Vinca alkaloid cytotoxic Pregnancy: Vinblastine may cause foetal toxicity when administered to pregnant women; it causes resorption of foetuses in animals and produces gross foetal abnormalities in surviving offspring. There are no adequate and controlled studies in pregnant women, and the drug should be used during pregnancy only in life-threatening situations or severe disease for which safer drugs cannot be used or are ineffective. Female patients of reproductive potential should use highly effective contraception during treatment and for at least 6 months after the last dose; male patients with female partners of reproductive potential for at least 3 months after the last dose. Mothers should not breast-feed during vinblastine therapy and for 1 week after the last dose. Male and female fertility may be compromised — discuss fertility preservation before treatment.

Vinblastine sulfate (Specialist drug)

Vinblastine sulfate is a vinca alkaloid cytotoxic given by intravenous injection for cancers including Hodgkin lymphoma, certain other lymphomas and testicular germ cell tumours.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 6 mg/m² body surface area

Route: Intravenous only — injected either directly into the vein or into the injection site of a running intravenous infusion, over about one minute. FOR INTRAVENOUS USE ONLY: FATAL IF GIVEN BY OTHER ROUTES. Must not be given intramuscularly, subcutaneously or intrathecally.

Frequency: Usually administered no more frequently than once every seven days

eMC SPC for Vinblastine Sulfate 1 mg/ml solution for injection. Must be used only by physicians experienced in cytotoxic chemotherapy. The SPC states this 6 mg/m² recommended dose applies to adults, the elderly AND children. TESTICULAR TUMOURS: the dosage may be increased to 0.2 mg/kg administered on each of two consecutive days every three weeks. ADMINISTRATION: to minimise extravascular spillage it is suggested that the syringe and needle be rinsed with venous blood before withdrawal. The dose should not be diluted in large volumes of diluent (i.e. 100 to 250 ml) or given intravenously for prolonged periods (30 to 60 minutes or more), since this frequently results in vein irritation and increases the chance of extravasation. Because of the enhanced possibility of thrombosis it is considered inadvisable to inject vinblastine into an extremity in which the circulation is impaired or potentially impaired. Syringes containing this product should be over-labelled with the intrathecal warning label provided. HEPATIC: as vinblastine is excreted principally by the liver, toxicity may be increased in hepatic insufficiency and initial doses may need to be reduced; a 50% dose reduction is recommended for patients with a direct serum bilirubin value above 3 mg/100 ml. MYELOSUPPRESSION is the dose-limiting factor; the granulocyte nadir occurs five to ten days after the last day of administration with recovery usually complete within a further seven to fourteen days. §4.8 warns that the use of small amounts of vinblastine daily for long periods is not advisable even if the total dosage is similar. DIFFERENT US SCHEDULE (not used for this draft): the US label describes an incremental weekly adult schedule starting at 3.7 mg/m² and escalating (5.5, 7.4, 9.25, 11.1 mg/m²) to a maximum not exceeding 18.5 mg/m², titrated against the white cell count; do not combine that schedule with the UK SPC dose above. eMC §4.5 was not captured in the fetched bundle.

Dose adjustments

Renal

Since metabolism and excretion are primarily hepatic, no modification is recommended for patients with impaired renal function (§4.2).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients (§4.3)
For intravenous use only — fatal if given by other routes
Patients who are leucopenic
Presence of bacterial infection — such infections should be brought under control with antiseptics or antibiotics before initiating vinblastine

Side effects

Leucopenia — the most common side effect and the dose-limiting factor; also neutropenia, thrombocytopenia and anaemia
Alopecia and oral mucosal blistering/stomatitis
Constipation, nausea, vomiting, abdominal pain and diarrhoea; also ileus, haemorrhagic enterocolitis, rectal bleeding and peptic ulcer haemorrhage
Neurological effects — peripheral neuropathy, numbness, paraesthesia, loss of deep tendon reflexes, headache, dizziness and convulsions
Injection site phlebitis and cellulitis (in extreme cases skin exfoliation) and extravasation injury; also inappropriate anti-diuretic hormone secretion at higher than recommended doses, myalgia, bone and jaw pain, malaise and asthenia

Interactions

Phenytoin — simultaneous oral or intravenous administration with antineoplastic combinations that included vinblastine has been reported to reduce blood levels of the anticonvulsant and to increase seizure activity; adjust the phenytoin dose on serial blood level monitoring (US label)
Inhibitors of hepatic cytochrome P450 CYP3A — concurrent administration may cause an earlier onset and/or increased severity of side effects; caution is required, as also in patients with hepatic dysfunction (US label)
Erythromycin — enhanced toxicity has been reported in patients receiving concomitant erythromycin (US label)
Other ototoxic agents such as platinum-containing oncolytics — particular caution is warranted, as vinca alkaloids have rarely caused vestibular and auditory damage to the eighth cranial nerve (§4.8)
Note: eMC §4.5 was not captured in the fetched bundle — the full UK interactions section must be checked on the SPC

Clinical monograph

How it works

It binds tubulin and inhibits microtubule assembly, arresting cells in metaphase and preventing cell division.

Prescribing in practice

It is for intravenous use only and is fatal if given by the intrathecal route; administration must follow strict spinal-injection safety procedures.
It is a potent vesicant, so extravasation must be avoided and managed promptly if it occurs.
Myelosuppression, particularly neutropenia, is dose-limiting and requires count-guided dosing.

Monitoring

Monitor full blood count before each dose, together with hepatic function and clinical assessment for neuropathy and infection.

Counselling the patient

Report fever, sore throat or other signs of infection urgently as the white cell count may be low.
Tell the team at once about pain, swelling or leakage at the injection site.
Report numbness, tingling or constipation, which may indicate nerve effects.

Evidence & guidelines

Its role is established within long-standing combination chemotherapy regimens supported by clinical guidelines.

Reference: SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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