vinBLAStine

Appearance:

Clear, colourless solution for injection

Monograph Name:

vinblastine

Monograph Body:

Drug Monograph

A - Drug Name

vinBLAStine

B - Mechanism of Action and Pharmacokinetics

Similar to other vinca alkaloids, vinblastine binds to the microtubular proteins of the mitotic spindle, leading to depolymerization of the microtubule and mitotic arrest at metaphase or cell death. It also has complex effects on nucleic acid and protein synthesis in high concentrations. Vinblastine has some immunosuppressant effects. The vinca alkaloids are considered to be cell cycle phase-specific (M and S phases).

Distribution

Rapid and extensive binding to tissues and to formed elements of peripheral blood. Distributes to the liver.

PPB

99%

Cross blood brain barrier?

poorly

Metabolism

Extensively metabolized in the liver

Active metabolites

Yes

Inactive metabolites

Yes

Elimination

Slowly excreted in urine and feces (via bile).

Urine

< 1% unchanged

Feces

95%

Half-life

25 hours (terminal)

C - Indications and Status

Health Canada Approvals:

Frequently responsive:
- Hodgkin disease
- Lymphocytic lymphoma
- Histolytic lymphoma
- Mycosis fungoides
- Testicular cancer
- Kaposi's sarcoma
- Letterer-Siwe disease (histiocytosis-X)
Less frequently responsive:
- Choriocarcinoma resistant to other chemotherapy
- Breast cancer (unresponsive to endocrine surgery and hormonal therapy)

Other Uses:

Bladder cancer
Non-small cell lung cancer
Desmoid tumour
CNS cancer

D - Adverse Effects

Emetogenic Potential:

Minimal

Extravasation Potential: Vesicant

The incidences for the adverse effects are based on product monographs where available. Adverse events from other trial data or severe / post-marketing events may also be included.

ORGAN SITE	SIDE EFFECT* (%)	ONSET**
Auditory	Hearing impaired (rare)	E
Cardiovascular	Arterial thromboembolism (in combination with cisplatin and bleomycin)	E
	ECG changes (transient; rare)	E
	Hypertension (≤10%)	I E
Dermatological	Alopecia (>10%) (usually incomplete; re-growth in some cases while on treatment)	E
	Photosensitivity (≤10%)	E
	Rash (≤10%)	E
Gastrointestinal	Abdominal pain (>10%)	E
	Anorexia (>10%)	E
	Constipation (>10%) (may be severe)	E
	Diarrhea (≤10%)	E
	Mucositis (>10%)	E
	Nausea, vomiting (>10%)	I
General	Fatigue (≤10%)	E
	Pain (in tumour-containing tissue, rare)	I
Hematological	Immunosuppression	E
	Myelosuppression ± infection, bleeding (>10%)	E
Hypersensitivity	Hypersensitivity (rare)	I
Injection site	Phlebitis (≤10%)	I E
Metabolic / Endocrine	Hyperuricemia (≤10%) (during periods of active cell lysis)	I
	SIADH (rare)	E
Musculoskeletal	Musculoskeletal pain (≤10%) (including jaw pain, may be severe)	E
Nervous System	Depression (≤10%)	E
	Dysgeusia (>10%)	E
	Headache (≤10%)	E
	Paresthesia (20%) (autonomic, loss of deep tendon reflex, cranial neuropathy - rare)	E
	Seizure (≤10%)	E
Respiratory	Bronchospasm / pneumonitis (or shortness of breath, especially in combination with mitomycin; ≤10%)	I
Vascular	Peripheral ischemia (≤10%) (Raynauds; in combination with cisplatin and bleomycin)	D

* "Incidence" may refer to an absolute value or the higher value from a reported range.
"Rare" may refer to events with < 1% incidence, reported in post-marketing, phase 1 studies,
isolated data or anecdotal reports.

** I = immediate (onset in hours to days) E = early (days to weeks)
D = delayed (weeks to months) L = late (months to years)

Myelosuppression and neurotoxicity are the main dose-limiting effects of vinblastine.

Hyperuricemia during periods of active cell lysis, which is caused by cytotoxic chemotherapy of highly proliferative tumours of massive burden (e.g. some leukemias and lymphomas), can be minimized with allopurinol and hydration. In hospitalized patients the urine may be alkalinized, by addition of sodium bicarbonate to the IV fluids, if tumour lysis is expected.

