What are vinca alkaloids. How do they work in cancer treatment. What are the common side effects of vinca alkaloids. Which cancers are treated with vinca alkaloids. How are vinca alkaloids administered to patients. What precautions should be taken when using vinca alkaloids.

Understanding Vinca Alkaloids: A Powerful Class of Chemotherapy Drugs

Vinca alkaloids are a group of chemotherapy drugs derived from the Madagascar periwinkle plant (Catharanthus roseus). These compounds have become invaluable in the treatment of various cancers due to their ability to disrupt cell division. The most well-known vinca alkaloid is vincristine, but the class also includes vinblastine, vinorelbine, and vindesine.

How do vinca alkaloids work?

Vinca alkaloids exert their anti-cancer effects by binding to tubulin proteins in cells. This binding prevents the formation of microtubules, which are essential for cell division. As a result, cancer cells are unable to complete mitosis, leading to cell cycle arrest and eventual cell death. This mechanism of action makes vinca alkaloids particularly effective against rapidly dividing cancer cells.

The Versatility of Vinca Alkaloids in Cancer Treatment

Vinca alkaloids have demonstrated efficacy in treating a wide range of cancers. Some of the most common applications include:

• Leukemias (especially acute lymphoblastic leukemia)
• Lymphomas (Hodgkin’s and non-Hodgkin’s)
• Neuroblastoma
• Wilms’ tumor
• Rhabdomyosarcoma
• Ewing’s sarcoma
• Certain brain tumors
• Lung cancer (particularly small cell lung cancer)
• Breast cancer
• Testicular cancer

The versatility of vinca alkaloids makes them a valuable component of many combination chemotherapy regimens. Oncologists often use these drugs in conjunction with other chemotherapeutic agents to enhance overall treatment efficacy.

Administration and Dosing of Vinca Alkaloids

Vinca alkaloids are typically administered intravenously (IV) due to their poor oral bioavailability. The specific dosing and schedule depend on several factors, including the type of cancer, the patient’s overall health, and the presence of other treatments in the regimen.

What are the common methods of administration?

1. Peripheral IV line: A small catheter is inserted into a vein in the arm or hand.
2. Central venous catheter: A longer tube is placed into a larger vein, often in the chest or arm, for longer-term treatment.
3. Port-a-cath: A small device implanted under the skin that connects to a major vein, allowing for easier repeated access.

Patients typically receive vinca alkaloids as part of a chemotherapy cycle, which includes treatment periods followed by rest periods to allow the body to recover. The duration and frequency of these cycles vary depending on the specific treatment protocol.

Common Side Effects of Vinca Alkaloids

While vinca alkaloids are effective cancer treatments, they can also cause a range of side effects due to their impact on healthy cells. It’s important for patients and caregivers to be aware of these potential side effects and to report any concerns to their healthcare team promptly.

What are the most frequently reported side effects?

• Increased risk of infection: Due to a decrease in white blood cells (neutropenia)
• Hair loss (alopecia): Affecting not only the scalp but potentially body hair as well
• Peripheral neuropathy: Numbness, tingling, or pain in fingers and toes
• Fatigue: Persistent tiredness and weakness
• Nausea and vomiting: Often manageable with anti-emetic medications
• Constipation: Particularly common with vincristine
• Abdominal pain: May be related to effects on the digestive system
• Changes in vision: Including temporary vision disturbances
• Bladder problems: Such as difficulty urinating or urinary retention
• Muscle or bone pain: Often temporary but can be significant

It’s crucial to note that not all patients will experience all of these side effects, and the severity can vary greatly between individuals. Many side effects are temporary and resolve after treatment is completed, while others may require ongoing management.

Managing Side Effects and Supportive Care

Effective management of side effects is an essential component of cancer treatment with vinca alkaloids. Healthcare teams work closely with patients to monitor for adverse effects and implement strategies to mitigate their impact on quality of life.

How can patients cope with common side effects?

