Oncovin (Vincristine)
Vinca Alkaloid Chemotherapy for Leukaemia, Lymphoma and Lung Cancer
Quick Facts About Oncovin
Key Takeaways About Oncovin (Vincristine)
- Intravenous only – intrathecal administration is fatal: Vincristine must never be given into the spinal canal. This is one of the most critical safety warnings in all of oncology
- Dose-limiting neurotoxicity: Peripheral neuropathy (numbness, tingling, weakness) is the main dose-limiting side effect and may require dose reduction or discontinuation
- Part of combination chemotherapy: Vincristine is rarely used alone; it is a key component of regimens such as CHOP, MOPP and various ALL protocols
- Hair loss is very common: Nearly all patients experience reversible alopecia during treatment, which typically recovers after treatment ends
- Liver function matters: Dose adjustments are necessary in patients with liver impairment, as vincristine is primarily metabolised hepatically via CYP3A4
What Is Oncovin and What Is It Used For?
Oncovin contains the active substance vincristine sulfate, a plant-derived chemotherapy agent belonging to the vinca alkaloid class. It is used in combination with other anticancer medications to treat leukaemia, malignant lymphoma and small cell lung cancer. Vincristine works by disrupting cell division, causing cancer cells to stop multiplying and ultimately die.
Vincristine was originally isolated from the periwinkle plant (Catharanthus roseus, formerly known as Vinca rosea), which is the origin of the “vinca alkaloid” class name. Since its introduction into clinical practice in the 1960s, vincristine has become one of the most widely used chemotherapy agents worldwide. The World Health Organization includes vincristine on its Model List of Essential Medicines, underscoring its critical importance in cancer treatment globally.
Vincristine exerts its anticancer effect by binding to tubulin, the protein building block of microtubules. Microtubules are essential structural components of the mitotic spindle, the apparatus that separates chromosomes during cell division. By preventing microtubule assembly, vincristine arrests dividing cells at metaphase (the M-phase of the cell cycle), triggering programmed cell death (apoptosis). Because cancer cells divide more rapidly than most normal cells, they are particularly susceptible to this mechanism of action.
The primary clinical indications for vincristine include:
- Acute lymphoblastic leukaemia (ALL): Vincristine is a cornerstone of virtually all ALL treatment protocols in both children and adults. It is typically combined with corticosteroids, anthracyclines and asparaginase during induction chemotherapy
- Hodgkin lymphoma: Vincristine is a component of the classic MOPP regimen (mechlorethamine, Oncovin, procarbazine, prednisone) and various modified protocols
- Non-Hodgkin lymphoma: As part of the CHOP regimen (cyclophosphamide, hydroxydaunorubicin, Oncovin, prednisone), vincristine is used to treat aggressive B-cell lymphomas and other subtypes
- Small cell lung cancer: Vincristine-containing regimens are used particularly when first-line treatments have not been effective
Vincristine may also be used off-label in the treatment of other malignancies, including Wilms tumour, neuroblastoma, rhabdomyosarcoma, Ewing sarcoma and certain brain tumours, particularly in paediatric oncology. Its role in these conditions is well established through decades of clinical experience and randomised controlled trials, even though some indications may not be formally listed in all regulatory approvals.
Vincristine is one of the oldest and most effective chemotherapy agents still in widespread clinical use. Despite being over 60 years old, it remains irreplaceable in many cancer treatment protocols due to its unique mechanism of action and its synergistic effects when combined with other anticancer drugs. It is available as a generic medication in many countries, ensuring broad global access.
What Should You Know Before Receiving Oncovin?
Treatment with vincristine should only be carried out by physicians experienced in cancer treatment. Before starting vincristine, your oncologist will assess your liver function, neurological status, and current medications. Vincristine is contraindicated in patients with Charcot-Marie-Tooth disease and in those receiving radiation therapy to the liver area.
