Sulfate 881
should be avoided in smokers,''''' and high doses of Systematic Reviews; Issue 2. Chichester: John Wiley; 2008 (accessed PhannacopoeialPreparations may have adverse effects. 12 The carotenoids, 09/05/08). USP 36: Veneporfin for Injection. vitamins 29. NICE. Ranibizumab and pegaptanib for the treatment of age-related lutein and zeaxanthin, have been promoted as retinal macular degeneration: Technology Appraisal Guidance ISS (issued protectants, but controlled data are lacking.9•10•14·34·35 August 2008). Available at: http://www.nice.org.uk/nicemedia/pdf/ Sorne recmn1nend that those at risk of AMD should be TA I55guidance.pdf (accessed 01/10/09) IBANM, usAN, rtNNMJ 30. BrownDM, eta!. CLEAR-IT 2 Investigators. Primary endpoint results of a Vinblastine Sulfate encouraged to stop smoking and to consume a diet phase II study of vascular endothelial growth factor trap-eye in wet age . Vimblasrina; . Sti fei including vegetables, fish, whole grains, and nuts, and to related macular degeneration. Ophthalmology 2011; 118: 1089-97. 29060-LE; :Nsc:49842; . i o reduce consumption of fats especially vegetable oil.7•12•34 31. Heier JS, et a!. CLEAR·IT 2 Investigators. The 1-year results of CLEAR-IT vinbla>�[na; Vi nblastiinisulf<�atti; Yinblastinde SU.Ifm; _Vinbl�fiO<;de A prospective cohort study found that a high dietary 2, a phase 2 study of vascular endothelial growth factor trap-eye dosed sulfate de; Vinblastine; Sttllate Vinblastine Sulphate; Ophthalmology 118: 1098-- intake of vitamin E and zinc, or an above-median intake as-needed after 12-week fixed dosing. 20ll; Vinblastlni Sulfa$; Vinblastino de;sulfates;c Vinb!asti!JSUl{at; 1106. Correction. ibid.; 1700. . of the combination of vitamins C and E, betacarotene, et a!. Nlnbla�tin-sulfat; Vinblasztin-'Qulfat; 'Vin�leukobJaslihe 32. Wong TY, Clinical update: new treatments for age-related macular sui' and zinc were associated with a lower risk of incident degeneration. Lancet 2007; 370: 204-6. phate; VLB {vinbiastlmel;Winbl astyny siaro:ar); s.W.OhactfiHa . AMD, 36 Daily supplementation with folic acid, pyrid 33. Liu M, Regillo CD. A review of treatments for macular degeneration: a synopsis of currently approved treatments and ongoing clinical trials. . oxine, and cyanocobalamin during an average of 7. 3 CulT Opin Ophthalmo/ 2004; 15: 221-6. C<;:y,6llb$ctT,HssN40,,H2S0,=9®. . . 1. · years of follow-up reduced the risk of AMD in a large 34. Anonymous. Nutritional supplements for macular degeneration. Drug l43°6i'4(Vinblasrine sulfate}, = . cohort of women at increased risk for vascular disease; Ther Bull 2006; 44: 9-1 1. CAS 865 -2 F4 Mnblasrine); . . .. Am .. benefit emerged at about 2 years of follow-up and 3S. Zhao L, Sweet BY. Lutein and zeaxanthin for macular degeneration. \fet J Health-Syst Pharm 2008; 65: 1232-8. ATC-t01CA01: . persisted throughout the study, 37 However, systematic 36. van Leeuwen R, et a!. Dietary intake of antioxidants and risk of age ATC N()QW-22Y02B.:;,._:QLOICAOi, reviews38•39 have found no evidence to support the role related macular degeneration. 200S; 294: 3101-7. Description.UNII _; Vinblastine sulfate is the sulfate of an of antoxidant vitamin and mineral supplements in the 37. Christen WG, et al. Folic add,lAMA pyridoxine, and cyanocobalamin primary prevention of AMD. combination treatment and age-related macular degeneration in alkaloid, vincaleukoblastine, extracted from Catharanthus Retinal or macular surgery, and transpupillary thermo women: the Women's Antioxidant and Folic Acid Cardiovascular Study. roseus (Vinca rosea) (Apocynaceae), • Arch Intern Med 2009; 169: 3 3 5--41. therapy have been investigated; U0•13·14•33 however, long 38. Chong