• Infection risk: Practice good hygiene, avoid crowds, and report any signs of infection immediately
• Hair loss: Consider wigs, scarves, or hats; some patients opt for scalp cooling treatments
• Neuropathy: Gentle exercise, physical therapy, and in some cases, medication can help manage symptoms
• Fatigue: Balance rest with light activity, maintain good nutrition, and consider energy conservation techniques
• Nausea: Take anti-emetic medications as prescribed, eat small, frequent meals, and stay hydrated
• Constipation: Increase fiber intake, stay hydrated, and use laxatives as recommended by the healthcare team

Open communication between patients and their healthcare providers is crucial for effective side effect management. Patients should be encouraged to report any new or worsening symptoms promptly.

Precautions and Considerations When Using Vinca Alkaloids

While vinca alkaloids are powerful tools in cancer treatment, their use requires careful consideration and monitoring. Healthcare providers must take several precautions to ensure patient safety and optimize treatment outcomes.

What are the key precautions for vinca alkaloid use?

1. Dosage calculation: Precise dosing based on body surface area and individual patient factors is critical
2. Administration route: Vinca alkaloids must be given intravenously; intrathecal administration can be fatal
3. Drug interactions: Careful review of concurrent medications to avoid potential interactions
4. Liver function: Dose adjustments may be necessary for patients with impaired liver function
5. Pregnancy and breastfeeding: Vinca alkaloids can cause fetal harm and should be avoided during pregnancy; breastfeeding is not recommended during treatment
6. Fertility: Patients should be counseled on potential fertility impacts and options for preservation

Healthcare providers must also be vigilant for signs of cumulative toxicity, particularly neurotoxicity, which can occur with prolonged use of vinca alkaloids.

Advances in Vinca Alkaloid Research and Development

The field of vinca alkaloid research continues to evolve, with ongoing efforts to enhance efficacy and reduce toxicity. Several areas of investigation are particularly promising for the future of these drugs in cancer treatment.

What are the current trends in vinca alkaloid research?

• Novel formulations: Development of liposomal and nanoparticle formulations to improve drug delivery and reduce side effects
• Combination therapies: Exploration of synergistic effects with other cancer treatments, including targeted therapies and immunotherapies
• Overcoming drug resistance: Investigation of mechanisms of resistance and strategies to counteract them
• Personalized medicine: Use of genetic and molecular profiling to identify patients most likely to benefit from vinca alkaloid therapy
• Synthetic analogues: Creation of new compounds based on the vinca alkaloid structure with potentially improved therapeutic profiles

These research directions hold promise for expanding the utility of vinca alkaloids and potentially developing more targeted and less toxic treatment options for cancer patients.

The Role of Vinca Alkaloids in Modern Cancer Care

Despite the development of newer targeted therapies and immunotherapies, vinca alkaloids remain a cornerstone of many cancer treatment regimens. Their broad spectrum of activity, established efficacy, and well-understood side effect profile make them valuable tools in the oncologist’s arsenal.

Why do vinca alkaloids continue to be important in cancer treatment?

• Proven efficacy: Decades of clinical use have demonstrated their effectiveness in various cancer types
• Combination potential: Vinca alkaloids often work synergistically with other chemotherapy drugs and newer targeted agents
• Cost-effectiveness: As generic drugs, many vinca alkaloids are more affordable than newer cancer therapies
• Pediatric use: Vinca alkaloids play a crucial role in treating childhood cancers, where long-term safety data is particularly important
• Salvage therapy: They can be effective in relapsed or refractory cancers where other treatments have failed

As cancer treatment continues to evolve, vinca alkaloids are likely to remain an important component of many treatment protocols, particularly in combination with newer therapies.

In conclusion, vinca alkaloids represent a powerful class of chemotherapy drugs that have significantly impacted cancer treatment over the past several decades. Their mechanism of action, targeting rapidly dividing cells, makes them effective against a wide range of cancers. While side effects can be significant, careful management and supportive care can help patients tolerate treatment and achieve better outcomes. As research continues, we may see even more refined and effective uses of these important drugs in the fight against cancer.

Vincristine | Cancer information | Cancer Research UK

Vincristine is a type of chemotherapy. It is a treatment for a number of different cancer types. You usually have vincristine with other cancer drugs.

How does vincristine work?