Neurotoxicity with the vinca alkaloids is qualitatively similar but quantitatively different (vincristine> vinblastine>vinorelbine). Symptoms tend to be worse with prolonged exposure. Neurotoxicity may manifest as numbness, paresthesia, mental depression, loss of deep tendon reflex, headache, malaise, dizziness, seizures or psychosis. Cranial nerve neuropathy may lead to vocal cord paresis or paralysis, oculomotor nerve dysfunction, hearing impairment and facial nerve palsies. Vocal cord effects or facial nerve palsies tend to be bilateral and reversible when treatment with vinblastine is discontinued. High doses (> 20 mg) may be associated with autonomic neuropathy, which manifests as constipation, abdominal pain, urinary retention and paralytic ileus.

Severe jaw pain or parotid gland pain can occur within a few hours of the first dose of vinblastine. This is not an indication to stop or modify the dose; treat with analgesics.

E - Dosing

Refer to protocol by which patient is being treated.

Dosage may be reduced and/or delayed in patients with bone marrow depression due to cytotoxic/radiation therapy. Do not re-treat with vinblastine until marrow recovery has occurred.

Adults:

Intravenous: 6 mg/m² Every 1 week
(range 3.7-18.5 mg/m²; usual weekly dose: 5.5 – 7.4 mg/m²; maximum weekly dose: 18.5 mg/m²)

Intravenous: 6 mg/m² on days 1 and 15; every 4 weeks (ABVD)

Intravenous: 0.11 mg/kg days 1 and 2; every 3 weeks (VEIP)

Intravenous: 3 mg/m² day 2 Every 14 days (MVAC(HD))

Dosage with Toxicity:

Modify according to protocol by which patient is being treated.

Suggested:

Worst Toxicity / Counts in Previous Cycle (x 10⁹/L)	Dose (% previous dose)*
Febrile neutropenia, grade 4 ANC for ≥ 5-7 days or thrombocytopenic bleeding	75%*
Grade 3 related organ / non-hematologic	Hold, then 75%*
Grade 4 related organ / non-hematologic	Discontinue

*Do not retreat until ANC ≥ 1-1.5 x 10⁹L, platelets ≥ 100 x 10⁹L and toxicity ≤ grade 2

Dosage with Hepatic Impairment:

Bilirubin	% Usual dose
>1 - 2.5 x ULN	50%
> 2.5 x ULN	25%

Dosage with Renal Impairment:

No adjustment required.

Dosage in the elderly:

Toxicity may be increased; used with caution.

Children:

Refer to protocol being used.

F - Administration Guidelines

FOR INTRAVENOUS USE ONLY.
Intrathecal administration of other vinca alkaloids has resulted in death. Containers with this product should be labelled:
“WARNING – FOR INTRAVENOUS USE ONLY. FATAL if given intrathecally.”

Direct IV push is not recommended to reduce the risk of inadvertently administering vinca alkaloids via intrathecal route.
Mix in 50 mL minibag (NS or D5W).
Dilutions in large volumes (≥ 100mL) and infusions over ≥30-60 minutes are not recommended, since these can increase the risk of vein irritation and extravasation.
If any signs or symptoms of extravasation occur, the injection or infusion should be immediately terminated and restarted in another vein. Any known or suspected extravasation should be managed promptly according to local guidelines.

Store unopened vials at 2 to 8ºC; protect from light.

G - Special Precautions

Contraindications:

Patients who have hypersensitivity to vinblastine or its formulation
Patients with severe myelosuppression or infection
Intrathecal vinblastine administration is absolutely contraindicated.

Other Warnings/Precautions:

Myelosuppressive effects are more marked in patients with bone marrow infiltration, cachexia or skin ulcers
Use with caution in hepatic impairment due to an increased risk of neurotoxicity.
Use with caution in patients with ischemic heart disease and in combination with neurotoxic drugs.
Do not give vinblastine more frequently than once every 7 days.
Standard doses of vinblastine given for prolonged periods (e.g. daily for 7 days) may result in permanent or fatal neurologic toxicity and should not be used.

Other Drug Properties:

Carcinogenicity: Yes

Pregnancy and Lactation:

Mutagenicity: Yes
Embryotoxicity: Yes
Teratogenicity: Yes

Vinblastine is contraindicated in pregnancy. Adequate contraception should be used by both sexes during vinblastine treatment and for at least 6 months after the last dose (general recommendation).
Breastfeeding:
Breast feeding is not recommended due to the potential secretion of vinblastine into breast milk.
Fertility effects: Yes

Aspermia and amenorrhea have been reported. Recovery of menses is variable.

