DBL Vinblastine Special Precautions

Warnings: Vinblastine must be used only by physicians experienced in cytotoxic chemotherapy.
This preparation is for intravenous use only. Fatal if given by any other route.
As with other antineoplastic agents, Vinblastine Injection may cause a severe local reaction on extravasation. If leakage into the surrounding tissue should occur during intravenous administration of vinblastine, the infusion should be discontinued immediately and any remaining portion of the dose should be introduced into another vein. Local injection of hyaluronidase with the application of heat has been used to disperse the medicine in order to minimise discomfort and the possibility of tissue damage.
Caution is advised when injecting vinblastine into extremities. If the circulation is impaired, the risk of thrombosis is increased.
Liver disease may alter the elimination of vinblastine in the bile, markedly increasing toxicity to peripheral nerves and necessitating a dosage modification in affected patients.
Precautions: Patients should be carefully monitored for infection until white cell count has returned to normal levels if leukopenia with less than 2.0 x 10⁹ white blood cells per litre (2000/mm³) occurs following a dose of Vinblastine Injection.
When cachexia or ulcerated areas of the skin surface are present, there may be more profound leukopenic response to the medicine; therefore its use should be avoided in older persons suffering from either of these conditions.
Leucocyte and platelet counts have sometimes fallen precipitously after moderate doses of Vinblastine Injection in patients with malignant-cell infiltration of the bone marrow. Further use of the medicine in such patients is inadvisable.
The use of small amounts of Vinblastine Injection daily for long periods of time is not advised, since little or no added therapeutic effect has been demonstrated, even though the resulting total weekly dosage may be similar.
It is important to strictly adhere to the recommended dosage schedule.
Convulsions, severe and permanent central nervous system damage and even death have occurred when amounts of several times the recommended weekly dosage were given in 7 daily installments for long periods.
Avoid contamination of the eye with Vinblastine Injection. If accidental contamination occurs, severe irritation (or corneal ulceration if delivered under pressure) may result. Wash the eye with water immediately and thoroughly.
A risk-benefit assessment should be considered when the following medical problems exist in patients who are to receive Vinblastine Injection: chickenpox (existing or recent exposure), herpes zoster, gout or a history infection.
Effects on Ability to Drive and Use Machines: Effects of this medicine on a person's ability to drive and use machines were not assessed as part of its registration. However, adverse effects of vinblastine sulfate (with unknown frequency) may include dizziness and motor dysfunction which could affect the ability to drive or use machines (see Adverse Reactions). Patients should refrain from driving or using machines until they know that the medicinal product does not negatively affect these abilities.
Use in hepatic impairment: A risk-benefit assessment should be considered in patients with a history of impaired hepatic function.
Use in renal impairment: A risk-benefit assessment should be considered in patients with a history of urate renal stones.