Vincristine is a chemotherapy drug that belongs to a group of drugs called vinca alkaloids. 

Vincristine works by stopping the cancer cells from separating into 2 new cells. So, it stops the growth of the cancer.

How you have vincristine?

You have vincristine into your bloodstream (intravenously). 

You might have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

Or you might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

How often do you have vincristine?

You have chemotherapy as cycles of treatment. This means you have the cancer drug or drugs and then a rest to allow your body to recover. Your treatment plan depends on which cancer you have. Your doctor or nurse will talk to you about this, so you know what to expect.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of vincristine?

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you’re having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 
• your side effects aren’t getting any better
• your side effects are getting worse

Early treatment can help manage side effects better.  

Contact your advice line immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

We haven’t listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

You might have one or more of these side effects. They include:

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer.

Numbness or tingling in fingers or toes

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your healthcare team if you’re finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Tiredness and weakness (fatigue) during and after treatment 

Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don’t push yourself, rest when you start to feel tired and ask others for help.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your doctor, nurse or pharmacist if you are constipated for more than 3 days. They can prescribe a laxative.

Also tell your doctor about any changes to your bowel habits.

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Changes to your eyesight

Tell the team looking after you if you notice any changes or have pain. This is usually rare and temporary. 

Problems with your bladder

Let your doctor know if you are having this. Let your treatment team know if you are having problems passing urine or have pain.

Muscle or bone pain

You might feel some pain from your muscles and bones, including pain in your jaw or back. Speak to your doctor or nurse about what painkillers you can take to help with this.

Sore mouth

You might get a sore mouth and mouth ulcers.  It may be painful to swallow drinks or food. You will have mouth washes to keep your mouth healthy.

You can have painkillers to reduce the soreness. Take them half an hour before meals to make eating easier.

Swelling and pain at the drip site

Tell your nurse straight away if you have any pain, redness, swelling or leaking around your drip site.

Allergic reaction

A small number of people have an allergic reaction while having this treatment. Symptoms can include a rash, shortness of breath, redness or swelling of the face, feeling hot, dizziness, and a sudden need to pass urine.

Tell your doctor or nurse immediately if you have any of these symptoms or feel unwell at all while you are having the treatment or shortly afterwards.

Hearing changes

You might have some hearing loss, especially with high pitched sounds. Tell your doctor or nurse if you notice any changes.

These changes are due to damage to one of the cranial nerves. You may also have difficulty with balance including dizziness, feeling like the room is spinning (vertigo) and uncontrolled eye movement (nystagmus).

Loss of appetite and weight loss

You might not feel like eating and may lose weight. It is important to eat as much as you can. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Skin rash

Tell your doctor or nurse if you have a skin rash. They can prescribe medicine to soothe your skin.

Headaches

Let your doctor or nurse know if you have headaches. They can give you painkillers.

Diarrhoea

This is a rare side effect.

Contact your advice line if you have diarrhoea, such as if you’ve had 4 or more loose watery poos (stools) in 24 hours. Or if you can’t drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Heart problems

This includes coronary heart disease and a heart attack. This is a possible side effect if you have had radiotherapy to part of the chest before (the mediastinum), and you have had vincristine with other chemotherapy drugs. It is not clear if this side effect is directly caused by the vincristine.

Tell your doctor or nurse immediately, or call 999, if you have symptoms of a heart attack. These include: chest pain, pain spreading from the chest to your arms, jaw, back or tummy, feeling dizzy, sweaty, short of breath, coughing or wheezing, being sick or an overwhelming feeling of anxiety.

Bruising, bleeding gums or nose bleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Low sodium levels

You may develop low sodium levels in your blood. This is due to your body making too much anti diuretic hormone. This means your body holds on to too much water. As your blood becomes more dilute, your levels of sodium drop. This is rare, but you have regular blood tests to check for this.

Fits (seizures)

Tell your doctor or nurse straight away if this happens.

Muscle weakness

Your muscles may get weaker. This can make it difficult to walk and cause difficulty with your speech.

Changes in blood pressure

During treatment, your blood pressure may be lower or higher than normal. Tell your nurse if you feel dizzy or faint. Or if you have headaches, nosebleeds, blurred or double vision, or shortness of breath.

