Vincristine

ONCOVIN

What it isVinca alkaloid preventing microtubule assembly; leukemia and lymphoma.

Why this oneIt causes almost no myelosuppression, so it combines freely with agents that do.

What limits it⚑ Intrathecal administration is uniformly fatal; dispense it in a minibag, never a syringe. Peripheral neuropathy is dose-limiting.

FDA-approved for

BOXED WARNING For intravenous use only — fatal if given by other routes (e.g., intrathecal); administer only by experienced personnel

FDA dosing	Population	Start	Target	Max
Antineoplastic (per protocol)	adult	1.4 mg/m2 IV weekly	1.4 mg/m2 IV weekly	1.4 mg/m2 IV weekly
Antineoplastic (per protocol)	pediatric >10 kg	1.5-2 mg/m2 IV weekly	1.5-2 mg/m2 IV weekly	1.5-2 mg/m2 IV weekly
Antineoplastic (per protocol)	pediatric ≤10 kg	0.05 mg/kg IV weekly	0.05 mg/kg IV weekly	0.05 mg/kg IV weekly

Renal Undefined

Hepatic Reduce dose 50% if direct serum bilirubin >3 mg/100 mL

Neurotoxicity is dose-related; extreme care in dose calculation and administration

Alopecia (hair loss)
Neuromuscular effects (neuritic pain, sensory loss, paresthesia, difficulty walking)
Leukopenia
Constipation

Pregnancy See Warnings (usage in pregnancy)

Lactation Undefined

⚠ BOXED WARNINGS

Cost, est. cash$50–$10,000/month or cycle

Generic entry1986

Therapeutic safety burden4 / 4

Overdose danger3 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk3 / 4

Legacy pregnancy categoryD

Defining liabilityPotentially severe peripheral/autonomic neurotoxicity; intrathecal administration is fatal.

CYP3A4 substrate