EW-T, et a!. Dietary antioxidants and primary prevention of age Pharmacopoeias, In Chin,, Bur, (see p, vii), Int,, Jpn, US, and term data are lacking for surgery, 12 and use of related macular degeneration: systematic review and meta-analysis. Viet BMJ 335: transpupil!ary thermotherapy is not recommended, 15 2007; 7SS-9. Ph. Eur. 8: (Vinblastine Sulfate), A white or slightly Radiotherapy has also been tried with mixed results 9,13 39. Evans JR, Henshaw K. Antioxidant vitamin and mineral supplements for preventing age-related macular degeneration. Available in The yellowish, very hygroscopic, crystalline powder, It loses not Retinal transplantation is under investigation.6•10•14 Gene Cochrane Database of Systematic Reviews; Issue l. Chichester: John more than 15% of its weight on drying, Freely soluble in silencing with bevasiranib, a short interfering RNA Wiley; 2008 (accessed 09/05/08). water; practically insoluble in alcohol. A 0,15% solution in (siRNA) therapeutic designed to turn off or silence the 40. Arjamaa 0. Gene silencing in wet age-related macular degeneration. Lancet 368: water has a pH of 3.5 to 5.0. Store at a temperature not gene that produces VEGF, is also under investigation for 2006; 630-l. 41. Chappelow AV, Kaiser PK. Neovascular age-related macular degenera exceeding -20 degrees in airtight glass containers. Protect wet AMD.I2A0.4I tion: potential therapies. Drugs 2008; 68: 1029-36. from light, 1. Soubrane G, Bressler NM. Treatment of subfoveal choroidal neovascularisation in age related macular degeneration: focus on USP 36; (Vinblastine Sulfate), A white or slightly yellow, clinical application of verteporfin photodynamic therapy. Br J Adverse Effects and Precautions odourless, hygroscopic, amorphous or crystalline powder. It Ophthalmol 2001; 85: 483-9S. loses not more than 15% of its weight on drying. Freely 2. NICE. Guidance on the use of photodynamic therapy for age-related Photosensitivity will occur in all patients treated with macular degeneration: Technology Appraisal 68 (issued September soluble in water, A 0,15% solution in water has a pH of 3.5 verteporfin and patients should not be exposed to direct -l 2003). Available at: http://www.nice.org.uk/nicemedia/pdf/68_ to 5,0, Store at a temperature between -25 degrees and 0 PDTGuidance.pdf (accessed 01110/09) sunlight for 2 to 5 days after treatment. However, exposure degrees in airtight containers. Protect from light. 3. El-Arnir AN, et a!. Age-related macular degeneration. Br J Hosp Med to ambient indoor light is encouraged, as it allows gradual 66: 200S; 677-81. inactivation of any remaining drug. Headaches, injection Stability. Between about 5 and 20% of active drug was 4. Messmer KJ,Abel SR. Verteporfin for age-related macular degeneration. site reactions, and visual disturbances occur frequently. Ann Pharmacother 2001; 35: 1S93-8. lost from solution when a solution of vinblastine sulfate S. Wormald R, et a!. Photodynamic therapy for neovascular age-related Extravasation at the injection site may produce severe pain 3 micrograms/mL in glucose 5% injection was stored for macular degeneration. Available in The Cochrane Database of and inflammation and requires interruption of therapy. 