Your blood pressure usually goes back to normal while you are on treatment or when treatment ends.

Second cancers

There is a small risk that you may get a second cancer some years after this treatment. Your doctor will discuss this with you.

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you’re having treatment and for a few months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner falls pregnant while having treatment.

Fertility

You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment. For example, if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine – talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations – You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn’t possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

• Electronic Medicines Compendium
  Accessed January 2019

• Immunisation against infectious disease: Chapter 6: General contraindications to vaccination
  Public Health England
  First published: March 2013 and regularly updated on the Gov. UK website

Last reviewed: 

12 Aug 2022

Next review due: 

12 Aug 2025

Print page

Vinblastine (Velban®, Alkaban AQ) | OncoLink

Vinblastine is a member of the vinca alkaloids family of chemotherapy agents. These medications work by interfering with cell division, which leaves the tumor unable to grow and spread. Vinblastine was developed from the Madagascar periwinkle plant.

How to Take Vinblastine

This medication is administered intravenously (IV, into a vein), by a trained professional. Specific dosage and dosing schedule depends on the person’s size and the type of cancer being treated.

This medication is a vesicant. Even when carefully and correctly administered by trained personnel, this drug may cause a feeling of burning and pain. There is a risk that this medication may leak out of the vein at the injection site, resulting in tissue damage that can be severe. If the area of injection becomes red, swollen, or painful at any time during or after the injection, notify your doctor or nurse immediately. Do not apply anything to the site unless instructed by your doctor or nurse.

The blood levels of this medication can be affected by certain foods and medications, so they should be avoided. These include: grapefruit, grapefruit juice, ketoconazole, rifampin, phenytoin, St. John’s wort, and many anti-fungal medications. Be sure to tell your healthcare provider about all medications and supplements you take.

Possible Side Effects of Vinblastine

There are a number of things you can do to manage the side effects of vinblastine. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:

Constipation

Vinblastine can cause serious constipation, abdominal pain and can even lead to a blockage or stoppage of the bowel (called paralytic ileus) if not treated promptly. There are several things you can do to prevent or relieve constipation. Include fiber in your diet (fruits and vegetables), drink 8-10 glasses of non-alcoholic fluids a day, and keep active. A stool softener once or twice a day may prevent constipation. If you do not have a bowel movement for 2-3 days, you should contact your healthcare team for suggestions to relieve the constipation.

Neurotoxicity

This is a toxicity that affects the nerves. The most common effect is called peripheral neuropathy, which affects the nerves in the hands and feet, causing causes numbness or tingling, often in the pattern of a stocking or glove. This can get progressively worse with additional doses of the medication and can lead to difficulty with balance or walking. In some people, the symptoms slowly resolve after the medication is stopped, but for some, it never goes away completely. You should let your healthcare provider know if you experience numbness or tingling in the hands and feet, as they may need to adjust the doses of your medication.

The vinca alkaloid chemotherapies are known to cause neuropathy, but they can also cause neurologic toxicity that presents as mental depression, headache, malaise, dizziness, and seizures. It can also cause toxicity of the cranial nerves, which affects the vocal cords (changes in voice), eyes (visual changes) or facial nerves (drooping of the face or mouth). Patients can develop severe pain in the jaw soon after the first treatment with vincristine, which is caused by the medication affecting the nerves. If you notice any of these problems, notify your healthcare team right away.

Low White Blood Cell Count (Leukopenia or Neutropenia)

White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn’t heal.

Tips to preventing infection:

• Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
• When working in your yard, wear protective clothing including long pants and gloves.
• Do not handle pet waste.
• Keep all cuts or scratches clean.
• Shower or bath daily and perform frequent mouth care.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your oncology care team before scheduling dental appointments or procedures.
• Ask your oncology care team before you, or someone you live with, has any vaccinations.

Mouth Ulcers (Sores)

Certain cancer treatments can cause sores or soreness in your mouth and/or throat. Notify your doctor or nurse if your mouth, tongue, inside of your cheek or throat becomes white, ulcerated or painful. Performing regular mouth care can help prevent or manage mouth sores. If mouth sores become painful, your doctor or nurse can recommend a pain reliever.

