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動物種別の用量

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投与経路

禁忌

• Preexisting leukopenia or granulocytopenia (unless caused by the disease being treated)
• Active bacterial infection
• Neutrophil count < 3 x 10^9/L
• Platelet count < 100 x 10^9/L
• Pre-existing severe myelosuppression or active infection
• Pre-existing severe myelosuppression (Neutrophil count < 3 x 10^9/L or Platelet count < 100 x 10^9/L)

有害事象

• Gastroenterocolitis (nausea, vomiting, anorexia)
• Myelosuppression (neutropenia, thrombocytopenia, anemia; nadir at 4-9 days)
• Neurotoxicity (constipation, paralytic ileus, jaw and muscle pain, loss of deep tendon reflexes)
• Alopecia
• Stomatitis
• Syndrome of inappropriate ADH secretion (SIADH)
• Severe tissue irritation and cellulitis (if extravasated)
• Cats: Reversible axon swelling and paranodal demyelination
• Myelosuppression (primarily neutropenia)
• Gastrointestinal toxicity (vomiting, diarrhea, anorexia)
• Severe tissue necrosis (if extravasated)
• Myelosuppression (neutropenia, thrombocytopenia)
• Gastrointestinal toxicity

薬物相互作用

• Cisplatin · May cause additive risk for ototoxicity.
• Carboplatin · May cause additive risk for ototoxicity.
• P-glycoprotein inhibitors (e.g., Amiodarone, Ketoconazole, Cyclosporine, Diltiazem, Erythromycin, Spironolactone, Verapamil) · Can inhibit P-glycoprotein clearance of vinblastine, increasing the risk of severe toxicity, particularly in dogs with the MDR1 (ABCB1) mutation.
• Cimetidine · Inhibits hepatic cytochrome P450 enzymes, potentially decreasing vinblastine metabolism and increasing toxicity. · major
• Other myelosuppressive agents · Additive bone marrow suppression. · major

モニタリング

• Efficacy (tumor response)
• Complete blood counts (CBC) with platelets (monitor for nadir)
• Liver function tests (prior to therapy and repeated as necessary)
• Serum uric acid
• IV site for signs of extravasation during administration
• Haematology (CBC) prior to each treatment
• Biochemistry prior to first treatment
• Tumour restaging (lymph node palpation, cytology)
• Complete Blood Count (CBC) prior to every dose (specifically neutrophils and platelets)
• Tumor restaging at week 4 and week 12 (for high-risk tumors)
• IV catheter site for signs of extravasation during administration

過量投与

The lethal dose in dogs is reported as **0.2 mg/kg**. **Clinical Signs of Overdose:** Exacerbation of adverse effects, including profound myelosuppression, severe gastrointestinal signs, and neurotoxicity (similar to vincristine). * *Feline Case Report (4X IV overdose):* Depression, inability to jump, anorexia (days 1-11), neutropenia with fever, thrombocytopenia, anemia, vomiting, diarrhea, and syndrome of inappropriate ADH (SIADH). **Treatment:** Aggressive supportive care is required. Monitor cardiovascular and hematologic status closely. Treatment may include anticonvulsants, prevention/management of ileus, and management of SIADH (fluid restriction and loop diuretics to maintain serum osmolality).