48 hours in a range of intravenous burette giving sets, the Systematic Reviews; Issue 3. Chichester: John Wiley; 2007 (accessed Patients who have a severe decrease in vision should not be highest loss being from cellulose propionate sets and the 01/08/08). re-treated until their vision recovers. Other reported 6. Cook HL, et al. Age-related macular degeneration: diagnosis and lowest from one made from methacrylate butadiene styr management. Br Med Bull 2008; 85: 127--49. adverse effects include hypersensitivity, infusion-related ene.1 Similarly, storage in PVC tubing led to a 42 to 44% 7. Constable IJ. Age-related macular degeneration and its possible pain (mainly presenting as back pain), chest pain, loss from solution whereas only about 6% was lost over Med J Aust 2004; 181: 471-2. prevention. gastrointestinal disturbances, atrial fibrillation, hyper the 48 hours in polybutadiene tubing, The losses appeared 8. Yang YC. Preserving vision with veneporfin photodynamic therapy. tension, decreased hearing, and anaemia. Verteporfin Hosp Med 2004; 65: 39--43. 1 to be due to drug sorption, and were therefore greater 9. Comer GM, et al. Current and future treatment options for nonexudative should be used with care in patients with hepatic from the tubing which had a greater surface-area-to and exudative age-related macular degeneration. Drugs Aging 2004; 21: impairment and may be contra-indicated if impairment is volume ratio than the burettes, 967-92. severe. 1. McElnay JC, et al. Stability of methotrexate and vinblastine in burette 10. Bylsma GW, Guymer RH. Treatment of age-related macular administration sets. Int J Pharmaceutics 1988; 47: 239--47. degeneration. Clin Exp Optom 2005; 88: 322-34. ll. Treatment of age-related macular degeneration with photodynamic Porphyria. Licensed product information states that the therapy (TAP) Study Group. Photodynamic therapy of subfoveal use of verteporfin is contra-indicated in patients with por Uses and Administration choroidal neovascularization in age-related macular degeneration with phyria, However, the Drug Database for Acute Porphyria, veneporfin: one-year results of 2 randomized clinical trials-TAP report Vinblastine sulfate is an antineoplastic vinca alkaloid that Arch Ophthalmol 1999; 117: compiled by the Norwegian Porphyria Centre (NAPOS) 1. l329--4S. apparently acts by binding to the microtubular proteins of 12. Jager RD, et a!. Age-related macular degeneration. N Eng! J Med 2008; and the Porphyria Centre Sweden, classifies verteporfin as 358: 2606-17. not porphyrinogenic; it may be used as a drug of first the spindle and arresting mitosis at the metaphase; it is thus 13. Sun JK, Miller JW. Medical treatment of choroidal neovascularization choice and no precautions are needed. 1 specific for the M phase of the cell cycle. It also interferes secondary to age-related macular degeneration. Int Ophthalmol Clin with amino acid metabolism and possibly nucleic acid 200S; 45: I. The Drug Database for Acute Porphyria. Available at: http://www. llS-32. synthesis, and has some immunosuppressant activity. 14. Lois N. Neovascular age-related macular degeneration. Compr drugs-porphyria.org (accessed 11111111) Ophthalmol Update 2004; 5: 143-61. Multi drug resistance may occur. 1S. Chakravarthy U, et a!. Evolving European guidance on the medical Vinblastine sulfate is used, usually with other antineo management of neovascular age related macular degeneration. Br J Interactions plastics, in the treatment of Hodgkin's disease and other 90: Ophthalmol 2006; 1188-96. lymphomas, for some inoperable malignant neoplasms 16. Blumenkranz MS, et al. Verteporfin therapy for subfoveal choroidal Use of verteporfin with other drugs causing photosensitivity neovascularization in age-related macular degeneration: three-year should be avoided as the reaction may be increased. including those of the breast, bladder, and kidney, and in results of an open-label extension of 2 randomized clinical trials-TAP non-small cell lung cancer, choriocarcinoma, and Kaposi's report no. S. Arch Ophthalmo/ 2002; 120: 1307-14. sarcoma; vinblastine has also been used in the management et al. 17. Blinder