H - Interactions

Vinblastine is metabolized by CYP3A4 and is a potent CYP3A4 inhibitor.

AGENT	EFFECT	MECHANISM	MANAGEMENT
Mitomycin	Acute bronchospasm has occurred minutes to hours after administration. Reaction may occur up to 2 weeks after mitomycin.	Unknown	Caution; discontinue vinblastine if this occurs
Phenytoin	↓ serum concentration of phenytoin	Possibly ↓ absorption or increased metabolism of phenytoin	Monitor serum levels of phenytoin and adjust dose as needed
CYP3A4 inhibitors (i.e. ketoconazole, voriconazole, clarithromycin, erythromycin, ritonavir, fruit or juice from grapefruit, Seville oranges, starfruit or pomegranate )	↑ risk of neurotoxicity	inhibition of vinblastine metabolism	Avoid concomitant use
CYP3A4 substrates (i.e., aprepitant, tolterodine)	↑ toxicity of CYP3A4 substrates	↓ metabolism of CYP3A4 substrates	Avoid if possible. If must use, monitor or adjust dose.
CYP3A4 inducers (i.e. phenytoin, rifampin, dexamethasone, carbamazepine, phenobarbital, St. John’s Wort, etc)	↓ vinblastine effect	↑ metabolism of vinblastine	Caution
Bleomycin +/- cisplatin	Raynaud's phenomenon, nephrotoxicity, neurotoxicity, MI, CVA reported	Unknown	Caution
Ototoxic drugs (i.e., cisplatin, aminoglycosides)	↑ ototoxicity (reported with other vinca alkaloids)	Additive	Caution

I - Recommended Clinical Monitoring

Treating physicians may decide to monitor more or less frequently for individual patients but should always consider recommendations from the product monograph.

Recommended Clinical Monitoring

Monitor Type	Monitor Frequency
CBC	Baseline and before each dose
Liver function tests	Baseline and before each cycle
Clinical assessment for neurotoxicity, infection, bleeding, GI, local toxicity (i.e. extravasation), hypersensitivity, hyperuricemia	At each visit

Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version

K - References

Vinblastine sulfate: ASHP's Interactive Handbook on Injectable Drugs. Accessed April 16, 2020.

Bouffet E, Jakacki R, Goldman S, et al. Phase II study of weekly vinblastine in recurrent or refractory pediatric low-grade glioma. J Clin Oncol 2012; 30(12):1358-63.

CPhA Monograph: Vinblastine. Canadian Pharmacists Association, October 2017.

ISMP 2018-2019 Targeted Medication Safety Best Practices for Hospitals. (From http://www.ismp.org/tools/bestpractices)

Johnson IS, Armstrong JG, Gorman M, et al. The vinca alkaloids: a new class of oncolytic agents. Cancer Research 1963;23:1390-427.

Lafay-Cousin L, Holm S, Qaddoumi I, et al. Weekly vinblastine in pediatric low-grade glioma patients with carboplatin allergic reaction. Cancer 2005;103:2636-42.

McEvoy GK, editor. AHFS Drug Information 2011. Bethesda: American Society of Health-System Pharmacists, p. 1263-5.

Prescribing information: Vinblastine. Bedford Laboratories (US)., December 2001.

Product Monograph: Vinblastine. Pfizer Canada, April 2019.

Scripture CD, Figg WD. Drug interactions in cancer therapy. Nature Reviews Cancer 2006;6:546-58.

Summary of Product Characteristics: Vinblastine. Hospira UK Ltd., October 2018.

Vinblastine: BC Cancer Agency Cancer Drug Manual, February 2015.

Zidan J, Robenstein W, Abzah A, et al. Treatment of Kaposi's Sarcoma with Vinblastine in Patients with Disseminated Dermal Disease. IMAJ 2001;3:251-3.

April 2020 Updated adverse effects, dosing, warnings/precautions, administration, interactions and monitoring sections

L - Disclaimer

Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.

The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.

The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.

Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.

While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.

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Info Sheet Name:

vinblastine (patient)

Info Sheet Introduction:

• For treating certain lymphomas, cancer of the bladder, testes, Kaposi's sarcoma, or other cancers.