Contraindications
You should not receive vincristine if any of the following apply to you:
- Allergy to vincristine sulfate or any of the other ingredients in this medicine – symptoms of a severe allergic reaction may include fever, rash, swelling and sometimes low blood pressure
- Charcot-Marie-Tooth disease (hereditary motor and sensory neuropathy) – a genetic condition affecting nerves and muscles. Vincristine can dramatically worsen this condition and cause severe, potentially irreversible neurological damage
- Radiotherapy over an area that encompasses the liver – concurrent hepatic irradiation significantly increases the risk of severe liver toxicity when combined with vincristine
Vincristine must only be given intravenously (into a vein). Intrathecal administration (injection into the spinal canal) is almost invariably fatal. This is one of the most important safety warnings in oncology. Hospitals and clinics have strict protocols to prevent this catastrophic medication error, including clearly labelled syringes bearing the warning “For intravenous use only. Intrathecal injection is fatal.”
Warnings and Precautions
Talk to your doctor or nurse before you receive vincristine if you have any of the following conditions:
- Liver problems: Vincristine is extensively metabolised by the liver. If you have impaired liver function (elevated bilirubin), your dose may need to be reduced to prevent toxicity. Your doctor will monitor your liver function with blood tests before and during treatment
- Pre-existing peripheral neuropathy: If you already have nerve damage (numbness, tingling or weakness in the hands or feet), vincristine may worsen these symptoms significantly. Your doctor will carefully assess the benefit-risk ratio before starting treatment
- Constipation or bowel problems: Vincristine commonly causes constipation and can lead to paralytic ileus (complete bowel obstruction). Prophylactic laxative therapy is often recommended
- Infection: Vincristine may lower your white blood cell count, making you more susceptible to infections. Report fever, sore throat or other signs of infection to your healthcare team immediately
Pregnancy and Breastfeeding
Vincristine is suspected of causing serious birth defects during pregnancy. The drug should only be used during pregnancy when the potential benefit to the mother clearly outweighs the risk to the foetus, and only after careful consideration by the treating oncologist. Women of childbearing potential must use effective contraception during vincristine treatment.
It is not known whether vincristine passes into breast milk. Due to the potential for serious adverse effects in nursing infants, breastfeeding should be discontinued during vincristine treatment. Discuss the timing of breastfeeding resumption with your oncologist after treatment has been completed.
Driving and Operating Machinery
Vincristine can affect your ability to drive or operate machinery, particularly at the start of treatment and when the dose is increased. Side effects such as dizziness, visual disturbances, impaired coordination (ataxia) and peripheral neuropathy may impair your ability to perform these activities safely. You are responsible for assessing whether you are fit to drive or operate machinery while receiving this treatment. Discuss any concerns with your doctor.
Important Information About Ingredients
Oncovin solution contains methylparahydroxybenzoate (E218) and propylparahydroxybenzoate (E216) as preservatives. These substances may cause allergic reactions (possibly delayed) and, rarely, bronchospasm (tightening of the airways). The solution also contains mannitol and water for injections. Acetic acid and sodium acetate trihydrate may have been added to adjust the pH. The product contains less than 1 mmol (23 mg) sodium per ml, meaning it is essentially sodium-free.
How Does Oncovin Interact with Other Drugs?
Vincristine interacts with several important drug classes, particularly azole antifungals and other CYP3A4 inhibitors, which can significantly increase vincristine blood levels and toxicity. Always inform your oncologist about all medications you are taking, including prescription drugs, over-the-counter medicines and herbal supplements.