KJ, Verteporfin therapy of subfoveal choroidal Pharmacokinetics of Langerhans-cell histiocytosis and advanced mycosis neovascularization in pathologic myopia: 2-year results of a randomized clinical trial-YIP report no. 3. Ophthalmology 2003; 110: 667-73. After intravenous doses, elimination of verteporfin is hi fungoides. It was formerly used with bleomycin and 18. Kearn SJ, et a!. Verteporfin: a review of its use in the management of exponential, with a terminal plasma elimination half-life of cisplatin (PVB) for testicular cancer, but other regimens are 63: subfoveal choroidal neovascularisation. Drugs 2003; 2S21-S4. about 5 to 6 hours. Protein binding is about 90%, It is now preferred. See the cross-references given below. 19. Wickens J, Blinder KJ. A preliminary benefit-risk assessment of Vinblastine sulfate is given by intravenous injection. verteporfin in age-related macular degeneration. Drug Safety 2006; 29: metabolised in the liver. It is excreted in faeces via the bile, 189-99. mostly as unchanged drug, with less than l% of a dose Care should be taken to avoid extravasation and the 20. Cruess AF, et a!. Photodynamic therapy with veneporfin in age-related recovered in the urine. intravenous injection may be given over minute into a macular degeneration: a systematic review of efficacy, safety, treatment freely-running infusion of sodium chlorideI 0. 9% if modifications and phannacoeconomic properties. Acta Ophthalmol 2009; References. preferred. However, UK guidelines recommend that for 87: 118-32. l. Houle J-M, Strong A. Clinical pharmacokinetics of verteporfin. J Clin adults and adolescents, the required dose should be supplied 21. Meads c, Hyde c. Photodynamic therapy with verteporfin is effective, Pharmacol 2002; 42: S47-S7. but how big is its effect? Results of a systematic review. Br J Ophthalmol in a 50 mL infusion bag of sodium chloride 0. 9% and 2004; 88: 212-17. infused intravenously over 5 to 10 minutes. (For 22. Veneporfin Roundtable Participants. Guidelines for using verteporfin adolescents treated in specialised paediatric units, see (Visudyne) in photodynamic therapy for choroidal neovascularization due to age-related macular degeneration and other causes: update. ProprietaryPreparations (details are given in Volume B) Administration in Children, p. 882,1,) Retina 2005; 25: 119-34. The usual dose of vinblastine sulfate is about 6mg/m2, 23. Sternberg P, Lewis H. Photodynamic therapy for age-related macular Single-ingredient Preparations, Arg.: Visudyne; Austral.: Visu not more often than once every 7 days, Single doses starting 137: degeneration: a candid appraisal. Am J Ophthalmo/ 2004; 483-S. dyne; Austria: Visudyne; Belg.: Visudyne; Braz.: Visudyne; at 3.7 mg/m2 and increasing at weekly intervals, over 4 24. Anonymous. A view on new drugs for macular degeneration. DrngTher Canad.: Visudyne; Chile: Visudynet; China: Visudyne (ii!;:imi!i 45: weeks, to a usual maximum dose of 11.1 mg/m2 have been Bull 2007; 49-52. $); Cz.: Visudyne; Denm.: Visudyne; Fin.: Visudyne; Fr.: Visu 2S. Rosenfeld PJ, et a!. MARINA Study Group. Ranibizumab for neovascular given; doses have been increased above this, but should not dyne; Ger.: Visudyne; Gr.: Visudine; Hong Kong: Visudyne; age-related macular degeneration. N Eng! J Med 2006; 355: 1419-31. exceed 18.5 mg/m2• If a maintenance dose is required, it et al. Hung.: Visudyne; Indon.: Visudyne; Irl. : Visudyne; Israel: Visu 26. Brown DM, ANCHOR Study Group. Ranibizumab versus may be given every 7 days provided white cell counts permit verteporfin for neovascular age-related macular degeneration. N Eng! J dyne; Ital.: Visudyne; Jpn: Visudyne; Malaysia: Visudyne; Med 2006; 355: 1432--44. Neth.: Visudyne; Norw.: Visudyne; NZ: Visudyne; Philipp. : (see below), and should be the maximum dose that the 27. Takeda AL, et al. Pegaptanib and ranibizumab for neovascular age Visudyne; Pol. : Visudyne; Port. : Visudyne; Rus.: Visudyne patient is able to tolerate without serious leucopenia Br J Ophthalmol related macular degeneration: a systematic review. (BH3y.LJ;HH); S.Afr.: Visudyne; Singapore: Visudyne; Spain: Visu occurring. 