• Brush with a soft-bristle toothbrush or cotton swab twice a day.
• Avoid mouthwashes that contain alcohol. A baking soda and/or salt warm water mouth rinse (2 level teaspoons of baking soda or 1 level teaspoon salt in an eight-ounce glass of warm water) is recommended 4 times daily.
• If your mouth becomes dry, eat moist foods, drink plenty of fluids (6-8 glasses), and suck on sugarless hard candy.
• Avoid smoking and chewing tobacco, drinking alcoholic beverages, and citrus juices.

Loss or Thinning of Scalp and Body Hair (Alopecia)

Your hair may become thin, brittle, or may fall out. This typically begins two to three weeks after treatment starts. This hair loss can be all body hair, including pubic, underarm, legs/arms, eyelashes, and nose hairs. The use of scarves, wigs, hats, and hairpieces may help. Hair generally starts to regrow soon after treatment is completed. Remember your hair helps keep you warm in cold weather, so a hat is particularly important in cold weather or to protect you from the sun.

High Blood Pressure

This medication can cause high blood pressure (hypertension). Patients should have their blood pressure checked regularly during therapy. Any hypertension should be treated appropriately.

Decrease in Appetite or Taste Changes

Nutrition is an important part of your care. Cancer treatment can affect your appetite and, in some cases, the side effects of treatment can make eating difficult. Ask your oncology care team about nutritional counseling services at your treatment center to help with food choices.

• Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals.
• If you are not eating enough, nutritional supplements may help.
• You may experience a metallic taste or find that food has no taste at all. You may dislike foods or beverages that you liked before receiving cancer treatment. These symptoms can last for several months or longer after treatment ends.
• Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products, and fish without a strong smell. Sometimes cold food has less of an odor.
• Add extra flavor to meat or fish by marinating it in sweet juices, sweet and sour sauce, or dressings. Use seasonings like basil, oregano, or rosemary to add flavor. Bacon, ham, and onion can add flavor to vegetables.

Fatigue

Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.

Nausea and/or Vomiting

Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.

Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Less common, but important side effects can include:

• Urinary retention: Some patients may experience an inability to urinate (even when you feel that you need to). If you notice you are unable to urinate, you should call your healthcare team right away or go to the emergency room to be evaluated.
• Pain in tumor-containing tissue: Some patients may experience pain in tumor-containing tissue. This is thought to occur due to swelling of that area during its response to treatment.
• Radiation Recall: This medication may cause radiation recall. It may present as a skin reaction that looks like a sunburn (redness, swelling, soreness, peeling skin) in areas where radiation was previously given. Notify your oncology care team if you notice this side effect. Treatment can include topical steroid ointments and a delay in your next chemotherapy dose. 

Sexual & Reproductive Concerns

This drug may affect your reproductive system, resulting in the menstrual cycle or sperm production becoming irregular or stopping permanently. In addition, the desire for sex may decrease during treatment.

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment, even if your menstrual cycle stops or you believe you are not producing sperm. You may want to consider sperm banking or egg harvesting if you may wish to have a child in the future. Discuss these options with your oncology team. You should consult with your healthcare team before breastfeeding while receiving this medication.

23.2. Vinca alkaloid derivatives

Vinpocetine
(cavinton*) – semi-synthetic derivative
vincamine alkaloid found in
periwinkle plant (Vinca
minor L. and Vinca
erecta), expands
predominantly cerebral vessels. Myotropic
antispasmodic effect of the drug
associated with inhibition of phosphodiesterase,
which contributes to the accumulation
cAMP smooth muscle cells. Vinpocetine
does not cause the phenomenon of “robbing”;
without affecting the blood supply of intact
areas, it enhances the blood supply
ischemic areas of the brain.
Vinpocetine improves cerebral circulation
(microcirculation) not only due to
vasodilation of the brain, but also for
score

raise
the ability of erythrocytes to deform,
which leads to a decrease in
blood viscosity, since aggregation
platelets are reduced. Besides,
vinpocetine increases brain resilience
to hypoxia, increases oxygen utilization,
enhances absorption and metabolism
glucose with switching to energy
more beneficial, aerobic oxidation pathway.