Info Sheet Date: Mardi, mars 9, 2021 Info Sheet body:

Medication Information Sheet

vinBLAStine (Vin-BLAST-een)

This document provides general information about your medication. It does not replace the advice of your health care professional. Always discuss your therapy with your health care professional and refer to the package insert for more details.

Appearance:

Clear, colourless solution for injection

What is this medication for?

For treating certain lymphomas, cancer of the bladder, testes, Kaposi's sarcoma, or other cancers.

What should I do before I have this medication?

Tell your health care team if you have or had significant medical condition(s), such as:
- liver disease
- nerve problems (numbness/tingling of fingers or toes)
- or any allergies

Remember to:

Tell your health care team about all of the other medications you are taking.
Keep taking other medications that have been prescribed for you, unless you have been told not to by your health care team.

How will this medication affect sex, pregnancy and breastfeeding?

Talk to your health care team about:

How this treatment may affect your sexual health.
Changes to your menstrual cycle (periods), if this applies to you.
How this treatment may affect your ability to have a baby, if this applies to you.

This treatment may harm an unborn baby. Tell your health care team if you or your partner are pregnant, become pregnant during treatment, or are breastfeeding.

If there is any chance of pregnancy happening, you and your partner together must use 2 effective forms of birth control at the same time until 6 months after your last treatment dose. Talk to your health care team about which birth control options are best for you.
Do not breastfeed while on this medication.

How is this medication given?

This drug is only given by injection into a vein. Talk to your health care team about your treatment schedule.
If you missed your treatment appointment, talk to your health care team to find out what to do.

What else do I need to know while on this medication?

Will this medication interact with other medications or natural health products?
- This medication can interact with other medications, vitamins, foods and natural health products. Interactions can make the treatment not work as well or cause severe side effects.
- Tell your health care team about all of your:
  - prescription and over-the-counter (non-prescription) medications and all other drugs, such as marijuana (medical or recreational)
  - natural health products such as vitamins, herbal teas, homeopathic medicines, and other supplements
- Check with your health care team before starting or stopping any of them.

If you take seizure medications (such as phenytoin), your health care team will monitor your blood levels closely and may change your dose.

What should I do if I feel unwell, have pain, a headache or a fever?

Always check your temperature to see if you have a fever before taking any medications for fever or pain (such as acetaminophen (Tylenol) or ibuprofen (Advil)).
- Fever can be a sign of infection that may need treatment right away.
- If you take these medications before you check for fever, they may lower your temperature and you may not know you have an infection.

How to check for fever:

Keep a digital (electronic) thermometer at home and take your temperature if you feel hot or unwell (for example, chills, headache, mild pain).

You have a fever if your temperature taken in your mouth (oral temperature) is:
- 38.3°C (100.9°F) or higher at any time
  
  OR
- 38.0°C (100.4°F) or higher for at least one hour.

If you do have a fever:

Try to contact your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
Ask your health care team for the Fever pamphlet for more information.

If you do not have a fever but have mild symptoms such as headache or mild pain:

Ask your health care team about the right medication for you. Acetaminophen (Tylenol®) is a safe choice for most people.
Talk to your health care team before you start taking Ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or ASA (Aspirin®), as they may increase your chance of bleeding or interact with your cancer treatment.
Talk to your health care team if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.

What to DO while on this medication:

DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
DO tell your health care team if you have any new pain, numbness or tingling of your hands or feet. This is especially important if you are having trouble doing tasks (like doing up buttons, writing, walking) or if you have severe pain or numbness.
DO protect your skin from the sun. Wear a long sleeved shirt, long pants and a hat. Apply sunscreen with UVA and UVB protection and an SPF of at least 30. Your skin may be more sensitive to the sun and you could develop a bad sunburn or rash more easily.

What NOT to DO while on this medication:

DO NOT eat or drink grapefruit, starfruit, Seville oranges or their juices (or products that contain these) while taking this drug. They may increase the amount of drug in your blood and increase side effects.
DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.

What are the side effects of this medication?

The following table lists side effects that you may have when getting vinblastine. The table is set up to list the most common side effects first and the least common last. It is unlikely that you will have all of the side effects listed and you may have some that are not listed.

Read over the side effect table so that you know what to look for and when to get help. Refer to this table if you experience any side effects while on vinblastine.