2007; 91: 1177-82. dyne; Swed.: Visudyne; Switz.: Visudyne; Thai. : Visudyne; For doses in children, see p. 882.1, 28. Vedula SS, Krzystolik MG. Antiangiogenic therapy with anti-vascular endothelial growth factor modalities for neovascular age-related Turk. : Visudyne; UK: Visudyne; USA: Visudyne; Venez. : Visu White cell counts should be made before each injection macular degeneration. Available in The Cochrane Database of dyne. and some sources suggest a repeat dose should not be given
The symbol denotes a preparation no longer actively marketed t 882
unless the count has risen to at least 4000 cells/nun3 (but see The vinca alkaloids can produce central and peripheral have occurred. For reports of vascular toxicity and Ray also Bone-marrow Depression, p. 730.3). Dosage reduction (including autonontic) neurotoxicity, although these effects naud's syndrome associated with the use of vinca alkaloids is recommended in patients with hepatic impairment (see are less frequent with vinblastine. Symptoms include with bleomycin and other drugs, see Effects on the Cardio below). malaise, weakness, headache, depression, paraesthesia and vascular System, p. 727.2. numbness, loss of deep tendon reflexes. peripheral 1. Dyke RW. Acute bronchospasm after a vinca alkaloid in patients Administration. Administration errors have occurred with neuropathies, constipation and adynamic ileus, jaw pain, previously treated with mitomycin. N Eng! J Med 1984; 310: 389. et al. the vinca alkaloids (see Administration Error, below). For and convulsions. Damage to the eighth cranial nerve may 2. Konits PH, Possible pulmonary toxicity secondary to vinblastine. Cancer 1982; 50: 2771-4. UK guidelines on dilution of vinca alkaloids to avoid inad result in vestibular and auditory toxicity leading to 3. Ozols RF, et al. MVP {mitomycin, vinblastine, and progesterone): a vertent intrathecal use, see p. 883.2. dizziness, nystagmus, vertigo, and partial or total deafness. second-line regimen in ovarian cancer with a high incidence of A routine prophylactic regimen against constipation is pulmonary toxicity. Cancer Treat Rep 1983; 67: 721-2. Administration in children. Doses of vinblastine sulfate in recommended in patients receiving high doses of vinblast children vary according to the disease treated, the sche ine. Overdosage has caused permanent damage to the CNS. Antivirals. Severe myelosuppression has occurred in dule used, and whether it is used as a single agent or as Intrathecal use of the vinca alkaloids is contra-indicated patients given relatively high doses of vinblastine with part of a combination chemotherapy regimen. The usual because of the likelihood of fatal neurotoxicity (see interfe ron a/fa-nl. dose is about 6 mg/m2 given intravenously, not more Administration Error, below). A patient who had been given vinblastine 6 mg/m2 every often than once every 7 days. Single doses starting at Other reported effects include skin reactions, alopecia, 3 weeks had severe gastrointestinal and haematological 2.5 mg/m2 and increasing at weekly intervals, over 4 ischaemic cardiotoxicity, hypertension, dyspnoea and toxicity and moderate renal failure when HAART with weeks, to a usual maximum dose of 7.5 mg/m2 have been bronchospasm, and bone and