2 ml IV Injection?
VCR 2 mg/2 ml IV Injection is a medicine that contains Vincristine Sulfate. It is made by Eskayef Pharmaceuticals Ltd. It belongs to the Cytotoxic Chemotherapy group of medicines.
What is VCR used for?
VCR IV Injection (vincristine sulfate) is used to treat acute leukemia. It has also been shown to be useful alongside other oncolytic agents in Hodgkin's disease, non-Hodgkin's malignant lymphomas (lymphocytic, mixed-cell, histiocytic, undifferentiated, nodular and diffuse types), rhabdomyosarcoma, neuroblastoma and Wilms' tumor.
What are the side effects of VCR?
Before VCR is used, patients and/or their parents or guardians should be told that unwanted symptoms are possible. In general the adverse reactions are reversible and depend on the dose.
Can I take VCR during pregnancy or while breastfeeding?
Vincristine Sulfate is Pregnancy Category D. There are no adequate and well controlled studies in pregnant women. Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
How should I store VCR?
Keep Vincristine Sulfate in a refrigerator at 2°C - 8°C. Don't freeze it, and protect it from light.
Can I take other medicines with VCR?
Some medicines can interact with Vincristine Sulfate, for example: Doxorubicin Hydrochloride, Isoniazid, Methotrexate, Allopurinol. Tell your doctor or pharmacist about every medicine you take.
Do I need a prescription for VCR?
VCR is a prescription (Rx) medicine. Take it as your doctor advises.