Vinpocetine
indicated for chronic insufficiency
cerebral circulation, conditions
after a stroke, with neurological and
mental disorders in patients with
cerebrovascular insufficiency,
in vascular diseases of the eye and
decreased hearing acuity of vascular or
toxic genesis. Assign inside
During a long time. At
need to be administered intravenously
drip.

Side effects
effects: decreased blood pressure, nausea and
dizziness. With rapid intravenous
the introduction of possible tachycardia, extra-
systole, intraventricular slowdown
conductivity.

23.3. Ergot alkaloid derivatives

Nicergoline
(sermion ^*)
– synthetic derivative of alkaloids
ergot, with attached bromine
residue of nicotinic acid.
The vasodilating effect of the drug
associated with α-adrenergic blocking and direct
myotropic action. Expands arterioles
brain and peripheral vessels.
Improves cerebral, pulmonary, renal
blood flow and blood supply to the extremities.

Apply
with disorders of cerebral circulation
against the background of atherosclerosis and thromboembolism,
in disorders of the peripheral
blood circulation, etc. Introduced inside and
parenterally. When taken orally in
therapeutic doses does not affect blood pressure,
possible after intravenous administration
hypotensive effect. Of the side
effects are also possible dizziness,
itching, dyspeptic disorders.

23.4. Derivatives of nicotinic acid

Nicotine
acid has a pronounced
vasodilating effect as
peripheral vessels, and on the vessels
brain. nicotinic acid is bad
tolerate (see the chapter “Means used
with atherosclerosis”), therefore, with
disorders of cerebral circulation
use its derivatives with less
pronounced side effects.

Xanthinol
nicotinate (Complamin*) in its structure
has elements of nicotinic acid and
theophylline. The drug expands
peripheral vessels and vessels of the brain,
improves both peripheral and
cerebral circulation, reduces
phenomena of cerebral hypoxia, several
reduces platelet aggregation. A drug
used for disorders of the peripheral
and cerebral circulation associated
with cerebral atherosclerosis.

Nicotinoyl-GABA
(Pikamilon*) belongs to the group of derivatives
GABA, combines the structure of GABA and nicotinic
acids, mainly expands
brain vessels.

Cardiotoxic effects of yew tree alkaloids and periwinkle rosea | Mal

1. Seliverstova DV, Evsina OV. Cardiotoxicity of chemotherapy. Heart: a journal for practitioners. 2016;15(1):50–7.

2. Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2014;27(9):911–39. https://doi.org/10.1016/j.echo.2014.07.012

3. Szabó Z, Hornyák L, Miskei M, Székvölgyi L. Two targets, one hit: new anticancer therapeutics to prevent tumorigenesis without cardiotoxicity. Front Pharmacol. 2021;11:569955. https://doi.org/10.3389/fphar.2020.569955

4. Polikutina OM, Evtushenko VV, Zobnina AV, Borzyanitsa SM, Slepynina YuS, Barbarash OL. Cardiac arrhythmias as a manifestation of chemotherapy cardiotoxicity in the treatment of a patient with ovarian cancer. Creative cardiology. 2018;12(2):177–82. https://doi.org/10.24022/1997-3187-2018-12-2-177-182

5. Vasyuk YuA, Shupenina EY, Novosel EO, Agapov IS. Cardiac arrhythmias and conduction disturbances as manifestations of cardiotoxicity of anticancer treatment – myth or reality? Siberian Journal of Clinical and Experimental Medicine. 2020;35(1):13–21. https://doi.org/10.29001/2073-8552-2020-35-1-13-21

6. Zaborovsky AV, Gurevich KG. Simulation of directed drug transport. Part I. Single introduction. Siberian journal of oncology. 2017;16(1):59-65. https://doi.org/10.21294/1814-4861-2017-16-1-59-65

