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Vinca alkaloid cytotoxic Pregnancy: Women of childbearing potential should be advised to avoid becoming pregnant while receiving vincristine sulfate. Due to the potential for genotoxicity, teratogenicity, and embryo toxicity, female patients of reproductive potential are advised to use highly effective contraception during treatment and for at least 7 months following the last dose; male patients with female partners of reproductive potential are advised to use highly effective contraception during treatment and for at least 4 months following the last dose. Caution is necessary with the use of all oncolytic drugs during pregnancy. Vincristine sulfate can cause foetal harm following maternal or paternal exposure, although there are no adequate and well-controlled studies; studies in animals have shown teratogenic effects as well as embryolethality. If used during pregnancy, or if the patient becomes pregnant while receiving it, she should be informed of the potential hazard to the foetus. Breast-feeding: there is insufficient information on excretion in human breast milk; the mother should be advised not to breast-feed while on vincristine sulfate therapy and for 1 month following the last dose, or to discontinue/abstain from therapy, taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman. Fertility: male and female fertility may be compromised; it is recommended to discuss fertility preservation with men and women prior to treatment.

Vincristine sulfate (Specialist drug)

Brand names: Oncovin

Vincristine sulfate is a vinca alkaloid cytotoxic given intravenously, widely used in regimens for acute leukaemias, lymphomas and several solid tumours.

Adult dose

Dose: Adults - SPECIALIST, PROTOCOL-DRIVEN USE. The SPC lists one regimen for all indications (leukaemias, malignant lymphomas, multiple myeloma, solid tumours, paediatric solid tumours, idiopathic thrombocytopenic purpura) and states 'The following dosage regimens have been used': the recommended dose is 1.4 to 1.5 mg/m2 intravenously at weekly intervals, up to a maximum weekly dose of 2 mg. Dose from the patient's chemotherapy protocol.
Route: Intravenous only - FATAL IF GIVEN BY ANY OTHER ROUTE (never intrathecal, intramuscular or subcutaneous)
Frequency: Once weekly
Max: 2 mg per week (SPC: 'maximum weekly dose of 2 mg'; 'Individual doses should not exceed 2 mg')
SOURCE: UK SPC, Vincristine Sulfate 1 mg/ml Solution for Injection (eMC product 1501). Section 4.2: 'Because of the narrow range between therapeutic and toxic levels and variations in response, the dosage must always be adjusted to the individual.' 'Great care should be exercised in calculating and administering the dose, as overdosage may be extremely serious or even fatal.' 'It should only be administered by individuals experienced in vincristine administration.' 'The dose should not be increased beyond the level which produces therapeutic benefit. Individual doses should not exceed 2 mg; and white cell counts should be carried out before and after giving each dose.' The calculated dose is given 'according to the treatment protocol and under constant supervision for signs of extravasation'. Measure the dose by volume from the vial into an accurate dry syringe; do not add extra fluid to the vial. ROUTE SAFETY: 'TO REDUCE THE POTENTIAL FOR FATAL MEDICATION ERRORS DUE TO INCORRECT ROUTE OF ADMINISTRATION, VINCRISTINE SULFATE INJECTION IS RECOMMENDED TO BE DILUTED IN A FLEXIBLE PLASTIC CONTAINER AND PROMINENTLY LABELLED AS INDICATED FOR INTRAVENOUS USE ONLY - FATAL IF GIVEN BY OTHER ROUTES'; syringes should be labelled 'VINCRISTINE FOR INTRAVENOUS USE ONLY. FATAL IF GIVEN BY OTHER ROUTES'. Section 4.4 carries an emergency protocol for accidental intrathecal administration (immediate neurosurgical intervention) - consult the SPC. EXTRAVASATION: vincristine is a vesicant; if leakage occurs stop the injection immediately and give the remaining dose into another vein; local hyaluronidase and moderate heat help disperse the drug. Elderly: 'The normal adult dose is still appropriate in the elderly.' ITP: not recommended as primary treatment. Some sections of the product information we used were incomplete — check the full SPC.

Paediatric dose

Dose: 1.4 to 2 mg/m2 once weekly, with a maximum weekly dose of 2 mg. For children weighing 10 kg or less, the starting dose is 0.05 mg/kg as a weekly intravenous injection.
Route: Intravenous only - fatal if given by any other route
Frequency: Once weekly
Max: 2 mg per week (SPC: 'maximum weekly dose of 2 mg')
SPC section 4.2, Children: 'The suggested dose is 1.4 to 2 mg/m2 given on a weekly basis with a maximum weekly dose of 2 mg. For children weighing 10 kg or less the starting dose should be 0.05 mg/kg administered as a weekly intravenous injection.' The 0.05 mg/kg figure applies only to children weighing 10 kg or less (starting dose); it is not a general per-kg dose. The body-surface-area dose is calculated from the protocol; the 2 mg weekly cap applies. Specialist, protocol-driven use only; verify against a children's formulary.

Dose adjustments

Renal

Not stated - no renal-impairment dosing statement appears in any retrieved section of the UK SPC (sections 4.2, 4.3, 4.4, 4.6, 4.8) or the retrieved US label. Verify against the full SPC before advising.

Hepatic

SPC section 4.2: 'Because of the hepatic metabolism and biliary excretion of vincristine sulfate, reduced doses are recommended in patients with obstructive jaundice or other hepatic impairment. Patients with liver disease sufficient to decrease biliary excretion may experience an increase in the severity of side-effects. A 50 per cent reduction in the dose of vincristine sulfate is recommended for patients having a direct serum bilirubin value above 3 mg/100 ml (51 micromol/l).'

