DBL Vincristine Sulfate Dosage/Direction for Use

Dosage: Neurotoxicity appears to be dose related. Extreme care must be used in calculating and administering the dose of vincristine sulfate, since overdosage may have a very serious or fatal outcome.
Vincristine has been given by many different dosing schemes and in combination with many other medicines. Because of the narrow range between therapeutic and toxic levels and variations in response, the dosage must always be carefully adjusted according to the needs of the individual. Vincristine is usually administered at weekly intervals.
The calculated dose of the vincristine solution should be administered ONLY through a vein byintravenous infusion (IV) according to the treatment protocol and under constant supervision for signs of extravasation.
Children: The usual dose is 1.5 to 2.0 mg/m² body surface area (bsa).
For children weighing 10 kg or less, or having a bsa less than 1 m², the starting dose should be 0.05 mg/kg administered once a week.
Adults: The usual dose is 0.4 to 1.4 mg/m² bsa.
Elderly patients and those with underlying neurological disease may be more susceptible to the neurotoxic effects of vincristine. Dosage modification may also be required in patients with liver disease or jaundice. As stated under Contraindications, vincristine should not be given to patients receiving radiation therapy through ports that include the liver. When used in combination with L-asparaginase, vincristine sulfate should be given 12 to 24 hours before administration of the enzyme in order to minimise toxicity (see Interactions); administering L-asparaginase before vincristine may reduce hepatic clearance of vincristine sulfate.
Method of administration: This preparation is for intravenous use only (see Handling Precautions under Cautions for Usage) by individuals experienced in administration of vincristine sulfate. The intrathecal administration of vincristine sulfate is usually fatal.
Neurotoxicity appears to be dose related. Extreme care must be used in calculating and administering the dose of vincristine sulfate, since overdosage may have a very serious or fatal outcome.
DBL Vincristine Sulfate Injection should be inspected visually for particulate matter and discolouration prior to administration whenever solution and container permit.
DBL Vincristine Sulfate Injection may be infused via a flexible plastic container into the tubing or sidearm of a free-flowing intravenous infusion of 0.9% sodium chloride or 5% glucose, or directly into a vein. Care should be taken to avoid extravasation as this may cause local ulceration.
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 labeled as indicated for intravenous use only - fatal if given by other routes (see Contraindications and Precautions).
Always check the needle position before intravenously administering vincristine. If there is a swelling or other evidence of injection site leakage, it may cause considerable irritation. Cease the infusion immediately and give the remaining dose at another site. Immediately apply local measures (hyaluronidase, local heat) to try to reduce both discomfort and the risk of cellulitis.
Syringes should not be used for DBL Vincristine Sulfate Injection administration. Preparation must be by dilution in small volume intravenous bags (the 'minibag' technique), to protect against accidental administration via a spinal route.
Dosage adjustment: A 50% reduction in the dose of vincristine sulfate is recommended for patients having a serum bilirubin value above 3 mg/100 mL for both children and adults.