7. Krasheninnikova AA, Zavarzina VV, Panova DS, Gukasova NV, Kuznetsov SL, Tubasheva IA et al. Assessment of toxicological properties docetaxel in the composition of folate-modified polymer particles in an in vivo experiment. Russian biotherapeutic journal. 2020;19(2):55–64. https://doi.org/10.17650/1726-9784-2019-19-2-55-64

8. Gjyrezi A, Xie F, Voznesensky O, Khanna P, Calagua C, Bai Y, et al. Taxane resistance in prostate cancer is mediated by decreased drug-target engagement. J Clin Invest. 2020;130(6):3287–98. https://doi.org/10.1172/JCI132184

9. Weaver BA. How Taxol/paclitaxel kills cancer cells. Mol Biol Cell. 2014;25(18):2677–81. https://doi.org/10.1091/mbc.e14-04-0916

10. Yang CH, Horwitz SB. Taxol®: the first microtubule stabilizing agent. Int J Mol Sci. 2017;18(8):1733. https://doi.org/10.3390/ijms18081733

11. Vologdina IV, Zhabina RM, Korytova LI, Krasilnikova LA, Maslyukova EA, Maistrenko DN et al. Cardiovascular complications in cancer patients at the stage of chemoradiotherapy: the current state of the problem. Issues of oncology. 2018;64(4):470–7. https://doi.org/10.37469/0507-3758-2018-64-4-470-477

12. Shishkina ES, Baidina TV, Fokina ES, Minaeva NV. Somatic and autonomic neuropathies in oncohematological diseases (review). Medical almanac. 2018;(5):112–6.

13. Malevich OB. Vincristine-induced cranial neuropathy in a child with Ewing’s sarcoma. Russian Journal of Pediatric Hematology and Oncology. 2015;(2):85–8. https://doi.org/10.17650/2311-1267-2015-2-2-85-88

14. Sharipova MG, Smirnov DS, Yakupov MR, Spichak II. Chemoinduced polyneuropathy in children with oncological pathology. Pediatric Bulletin of the Southern Urals. 2016;(1):53–61.

15. Gunoev MB, Dzhambetova PM. Lux test: study of the genotoxicity of the drug vincristine in E. coli cells. In: All-Russian Scientific and Practical Conference of Students, Young Scientists and Postgraduates “Science and Youth”. Grozny: Chechen State University; 2018, pp. 139–43.

16. Halakhakun AD, Slivkin AI, Karlov PM. Possibilities of using the spectrophotometric method for standardization of alkaloid drugs vincristine and vinblastine in substances and dosage forms. Successes of modern science. 2017;1(6):34–45.

17. Kudryavtseva NM, Telegina GF. Periwinkle in modern pharmacotherapy (literature review). Pediatric Bulletin of the Southern Urals. 2020;(1):111–5.

18. Sidorova AA, Yaroshenko DV, Murashko EA, Grigoriev AV. Development of chromatographic and electrophoretic methods for the determination of vinblastine in blood plasma and prostate tissue. Journal of Analytical Chemistry. 2013;68(3):284–90. https://doi.org/10.1134/S1061934813030118

19. Pétain A, Zhong D, Chen X, Li Z, Zhimin S, Zefei J, et al. Effect of ethnicity on vinorelbine pharmacokinetics: a population pharmacokinetics analysis. Cancer Chemother Pharmacol. 2019;84(2):373–82. https://doi.org/10.1007/s00280-019-03872-9

20. Queen IA, Kopp MV. Oral vinorelbine in metastatic breast cancer: effective therapy in special epidemic conditions. effective pharmacotherapy. 2020;16(11):22–30.

21. Snegovaya AV, Vitsenya MV, Kopp MV, Larionova VB. Practical recommendations for the correction of cardiovascular toxicity induced by chemotherapy and targeted drugs. Malignant tumors. 2016;4(S2):418–27.

22. Gendlin GE, Storozhakov GI, Shuikova KV, Emelina EI, Klyushina GM, Mironkov AB et al. Acute cardiovascular events during the use of antitumor chemotherapy drugs: clinical observations. Clinical oncohematology. 2011:4(2):155–64.

