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Vinblastine

Availability - 10 ml vial at a concentration of 1mg/ml.

Route – IV with butterfly catheter

Dosage – Dogs:
For susceptible neoplastic disease:

  • 2 mg/M2 IV every 7-14 days (O’Keefe and Harris 1990)
  • For mast cell tumors after surgical removal @ 2 mg/M2, weekly for four weeks then every two weeks for eight weeks. Prednisolone is given concurrently starting at 2 mg/kg/day, tapering to 0.5 mg/kg/day (Davies, Wyatt 2002)
  • For lymphoma and mastocytoma: 2 mg/M2 weekly. For Lymphosarcoma and various carcinomas: 2.5 mg/M2 IV weekly (MacEwen and Rosenthal 1989)

Cats:
For susceptible neoplastic disease:

  • For Lymphosarcoma and mast cell neoplasms: 2 mg/M2 IV every 7-14 days(Couto 1989b)
  • 2 mg/M2 slow IV every 7-14 days (Golden and Langston 1988)

Storage – Refrigerate and protect from light. Once a bottle has been opened it should be placed in an individual Ziploc bag with the date and time it was opened written on the bag. It is to be stored in a chemotherapy ONLY refrigerator and is good for 30 days once it has been opened.

Pharmacokinetics – Extensively metabolized by the liver and is primarily excreted in the bile/feces. Lesser amounts eliminated in the urine.

Contraindications/Precautions – Vinblastine is contraindicated in patients with preexisting leucopenia or granulocytopenia or active bacterial infection.
Dose should be reduced in patients with hepatic disease.
Should be used with caution in herding breeds due to a potential neurotoxic substrate of P-glycoprotein.
Since Vinblastine may be a skin irritant, gloves and protective clothing should be worn when handling, preparing and administering the medication.

Extravasation - Can cause severe tissue irritation and necrosis. If extravasation should occur, immediately pack with warm water compress and infiltrate the area with saline and dexamethasone.

Possible Acute Side Effects

  • Vomiting
  • Anorexia
  • Diarrhea/Constipation
  • Lethargy
  • Renal failure
  • Seizures
  • Injection site reaction: red, swollen, painful
  • Allergic reaction including: facial twitching, hives, swelling on the face

Possible Delayed Side Effects

  • Bone marrow suppression
  • Stomatitis
  • Jaw pain
  • Paralytic ileus
  • Loss of deep tendon reflexes
  • Alopecia

Supplies

  • Patient chart with chemotherapy log sheet
  • M2 conversion chart
  • Calculator
  • Vinblastine
  • Luerlock syringe of appropriate size
  • Chemotherapy gloves – one pair per person
  • Chemotherapy gown – one per person
  • Protective eye wear – one per person
  • Chemotherapy mask – one per person
  • Chemotherapy medical waste bag
  • Chemotherapy sharps container

Catheter supplies – Hair clipper with 40 blade

  • Surgical scrub/alcohol
  • Butterfly catheter
  • Two 10 cc syringes with 6-10cc saline
  • Gauze pads
  • Bandaging material

Patient if treated in hospital

  • The patient should be housed in an appropriate sized cage or run, if caged a lower cage is suggested to avoid urine running to lower cage.
  • Cage/run should be in a location where they can be observed at all times
  • Patient identification card
  • Cage marked with a very visible sign indicating “Chemotherapy Patient”
  • Fresh water at all times

Pre-treatment

  • Physical by DVM
  • Physical by Oncology technician
  • Owner authorization papers signed
  • Chemistry panel – liver enzymes within normal limits
  • CBC – monitor neutrophil count, postpone treatment if less than 3,000/ul
  • Monitor WBC, postpone if low, possibly start antibiotics
  • Prepare all supplies
  • Calculate drug dose, triple check

Treatment Procedure

  • Have the patient walked prior to treatment
  • Procedure should be performed in Chemotherapy room or a low traffic area
  • Have assistant and yourself dress in appropriate clothing
  • Draw up Vinblastine with a Luerlock syringe
  • Make sure assistant and patient are comfortable
  • Prep and place butterfly catheter (alternate between right and left leg for each treatment)
  • Flush one syringe of saline into catheter, be 100% sure catheter is patent, if not patent, pull catheter and place a new catheter into a different leg and flush with saline syringe
  • Remove empty flush syringe
  • Attach Vinblastine syringe and administer as a bolus
  • Remove empty syringe
  • Attach second syringe of saline and flush catheter
  • Pull butterfly catheter with injection site covered with several gauze pads, once catheter is removed hold steady pressure over IV site for 5 minutes
  • Place a firm bandage over IV site and leave in place for one hour
  • Wear gloves when removing bandage, send gloves home with owner if out patient treatment is being performed
  • Place all waste material, syringes, catheter, gloves, etc. in appropriate waste containers

Patient Clean Up –

  • Medical staff must wear gloves when cleaning cage, bedding and excrement of all chemotherapy patients
  • Urine, stool and vomit is considered contaminated for 48 hours
  • All solid waste must be double bagged before being placed in the trash
  • If possible collect urine in a pan and flush it down the drain
  • If you do not catch the urine thoroughly rinse the area with copious amounts of water, avoiding splashing at all times
  • Blankets and bedding should be washed asap with regular disinfectant
  • Cage/run can be cleaned with regular disinfectant. DO NOT use a spray bottle or hose, avoid aerosolization

Discharge

  • Supply owner with written home care instruction. Go over the entire form at EVERY visit. Have owner sign two copies, one for them and one for the patient record. See our version of “Home Care Instruction” in our specialty folder
  • Supply owner with gloves
  • Schedule follow-up blood work, CBC 10 day post treatment
  • Schedule next tentative chemotherapy treatment

References:
Plumb’s Veterinary Drug Handbook
Vinblastine drug insert
Oncology for Veterinary Technicians and Nurses – Moore and Frimberger
Cancer In Dogs And Cats Medical and Surgical Management – Morrison
Managing The Canine Cancer Patient – Ogilvie and Moore