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Intrathecal administration - 'usually fatal'; the product is for intravenous use only and must not be given by intrathecal, intramuscular or subcutaneous injection
  • Hypersensitivity to vincristine sulfate or to any of the excipients listed in section 6.1
  • Demyelinating form of Charcot-Marie-Tooth syndrome
  • Careful notice should also be given to the conditions listed in section 4.4

Side effects

  • The most common adverse reaction is alopecia; the most troublesome adverse reactions are neuromuscular in origin. Reactions are generally reversible and related to dosage size and cumulative dosage
  • With single weekly doses, granulocytopenia, neuritic pain and constipation are usually of short duration (less than 7 days) and may lessen or disappear when the dose is reduced; they seem to increase when the calculated amount is given in divided doses
  • Sensory loss, paraesthesia, difficulty in walking, slapping gait, loss of deep-tendon reflexes and muscle wasting may persist for at least as long as therapy continues; generalised sensorimotor dysfunction may become progressively more severe with continued treatment
  • Listed in the section 4.8 table (frequency categories not reproduced because the fetched table lost its column alignment): infection, sepsis, neutropenic sepsis; thrombocytopenia, anaemia, granulocytopenia, neutropenia, haemolytic anaemia; decreased appetite, hyperuricaemia; peroneal nerve palsy, paraesthesia, coma, paralysis, seizure, multiple cranial nerve palsies, sensory loss, areflexia, neuralgia, nystagmus, ataxia, balance disorder, gait disturbance, dizziness, headache, paresis, motor dysfunction; transient blindness, optic atrophy; deafness, vertigo; myocardial infarction, coronary artery disease; hypotension, hypertension; oropharyngeal pain, acute respiratory distress syndrome, bronchospasm, dyspnoea; constipation, abdominal pain, vomiting, nausea, paralytic ileus, diarrhoea, intestinal perforation, gastrointestinal necrosis, mouth ulceration, salivary gland pain; veno-occlusive liver disease; alopecia, rash; myalgia, bone pain, pain in jaw, muscle atrophy; anaphylactic reaction, oedema; inappropriate antidiuretic hormone secretion; secondary malignancies
  • Vesicant: severe local reaction, ulceration or cellulitis on extravasation
  • Acute shortness of breath and severe bronchospasm have been reported with vinca alkaloids, most often in combination with mitomycin-C; acute uric acid nephropathy has been reported
  • Azoospermia and amenorrhoea can occur in post-pubertal patients treated with multiple-agent chemotherapy including vincristine
  • This side-effect list may be incomplete — check the full SPC.

Interactions

  • Azole antifungals: concomitant administration with vincristine has been associated with neurotoxicity, seizures, peripheral neuropathy, SIADH and paralytic ileus; reserve azole antifungals for patients who have no alternative antifungal options (SPC section 4.4)
  • Mitomycin-C: acute shortness of breath and severe bronchospasm reported with vinca alkaloids, most often in combination (SPC section 4.4)
  • Neurotoxic effect may be additive with other neurotoxic agents or increased by spinal cord irradiation and neurological disease (SPC section 4.4)
  • US labelling (not the UK SPC): phenytoin - blood levels of the anticonvulsant may fall and seizure activity increase, so base dosage on serial blood level monitoring; strong CYP3A inhibitors (e.g. itraconazole) and strong CYP3A inducers (e.g. St. John's Wort) should be avoided; with L-asparaginase give vincristine 12 to 24 hours before the enzyme; avoid liver-port radiation therapy
  • This interaction list may be incomplete — check the full SPC.

Monitoring

  • White cell counts before and after giving each dose (SPC section 4.2)
  • Direct serum bilirubin - a 50 per cent dose reduction is recommended above 3 mg/100 ml (51 micromol/l)
  • Neuromuscular status - neuromuscular rather than bone marrow toxicity usually limits dosage
  • Signs of infection - granulocytopenia is possible; if granulocytopenia or a complicating infection is present, administration of the next dose warrants careful consideration
  • Bowel function - constipation and paralytic ileus are labelled reactions
  • Infusion site - constant supervision for signs of extravasation
  • Route double-check before every dose - syringes and infusion bags must be labelled for intravenous use only, fatal if given by other routes
  • Protect the eyes from accidental contamination (highly irritant; can cause corneal ulceration)

Clinical monograph

How it works

It binds tubulin and inhibits microtubule formation, arresting dividing cells in metaphase.

Prescribing in practice

  • It is for intravenous use only and is fatal if administered intrathecally; rigorous spinal-injection safety measures are mandatory.
  • Dose-limiting peripheral neurotoxicity, including sensory and motor neuropathy and autonomic effects such as constipation, is common.
  • It is a vesicant and a specialist medicine requiring extravasation precautions and expert supervision.

Monitoring

Monitor for peripheral and autonomic neuropathy at each visit, alongside full blood count and bowel function.

Counselling the patient

  • Report numbness, tingling, weakness, difficulty walking or jaw pain promptly.
  • Use measures to prevent constipation and report severe or persistent constipation.
  • Tell staff immediately about pain or swelling at the injection site.

Evidence & guidelines

Vincristine is a core component of established combination regimens endorsed by oncology and haematology 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).

Related

Curated clinical cross-links plus same-class fallbacks.

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