BNF for Children 2011-2012

426 8.1.4 Vinca alkaloids and etoposide BNFC 2011–20128 Malignant disease and immunosuppressionliver function weekly—discontinue if liver toxicitydevelops; interactions: Appendix 1 (tioguanine)Hepatic impairment reduce doseRenal impairment reduce dosePregnancy avoid (teratogenicity reported when menreceiving tioguanine have fathered children); ensureeffective contraception during treatment in men orwomen; see also Pregnancy and Reproductive Function,p. 416Breast-feeding discontinue breast-feedingSide-effects see section 8.1; also stomatitis andhepatotoxicity; rarely intestinal necrosis and perforationIndication and doseInfant acute lymphoblastic leukaemia. By mouthConsult local treatment protocol for detailsLanvis c (GSK) ATablets, yellow, scored, tioguanine 40 mg, net price25-tab pack = £54.49Extemporaneous formulations available seeExtemporaneous Preparations, p. 68.1.4 Vinca alkaloids andetoposideThe vinca alkaloids, vinblastine and vincristine areused to treat a variety of cancers including leukaemias,lymphomas, and some solid tumours.Neurotoxicity, usually as peripheral or autonomic neuropathy,occurs with all vinca alkaloids and is a limitingside-effect of vincristine; it occurs less often with vinblastine.Children with neurotoxicity commonly haveperipheral paraesthesia, loss of deep tendon reflexes,abdominal pain, and constipation; ototoxicity has beenreported. If symptoms of neurotoxicity are severe, dosesshould be reduced, but children generally tolerate vincristinebetter than adults. Motor weakness can alsooccur and dose reduction or discontinuation of therapymay be appropriate if motor weakness increases. Recoveryfrom neurotoxic effects is usually slow but complete.Myelosuppression is the dose-limiting side-effect of vinblastine;vincristine causes negligible myelosuppression.The vinca alkaloids may cause reversible alopecia. Theycause severe local irritation and care must be taken toavoid extravasation. Constipation is common with vinblastineand vincristine; prophylactic use of laxativesmay be considered.Safe PracticeVinblastine and vincristine are for intravenousadministration only. Inadvertent intrathecal administrationcan cause severe neurotoxicity, which isusually fatal.The National Patient Safety Agency has advised(August 2008) that teenage patients treated in anadolescent unit should receive their vinca alkaloiddose in a 50 mL minibag. Teenagers and childrentreated in a child unit may receive their vincaalkaloid dose in a syringe.Etoposide, usually given by slow intravenous infusion,is used to treat acute leukaemias, lymphomas, and somesolid tumours. Etoposide may also be given by mouthbut it is unpredictably absorbed.ETOPOSIDECautions see section 8.1 and notes above; interactions:Appendix 1 (etoposide)Hepatic impairment avoid in severe impairmentRenal impairment consider dose reduction—consultlocal treatment protocol for detailsPregnancy avoid (teratogenic in animal studies); seealso Pregnancy and Reproductive Function, p. 416Breast-feeding discontinue breast-feedingSide-effects see section 8.1, dose limiting myelosuppression,mucositis more common if given withdoxorubicin; anaphylaxis associated with concentratedinfusions; hypotension associated with rapidinfusion; irritant to tissues if extravasatedLicensed use not licensed for use in childrenIndication and doseStage 4 neuroblastoma, germ-cell tumours,intracranial germ-cell tumours, rhabdomyosarcoma,soft-tissue sarcomas, neuroectodermaltumours (including medulloblastoma), relapsedHodgkin’s disease, non-Hodgkin’s lymphoma,Ewing tumour, acute lymphoblastic leukaemia,acute myeloid leukaemia. By mouth or by intravenous infusionConsult local treatment protocol for detailsEtoposide (Non-proprietary) AConcentrate for intravenous infusion, etoposide20 mg/mL, net price 5-mL vial = £12.15, 10-mL vial =£29.00, 25-mL vial = £60.75Brands include Eposin cEtopophos c (Bristol-Myers Squibb) AInjection, powder for reconstitution, etoposide (asphosphate), net price 100-mg vial = £26.17 (hosp.only)Vepesid c (Bristol-Myers Squibb) ACapsules, both pink, etoposide 50 mg, net price 20 =£99.82; 100 mg, 10-cap pack = £87.23 (hosp. only).Label: 23VINBLASTINE SULPHATECautions see section 8.1 and notes above; caution inhandling; interactions: Appendix 1 (vinblastine)Contra-indications see notes aboveSafe PracticeIntrathecal injection contra-indicatedHepatic impairment dose reduction may be necessary—consultlocal treatment protocol for detailsPregnancy avoid (limited experience suggests fetalharm; teratogenic in animal studies); see alsoPregnancy and Reproductive Function, p. 416Breast-feeding discontinue breast-feedingSide-effects see section 8.1 and notes above; abdominalpain, constipation, leucopenia, muscle pain; lesscommonly peripheral neuropathy; rarely paralyticileus; irritant to tissues if extravasatedLicensed use licensed for use in children (age rangenot specified by manufacturer)