Intrathecal Route
Contraindicated
Database
Intrathecal vincristine causes ascending paralysis and death
NEVER intrathecal — strict labelling/handling protocols (give in minibag)
Source: Kimi deep-research + Cla
Drug reference
Vincristine
Vinca alkaloid mitotic inhibitor · Antineoplastic
Also known as vincristine sulfate
START
1.4 mg/m² IV weekly (cap ~2 mg absolute) per regimen — IV ONLY, label syringe 'fatal if given intrathecally'
TYPICAL MAX
Commonly capped at 2 mg absolute per dose
STOP IF
Severe motor neuropathy/ileus, severe hyponatraemia (SIADH); never intrathecal
WATCH
Neuro exam (deep tendon reflexes) each dose, bowel regimen prophylaxis, sodium, extravasation precautions
CDSCO approvedSchedule HATC L01CA02
KDIGO 2024 + manufacturer label
- ONSET
- 8min · absorption onset
- PEAK
- 30min · plasma Cmax
- t½
- 3.5d · terminal t½
- DURATION
- 1w · weekly cycle
EXCRETION
Hepatic CYP3A4; ~80% biliary/faecal
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Avoid — teratogenic/fetotoxic; effective contraception
FDA category + note
Top interactionssee all 12 →
- Intrathecal RouteContraindicatedDatabaseKimi deep-research + Cla
- Live VaccinesContraindicatedDatabaseKimi deep-research + Cla
- AdalimumabSevereDatabaseDDInter
- AmprenavirSevereDatabaseDDInter
Available in India
15 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Binds tubulin, inhibiting microtubule polymerisation and arresting cells in metaphase (M-phase) → apoptosis; the neuronal microtubule effect underlies dose-limiting peripheral neuropathy.
Indications
Acute lymphoblastic leukaemia; Hodgkin and non-Hodgkin lymphomaMany paediatric/solid tumour combination regimens (Wilms, neuroblastoma, rhabdomyosarcoma)Idiopathic thrombocytopenic purpura (off-label)
Dosing
- Adult
- 1.4 mg/m² IV (commonly capped at 2 mg absolute dose) once weekly per regimen.
- Pediatric
- 1.5–2 mg/m² IV weekly (or weight-based <10 kg), per protocol.
- Renal adjustment
- No specific adjustment (hepatic/biliary elimination).
- Hepatic adjustment
- Bilirubin >3 mg/dL: reduce dose ~50%; significant hepatic dysfunction — dose-reduce.
- Geriatric
- Greater neuropathy/constipation; monitor/reduce.
- Max dose
- Commonly capped at 2 mg absolute per dose
Pharmacokinetics
Onset
Cytotoxic over days; neuropathy cumulative
Peak effect
Plasma rapid (IV)
Duration
Weekly cycle
Half-life
Triphasic; terminal ~85 h
Bioavailability
IV only
Protein binding
~75%
Metabolism
Hepatic CYP3A4
Excretion
Biliary/faecal (~80%); minor renal
Contraindications
- INTRATHECAL administration — uniformly FATAL (IV use only)
- Demyelinating Charcot–Marie–Tooth syndrome
- Severe hypersensitivity to vincristine
- Caution: significant hepatic impairment, pre-existing neuropathy
Side effects
Common
Peripheral neuropathy (sensory then motor; areflexia)Constipation/ileus, abdominal painAlopeciaJaw/limb pain
Serious
- Severe/irreversible peripheral and autonomic neuropathy
- Paralytic ileus/severe constipation
- SIADH/hyponatraemia
- Fatal if given intrathecally; severe extravasation tissue necrosis (vesicant)
- Bronchospasm (with mitomycin); seizures/encephalopathy
Pregnancy & lactation
Pregnancy
Avoid — teratogenic/fetotoxic; effective contraception
Lactation
Contraindicated — discontinue breastfeeding
Drug interactions
Live Vaccines
Contraindicated
Database
Immunosuppression
Avoid live vaccines
Source: Kimi deep-research + Cla
Adalimumab
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Amprenavir
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Atazanavir
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Baricitinib
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Boceprevir
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Ceritinib
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Certolizumab
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Cladribine
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Clarithromycin
Severe
Database
Drug interaction classified as: metabolism.
Source: DDInter
Clozapine
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Related guidelines
Ask House about Vincristine
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19