tumour pain. A syndrome of zidovudine, Iamivudine, abacavir, nevirapine, and lopinavir given; doses have been increased above this, but should inappropriate secretion of antidiuretic hormone has with ritonavir was reintroduced.1 The vinblastine dosage not exceed 12.5 mg/m2 occurred at high doses, and may be relieved by fluid was eventually stabilised at 2 mg/m2 during HAART without UK guidelines state that doses of vinca alkaloids may be restriction and, if necessary, a suitable diuretic. Rare cases of toxicity. anaphylaxis and anaphylactoid-type reactions have been given via a syringe to children and adolescents treated in I. Kotb R, et a!. Life-threatening interaction between antiretroviral therapy paediatric units.1 For adolescents treated in adolescent or reported with the vinca alkaloids. and vinblastine in HIV-associated multicentric Castleman's disease. Eur adult units, recommendations for administration are as for Vinblastine is irritant to the skin and mucous membranes J Haematol 2006; 76: 269-7 1. adults (see Uses and Administration, p. 881.3). and extravasation may cause necrosis, cellulitis, and 1. NHS National Patient Safety Agency. Rapid Response Report NPSA/ sloughing. The application of warmth and local injection 2008/RRR004 {issued llth August, 2008): using vinca alkaloid minibags of hyaluronidase may be of benefit in relieving the effects of Pharmacokinetics {adult/adolescent units). Available at: http://www.nrls.npsa.nhs.uk/ extravasation. By analogy with its use in the management Vinblastine is not reliably absorbed from the gastrointestinal EasySite Web /getresource .axd? AssetiD=602 90&type=full&servicety of vincristine overdosage (see p. 883.2), folinic acid has been pe=Attachment (accessed 29/09/09) tract. After intravenous use it is rapidly cleared from the suggested for use in overdosage with vinblastine. blood and distributed to tissues; it is reported to be Vinblastine should not be injected into an extremity with Administration in hepatic impairment. Licensed product concentrated in blood platelets. It is extensively protein impaired circulation because of an increased risk of information states that the dose of vinblastine should be bound. Vinblastine is metabolised in the liver, by thrombosis. It should be given with caution and at reduced reduced by 50% in patients having a direct serum bili cytochrome P450 isoenzymes of the CYP3A subfantily, to dosage to patients with hepatic impairment (see under Uses, rubin value above 3 mg per 100 mL. an active metabolite desacetylvinblastine, and is excreted in above). faeces via the bile, and in urine; some is excreted as Blood disorders, non-malignant. The vinca alkaloids vin unchanged drug. The terminal half-life is reported to be Administration error. Intrathecal doses of vinca alkaloids, blastine and vincristine have been used in the treatment about 25 hours. It does not cross the blood-brain barrier in including vinblastine, result in ascending paralysis and death. of auto-immune blood disorders such as immune throm significant amounts. For reference to the successful treatment of inadvertent bocytopenia (p. 1606.1). There are also reports of the intrathecal dosage of vincristine, and UK guidelines on References. haemolytic-uraemic syndrome/thrombotic thrombocyto dilution of vinca alkaloids to avoid intrathecal use, see I. Leveque D, Jehl F. Molecular pharmacokinetics of Catharanthus (vinca) penic purpura responding to treatment with intravenous 47: p. 883.2. alkaloids. J Clin Phannacol 2007; 579-88. injection of vincristine.1-3 For further details on the treat ment of thrombotic microangiopathies, see under Plasma, Handling ond disposal. A method for the