23. Gendlin GE, Emelina EI, Nikitin IG, Vasyuk YuA. A modern view on the cardiotoxicity of chemotherapy for oncological diseases, including anthracycline antibiotics. Russian journal of cardiology. 2017;(3):145–54. https://doi.org/10.15829/1560-4071-2017-3-145-154

24. Guskova NK, Vladimirova LYu, Sycheva EA, Morozova AA, Rozenko DA, Donskaya AK et al. Changes in the level of cardiomarkers during the development of acute myocardial infarction during chemotherapy of a patient with tongue cancer . South Russian journal of oncology. 2021;2(3):48–54. https://doi.org/10.37748/2686-9039-2021-2-3-6

25. Kaprin AD, Matskeplishvili ST, Potievskaya VI, Popovkina OE, Bolotina LV, Shklyaeva AV, etc. Cardiovascular diseases in cancer patients. Oncology. Journal them. P.A. Herzen. 2019;8(2):139–47. https://doi.org/10.17116/onkolog20198021139

26. Azizov VA, Sadigova TA, Muradova SR. Early cardiotoxic manifestations in breast cancer patients receiving taxol chemotherapy. Eurasian Cardiology Journal. 2017;(3):128–9.

27. Matyash MG, Kravchuk TL, Vysotskaya VV, Chernov VI, Goldberg VE. Anthracycline-induced cardiotoxicity: mechanisms of development and clinical manifestations. Siberian journal of oncology. 2008;(6):66–75.

28. Yandieva RA, Saribekyan EK, Mammadov MN. Cardiotoxicity in the treatment of cancer. International Journal of Heart and Vascular Diseases. 2018;6(17):3–11.

29. Matyash MG, Kravchuk TL, Vysotskaya VV, Chernov VI, Goldberg VE. Non-anthracycline cardiotoxicity. Siberian journal of oncology. 2009;(5):73–82.

30. Vatutin NT, Sklyannaya EV, El-Khatib MA, Taradin GG. Cardiovascular complications of anticancer therapy: definition, etiology, epidemiology, pathogenesis and classification (Part I). Russian journal of oncology. 2017;22(6):345–50. https://doi.org/10.18821/1028-9984-2017-22-6-345-350

31. Ostroumova OD, Cherniaeva MS, Kochetkov AI, Bakhteeva DI, Ivanov SN, Sychev DA. Drug-induced atrial fibrillation associated with the use of anticancer drugs. Safety and risk of pharmacotherapy. 2020;8(4):178–90. https://doi.org/10.30895/2312-7821-2020-8-4-178-190

32. Kovalenko EI, Artamonova EV. Nab-paclitaxel in the treatment of metastatic breast cancer. Medical alphabet. 2019;2(17):12–8. https://doi.org/10.33667/2078-5631-2019-2-17(392)-12-18

33. Zhu Z, Li X, Dong H, Ke S, Zheng WH. Let-7f and miRNA-126 correlated with reduced cardiotoxicity risk in triple-negative breast cancer patients who underwent neoadjuvant chemotherapy. Int J Clinic Exp Pathol. 2018;11(10):4987–95. PMID: 31949575

34. Rüger AM, Schneeweiss A, Seiler S, Tesch H, van Mackelenbergh M, Marmé F, et al. Cardiotoxicity and cardiovascular biomarkers in patients with breast cancer: data from the GeparOcto-GBG 84 trial. J Am Heart Assoc. 2020;9(23):e018143. https://doi.org/10.1161/JAHA.120.018143

35. Zhao D, Chen J, Liu X, Long X, Cao L, Wang J. Atrial fibrillation following treatment with paclitaxel: a case report. BiomedRep. 2018;9(6):540–4. https://doi.org/10.3892/br.2018.1158

36. Delyagin VM. Drug cardiotoxicity in children with oncological and hematological diseases. Togliatti Medical Council. 2016;(3–4):25–9.

37. Safronova EA, Grigoricheva EA, Shamurova YuYu, Evdokimov VV. Identification of the cardiotoxic effect of anticancer drugs. Continuing medical education and science. 2019;14(4):21–32.

38. Danilenko AA, Shakhtarina SV. Cardiac pathology in patients with Hodgkin’s lymphoma after treatment.