Critical Administration Information

There are several very critical points to be aware of when administering vincristine:

Intravenous Use Only: A critically important thing to know about vincristine is that it is fatal if given intrathecally - it is for intravenous use only.  It is extremely important to assure that it remains packaged in its original packaging, which is printed with a statement urging healthcare providers to keep the covering on the drug until the moment of injection. Even very drastic measures in an attempt to reverse damage after an accidental intrathecal administration have failed to prevent irreversible paralysis and/or death.

Vesicant: Vincristine should be given only by practitioners who are skilled in its administration. Any leakage of vincristine into the surrounding tissue around the intravenous needle or catheter will result in extravasation and probable tissue injury. The needle and/or catheter must be properly positioned and checked frequently throughout administration to assure proper placement. If an extravasation does occur, the drug must be discontinued immediately and a local injection of hyaluronidase should be administered.

Box Warnings & Precautions

• Only practitioners well experienced in the administration of vincristine sulfate should administer this drug. Extreme care should be employed to ensure the proper placement of the intravenous needle or catheter to be used for vincristine sulfate injection or infusion, to avoid extravasation. If extravasation occurs, tissue necrosis or injury is a likely result.
• Vincristine sulfate is indicated for intravenous use ONLY and is FATAL if given intrathecally.
• Patient with pre-existing neuromuscular disease should be carefully considered prior to administration of this drug.
• Vincristine does not appear to cross the blood brain barrier, and therefore may not be effective in the setting of central nervous system leukemia.
• Patient who experience sudden and severe shortness of breath and bronchospasm after receiving vincristine should not be rechallenged with the drug. This may occur in combination with mitomycin C. Onset of these symptoms may occur minutes to hours after drug administration and may require aggressive treatment.

(Vincasar PFS Injection^® package insert; Oncovin^®  package insert; NCI, 2010)