destruction of P epa at ons p. 1159.1. Vincristine has been given with normal r r i . .. vincristine or vinblastine wastes using sulfuric acid and ...... immunoglobulin in the management of a patient with potassium permanganate.1 Residues produced by degrada ProprietaryPreparations (details are given in Volume B) life-threatening thrombocytopenia due to sarcoidosis.4 tion of either drug by this method showed no mutageni Vincristine has also been used for life-threatening hae city in vitro. Single-ingredient Preparations. Arg.: Blastovin; Austral.: Velbet; mangioma (p. 1605.3). Austria: Velbe; Belg.: Vinblasint; Braz. : Faulblastina; Velban; Urine and fa eces produced for up to 4 and 7 days Vinatin; Chile: Lemblastine; China: Weibaoding I. Gutterman LA, et a!. The hemolytic-uremic syndrome: recovery after respectively after a dose of vinblastine should be handled treatment with vincristine. Ann Intern Med 1983; 98: 612-1 3. Denm.: Velbe; Fin.: Velbe; Fr. : Velbe; Gr. : Velbe; Hong Kong: wearing protective clothing. 2 (i'&iJ!(ilJi'); 2. Ferrara F, etal. Vincristine as salvage treatment for refractory thrombotic Velbastine; India: Cytoblastin; Israel: Blastovin; Ital. : Velbe; 78: thrombocytopenic purpura. Ann Hemato/ 1999; 521-3. I. Castegnaro M, et al. , eds. Laboratory decontamination and destruction Mex. : Lemblastine; Neth.: Blastivint; Norw. : Velbe; Philipp.: 3. Ferrara F, et al. Vincristine as treatment for recurrent episodes of of carcinogens in laboratory wastes: some antineoplastic agents. IARC Oncostin; Velbastine; Port. : Solblastin; S.Afr. : Cytoblastin; Sin thrombotic thrombocytopenic purpura. Ann Hematol 2002; 81: 7-10. Scientific Publications 73 Lyon: WHO/International Agency for Research 4. Lamer AJ. Life threatening thrombocytopenia in sarcoidosis. BMJ 1990; on Cancer, 1985. gapore: Velbastine; Swed. : Velbe; Switz. : Velbe; Turk.: Vinko; 300: 317-19. UK: Velbe; USA: Velban. 2. Harris J, Dodds U. Handling waste from patients receiving cytotoxic drugs. Pharm J 1985; 235: 289-9 1. Histiocytic syndromes. The value of systemic chemother Pharmacopoeial Preparations apy in patients with Langerhans-cell histiocytosis Porphyria. The Drug Database for Acute Porphyria, com BP 2014: Vinblastine Injection; (p. 692.1) is uncertain; however, it is certainly widely piled by the Norwegian Porphyria Centre (NAPOS) and USP 36: Vinblastine Sulfate for Injection. used in extensive disease, vinblastine being one of the the Porphyria Centre Sweden, classifies vinblastine as drugs often employed. 1•2 probably not porphyrinogenic; it may be used as a drug of 1. The French Langerhans' Cell Histiocytosis Study Group. A multicentre first choice and no precautions are needed.1 retrospective survey of Langerhans' cell histiocytosis: 348 cases observed l. The Drug Database for Acute Porphyria. Available at: http:l/www. Vincristine Sulfate tBANM, usAN, rtNNMJ 75: between 1983 and 1993. Arch Dis Child 1996; 17-24. drugs-porphyria.org (accessed 26/09/ll) Compooncl 2. Gadner H, et al. A randomized trial of treatment for multisystem .37231;· Su!ph�te; tjSC'()_75;;_'4; J Pediatr 138: _ . Langerhans' cell histiocytosis. 2001; 728-34. Correction. Oro\l.inc-aleu�obl�neLf:'\lib<:rtst• Sulphate;_!ne • s,.lfato :.d� __ let1rocrf>tina;22� ibid.; 139: 170. Interactions Sulfate. vioqJstina; Vi n�rlstt[la, sqif;lto Vincristine •. . : _ For a general outline of antineoplastic drug interactions, see d.<;de; Vincristine. Sufphate; · Vi nciisti[licle;· . \llncris Malignant neoplasms. Vinblastine plays an important role p. 733.3. Use with drugs that inhibit cytochrome P450 .· Stinsulflfa�ilt; -.Ylnkrlstiinlsqlfaat'ti; · •Viol
All cross-references refer to entries in Volume A