More Common Side Effects (more than 10 out of 100 people)
Side effects and what to do	When to contact health care team
Neuropathy (Tingling, numb toes or fingers) (may be severe) What to look for? Numbness or tingling of your fingers and toes may happen after starting your treatment. Sometimes it can be painful and feel like burning sensation, which may be severe. What to do? Talk to your health care team if you have symptoms of neuropathy. Numbness and tingling may slowly get better after your treatment ends. In rare cases, it may continue long after treatment ends. If you continue to have bothersome symptoms, talk to your health care team for advice.	Talk to your health care team, especially if you have trouble doing tasks like doing up buttons, writing, moving, severe pain or numbness
Low neutrophils (white blood cells) in the blood (neutropenia) When neutrophils are low, you are at risk of getting an infection more easily. Ask your health care team for the Neutropenia (Low white blood cell count) pamphlet for more information. What to look for? If you feel hot or unwell (for example if you have chills or a new cough), you must check your temperature to see if you have a fever. Do not take medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen). Do not eat or drink anything hot or cold right before taking your temperature. You have a fever if your temperature taken in your mouth (oral temperature) is: 38.3°C (100.9°F) or higher at any time OR 38.0°C (100.4°F) or higher for at least one hour. What to do? If your health care team has told you that you have low neutrophils: Wash your hands often to prevent infection. Check with your health care team before getting any vaccines, surgeries, medical procedures or visiting your dentist. Keep a digital thermometer at home so you can easily check for a fever. If you have a fever: If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you must get emergency medical help right away.	If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you MUST get emergency medical help right away.
Low platelets in the blood When your platelets are low, you are at risk for bleeding and bruising. Ask your health care team for the Low Platelet Count pamphlet for more information. What to look for? Watch for signs of bleeding: bleeding from your gums unusual or heavy nosebleeds bruising easily or more than normal black coloured stools (poo) or blood in your stools (poo) coughing up red or brown coloured mucus dizziness, constant headache or changes in your vision heavy vaginal bleeding red or pink coloured urine (pee) What to do? If your health care team has told you that you have low platelets: Tell your pharmacist that your platelet count may be low before taking any prescriptions or over-the-counter medication. Check with your healthcare team before you go to the dentist. Take care of your mouth and use a soft toothbrush. Try to prevent cuts and bruises. Ask your health care team what activities are safe for you. Your treatment may have to be delayed if you have low platelets. Your health care team may recommend a blood transfusion. If you have signs of bleeding: If you have a small bleed, clean the area with soap and water or a saline (saltwater) rinse. Apply pressure for at least 10 minutes. If you have bleeding that does not stop or is severe (very heavy), you must get emergency medical help right away.	Talk to your health care team if you have any signs of bleeding. If you have bleeding that doesn’t stop or is severe, you MUST get emergency medical help right away
Constipation (may be severe) What to look for? Having bowel movements (going poo) less often than normal. Small hard stools (poo) that look like pellets. The need to push hard and strain to have any stool (poo) come out. Stomach ache or cramps. A bloated belly, feeling of fullness, or discomfort. Leaking of watery stools (poo). Lots of gas or burping. Nausea or vomiting. What to do? To help prevent constipation: Try to eat more fiber rich foods like fruits with skin, leafy greens and whole grains. Drink at least 6 to 8 cups of liquids each day unless your health care team has told you to drink more or less. Be Active. Exercise can help to keep you regular. If you take opioid pain medication, ask your health care team if eating more fibre is right for you. To help treat constipation: If you have not had a bowel movement in 2 to 3 days you may need to take a laxative (medication to help you poo) to help you have regular bowel movements. Ask your health care team what to do. Ask your health care team for the Constipation Pamphlet for more information.	Talk to your health care team if it does not improve or if it is severe
Pains or cramps in the belly What to look for? Pain or cramps in your belly. Constipation and diarrhea can cause pain in your belly. What to do? If the pain is severe, gets worse or doesn’t go away, talk to your health care team about other possible causes.	Talk to your health care team if it does not improve or if it is severe
Low appetite What to look for? Loss of interest in food or not feeling hungry. Weight loss. What to do? Try to eat your favourite foods. Eat small meals throughout the day. You may need to take meal supplements to help keep your weight up. Talk to your health care team if you have no appetite. Ask your health care team for the Loss of Appetite pamphlet for more information.	Talk to your health care team if it does not improve or if it is severe
Nausea and vomiting (generally mild) What to look for? Nausea is feeling like you need to throw up. You may also feel light-headed. You may feel nausea within hours to days after your treatment. What to do? To help prevent nausea: It is easier to prevent nausea than to treat it once it happens. Drink clear liquids and have small meals. Get fresh air and rest. Do not eat spicy, fried foods or foods with a strong smell. Limit caffeine (like coffee, tea) and avoid alcohol. If you have nausea or vomiting: Take your rescue (as-needed) anti-nausea medication(s) as prescribed. Ask your health care team for the Nausea & Vomiting pamphlet for more information. Talk to your health care team if: nausea lasts more than 48 hours vomiting lasts more than 24 hours or if it is severe	Talk to your health care team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours or if severe
Taste changes What to look for? Food and drinks may taste different than usual. What to do? Eat foods that are easy to chew, such as scrambled eggs, pasta, soups, cooked vegetables. Taste foods at different temperatures, since the flavour may change. Try different forms of foods, like fresh, frozen or canned. Experiment with non-spicy foods, spices and seasonings.	Talk to your health care team if it does not improve or if it is severe
Mouth sores What to look for? Round, painful, white or gray sores inside your mouth that can occur on the tongue, lips, gums, or inside your cheeks. In more severe cases they may make it hard to swallow, eat or brush your teeth. They may last for 3 days or longer. What to do? To help prevent mouth sores: Take care of your mouth by gently brushing and flossing regularly. Rinse your mouth often with a homemade mouthwash. To make a homemade mouthwash, mix 1 teaspoonful of baking soda and 1 teaspoonful of salt in 4 cups (1L) of water. Do not use store-bought mouthwashes, especially those with alcohol, because they may irritate your mouth. If you have mouth sores: Avoid hot, spicy, acidic, hard or crunchy foods. Your doctor may prescribe a special mouthwash to relieve mouth sores and prevent infection. Talk to your health care team as soon as you notice mouth or lip sores or if it hurts to eat, drink or swallow. Ask your health care team for the Oral Care (Mouth Care) pamphlet for more information.	Talk to your health care team as soon as you notice mouth or lip sores or if it hurts to eat, drink or swallow
Hair thinning or loss (generally mild) What to look for? Your hair may begin to become thin or fall out during or after treatment. In most cases, your hair will grow back after treatment, but the texture or colour may change. In very rare cases, hair loss may be permanent. What to do? Use a gentle soft brush. Do not use hair sprays, bleaches, dyes and perms.	Talk to your health care team if this bothers you

