Clinician's Pocket Drug Reference 2008

212 Vincristinerenal cell, breast, non-small-cell lung), AIDS-related Kaposi sarcoma,* choriocarcinoma,histiocytosis Action: ↓ microtubule assembly Dose: 0.1–0.5 mg/kg/wk(4–20 mg/m 2 ); ↓ in hepatic failure Caution: [D, ?] Contra: Intrathecal use Disp:Inj 1 mg/mL in 10 mg vial SE: ↓ BM (especially leukopenia), N/V, constipation,neurotox, alopecia, rash, myalgia, tumor painVincristine (Oncovin, Vincasar PFS) WARNING: Chemotherapeuticagent; handle w/ caution; Fatal if administered intrathecally Uses: *ALL,breast & small-cell lung CA, sarcoma (eg, Ewing tumor, rhabdomyosarcoma),Wilms’ tumor, Hodgkin Dz & NHLs, neuroblastoma, multiple myeloma* Action:Promotes disassembly of mitotic spindle, causing metaphase arrest Dose: 0.4–1.4mg/m 2 (single doses 2 mg/max); ↓ in hepatic failure Caution: [D, ?] Contra: Intrathecaluse Disp: Inj 1 mg/mL, 5 mg vial SE: Neurotox commonly dose limiting,jaw pain (trigeminal neuralgia), fever, fatigue, anorexia, constipation & paralyticileus, bladder atony; no significant ↓ BM w/ standard doses; tissue necrosis w/extravVinorelbine (Navelbine) WARNING: Chemotherapeutic agent; handlew/ caution Uses: *Breast & non-small-cell lung CA* (alone or w/ cisplatin) Action:↓ polymerization of microtubules, impairing mitotic spindle formation; semisyntheticvinca alkaloid Dose: 30 mg/m 2 /wk; ↓ in hepatic failure Caution: [D, ?]Contra: Intrathecal use, rotavirus vaccine line Disp: Inj 10 mg SE: ↓ BM(leukopenia), mild GI, neurotox (6–29%); constipation/paresthesias (rare); tissuedamage from extravVitamin B 1 See Thiamine (page 200)Vitamin B 6 See Pyridoxine (page 178)Vitamin B 12 See Cyanocobalamin (page 69)Vitamin K See Phytonadione (page 170)Vitamin, multi See Multivitamins (Table 13)Voriconazole (VFEND) Uses: *Invasive aspergillosis, serious fungalInfxns* Action: ↓ ergosterol synth. Spectrum: Fungus: Aspergillus, Scedosporiumsp, Fusarium sp Dose: Adults & Peds ≥ 12 y. IV: 6 mg/kg q12h × 2, then 4 mg/kgbid; may ↓ to 3 mg/kg/dose. PO: < 40 kg: 100 mg q12h, up to 150 mg; > 40 kg: 200mg q 12 h, up to 300 mg; ↓ w/mild–moderate hepatic impair; IV w/ renal impair X1dose; PO w/o food Caution: [D, ?/–] Contra: Severe hepatic impair Disp: Tabs 50,200 mg; susp 200 mg/5 mL; 200 mg inj SE: Visual changes, fever, rash, GI upset, ↑LFTs Notes: for multiple drug interactions (eg, ↑ dose w/ phenytoin)Vorinostat (Zolinza) Uses: *Rx cutaneous manifestations in cutaneous T-cell lymphoma Action: Histone deacetylase inhibitor Dose: 400 mg PO dailyw/food; if intolerant ↓ 300 mg PO day for × 5 days each wk Caution: [D; ?/–] w/warfarin(↑ INR) Disp: Caps 100 mg SE: N/V/D, dehydration, fatigue, anorexia,dysgeusia, DVT, PE, ↓plt, anemia, hyperglycemia, QTc prolongation, Notes: MonitorCBC, lytes (K, Mg, Ca), glucose, & SCr q 2 wks × 2 mo then monthly; baseline,periodic ECGs; drink 2 L fluid/day