BNF for Children 2011-2012

BNFC 2011–2012 8.1.5 Other antineoplastic drugs 427Indication and doseHodgkin’s disease and other lymphomas. By intravenous injectionConsult local treatment protocol for detailsVinblastine (Non-proprietary) AInjection, vinblastine sulphate 1 mg/mL, net price 10-mL vial = £13.09Velbe c (Genus) AInjection, powder for reconstitution, vinblastine sulphate,net price 10-mg amp = £14.15VINCRISTINE SULPHATECautions see section 8.1 and notes above; neuromusculardisease; ileus; caution in handling; interactions:Appendix 1 (vincristine)Contra-indications see notes aboveSafe PracticeIntrathecal injection contra-indicatedHepatic impairment dose reduction may be necessary—consultlocal treatment protocol for detailsPregnancy avoid (teratogenicity and fetal loss in animalstudies); see also Pregnancy and ReproductiveFunction, p. 416Breast-feeding discontinue breast-feedingSide-effects see section 8.1 and notes above; constipation(see notes above), diarrhoea, intestinal necrosis,paralytic ileus may occur in young children; doselimitingneuromuscular effects (see notes above);urinary retention, rarely convulsions followed bycoma; inappropriate secretion of antidiuretic hormone;irritant to tissues if extravasatedLicensed use licensed for use in children (age rangenot specified by manufacturer)Indication and doseAcute leukaemias, lymphomas, paediatric solidtumours. By intravenous injectionConsult local treatment protocol for detailsVincristine (Non-proprietary) AInjection, vincristine sulphate 1 mg/mL, net price 1-mL vial = £13.47; 2-mL vial = £26.66; 5-mL vial =£44.16Oncovin c (Genus) AInjection, vincristine sulphate 1 mg/mL, net price 1-mL vial = £14.18; 2-mL vial = £28.058.1.5 Other antineoplasticdrugsAmsacrineAmsacrine has an action and toxic effects similar tothose of doxorubicin (section 8.1.2) and is given intravenously.It is occasionally used in acute myeloid leukaemia.AMSACRINECautions see section 8.1 and notes above; considermonitoring cardiac function; monitor electrolytes(fatal arrhythmias possible if hypokalaemia); previoustreatment with anthracyclines; also caution in handling—irritantto skin and tissuesHepatic impairment manufacturer advises reduceinitial dose by 20–30%Renal impairment manufacturer advises reduce initialdose by 20–30%Pregnancy avoid (teratogenic and toxic in animalstudies); may reduce fertility; see also Pregnancy andReproductive Function, p. 416Breast-feeding discontinue breast-feedingSide-effects see section 8.1; mucositis, phlebitis; lesscommonly diarrhoea, cardiotoxicity, haematuria,renal impairment, hepatotoxicity, skin rash; rarelyacute renal failure, grand mal seizuresLicensed use not licensed for use in childrenIndication and doseAcute myeloid leukaemia. By intravenous infusionConsult local treatment protocol for detailsAmsidine c (Goldshield) AConcentrate for intravenous infusion, amsacrine5 mg (as lactate)/mL, when reconstituted by mixingtwo solutions. Net price 1.5-mL (75-mg) amp with13.5-mL diluent vial = £54.08 (hosp. only)AsparaginaseAsparaginase is used almost exclusively in the treatmentof acute lymphoblastic leukaemia. Hypersensitivityreactions may occur and facilities for the managementof anaphylaxis should be available. A number ofdifferent preparations of asparaginase exist and only theproduct specified in the treatment protocol should beused.Crisantaspase is the enzyme asparaginase produced byErwinia chrysanthemi. Preparations of asparaginasederived from Escherichia coli are also available. Childrenwho are hypersensitive to asparaginase derivedfrom one organism may tolerate asparaginase derivedfrom another organism but cross-sensitivity occurs inabout 20–30% of individuals.CRISANTASPASECautions see section 8.1 and notes aboveContra-indications history of pancreatitis related toasparaginase therapyPregnancy avoid; see also Pregnancy and ReproductiveFunction, p. 416Breast-feeding discontinue breast-feedingSide-effects see section 8.1; also liver dysfunction,pancreatitis, diarrhoea; coagulation disorders;lethargy, drowsiness, confusion, dizziness, neurotoxicity,convulsions, headache; less commonly changesin blood lipids, anaphylaxis, hyperglycaemia; rarelyCNS depression; very rarely myalgia; abdominal painand hypertension also reported8 Malignant disease and immunosuppression