Other rare, but serious side effects are possible.
If you experience ANY of the following, speak to your cancer health care provider or get emergency medical help right away:

Fever, itchiness, rash, swollen lips, face or tongue, chest and throat tightness, usually during or shortly after the medication is given
Burning, stinging or other pain while the medication is being given
Red, itchy, bruised, and/or swollen skin where the injection was given
Swelling in your hands, ankles, feet or other areas of your body
Weight gain that is not normal for you, new pain in your lower back, peeing less than usual
Muscle spasms, cramping, weakness, twitching, or seizures, confusion
Difficulty swallowing
Drooling, drooping eyelids or face
Any changes to your hearing

Who do I contact if I have questions or need help?

My cancer health care provider is: ______________________________________________

During the day I should contact:________________________________________________

Evenings, weekends and holidays:______________________________________________

Other Notes:

____________________________________________________________________________

October 2020 Updated Sex / pregnancy / breastfeeding and Side effects sections

For more links on how to manage your symptoms go to www.cancercareontario.ca/symptoms.

The information set out in the medication information sheets, regimen information sheets, and symptom management information (for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.

Info Sheet (English):

vinblastine patient.pdf Info Sheet (French):

vinblastine pour le patient.pdf Monograph:

vinblastine.pdf Phonetic Spelling:

Vin-BLAST-een

Cancer Type: Central Nervous System Genitourinary Bladder / Urothelial Testis Hematologic Lymphoma - Hodgkin Rare Diseases Lung Non-Small Cell Sarcoma Desmoid Tumour Kaposi's Sarcoma Type of Content: Drug Monograph Status: Null Info Sheet Status: Null Global Date: Jeudi, avril 16, 2020 Universal Date: 2021-03-09 00:00:00 AddThis: Title URL: vinBLAStine Drug Display Status: Active Revision Summary:
Patient Info Sheet FR: Updated/Revised info sheet