Vincristine is metabolised primarily by the cytochrome P450 enzyme CYP3A4 in the liver. Drugs that inhibit or induce this enzyme can significantly alter vincristine blood levels, potentially leading to increased toxicity or reduced efficacy. The following interactions are particularly important:
Major Interactions
| Drug / Drug Class | Effect | Clinical Significance |
|---|---|---|
| Itraconazole | Potent CYP3A4 inhibition increases vincristine levels | Severe neurotoxicity reported; avoid combination or reduce vincristine dose |
| Posaconazole | Strong CYP3A4 inhibition | Significantly increased risk of neurotoxicity and ileus |
| Voriconazole | CYP3A4 inhibition increases vincristine exposure | Case reports of severe neurotoxicity; use with extreme caution |
| Ketoconazole (systemic) | CYP3A4 inhibition | Risk of enhanced vincristine toxicity; consider alternative antifungal |
| Mitomycin | Increased risk of bronchospasm and respiratory distress | Breathing difficulties reported; monitor respiratory function closely |
Minor Interactions
| Drug / Drug Class | Effect | Clinical Significance |
|---|---|---|
| Fluconazole, Isavuconazole | Moderate CYP3A4 inhibition | May increase vincristine levels; monitor for neurotoxicity |
| Cisplatin, Carboplatin | Additive ototoxicity and neurotoxicity | Monitor hearing and neurological function; often used together in protocols with careful dose adjustments |
| Aminoglycosides (e.g. gentamicin) | Additive ototoxicity | Risk of hearing damage may be increased; monitor audiometric function |
| Phenytoin, Carbamazepine | CYP3A4 induction may reduce vincristine levels | May decrease anticancer efficacy; consider anticonvulsant alternatives |
The interaction between vincristine and azole antifungals is of particular clinical importance because patients receiving chemotherapy frequently develop fungal infections requiring antifungal therapy. The European Society for Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN) recommend avoiding concomitant use of potent CYP3A4 inhibitors with vincristine whenever possible, or if co-administration is unavoidable, reducing the vincristine dose and closely monitoring for signs of neurotoxicity.
It is also worth noting that radiation therapy delivered to the mediastinum (the area between the lungs) followed by vincristine-containing chemotherapy has been associated with an increased risk of myocardial infarction (heart attack). Your oncologist will take this into consideration when planning your treatment sequence.
What Is the Correct Dosage of Oncovin?
Vincristine dosage is determined by your oncologist based on your body surface area, the specific cancer being treated, and the chemotherapy protocol being used. The medication is given only by intravenous injection. Single doses in adults generally should not exceed 2 mg. Treatment is always administered under the supervision of an experienced oncologist.
Vincristine is always administered as part of a multi-drug chemotherapy regimen. The exact dose, schedule and duration of treatment depend on the type of cancer, the treatment protocol being followed and your individual clinical characteristics. Your oncologist will calculate the appropriate dose for each cycle of chemotherapy.
Adults
Standard Adult Dosing
The typical adult dose is 1.4 mg/m² body surface area, administered intravenously once weekly or as specified by the treatment protocol. The maximum single dose is usually capped at 2 mg regardless of body surface area, to minimise the risk of severe neurotoxicity. Your oncologist may adjust this based on your treatment response and tolerance.
Children
Paediatric Dosing
In children, vincristine dosing is also calculated based on body surface area, typically at 1.5–2.0 mg/m² per dose, depending on the specific treatment protocol. Children weighing less than 10 kg or with a body surface area less than 1 m² may receive weight-based dosing (typically 0.05 mg/kg). Paediatric patients generally tolerate vincristine better than adults with respect to neurotoxicity, though they may be at higher risk for seizures.
Dose Adjustments
Hepatic Impairment
Dose reduction is essential in patients with liver dysfunction. When direct bilirubin exceeds 3 mg/dl (approximately 51 μmol/l), a 50% dose reduction is typically recommended. Your oncologist will review your liver function tests before each dose and adjust accordingly. Patients with severe liver disease may need to have vincristine temporarily withheld.
Administration
Vincristine is administered exclusively by the intravenous route. The injection is typically given over approximately 1 minute, either as a direct intravenous push or through a multi-way tap during an ongoing intravenous infusion. The solution may be diluted if needed with sterile 0.9% sodium chloride solution or 5% glucose solution to concentrations between 0.01 mg/ml and 1 mg/ml.
Great care must be taken to ensure that the injection is given entirely within the vein. If extravasation (leakage outside the vein) occurs, the administration must be stopped immediately, as vincristine can cause severe tissue irritation and damage. Any remaining dose should be given in a different vein. Local application of warmth can help disperse the extravasated drug and reduce discomfort.
Overdose
Vincristine overdose is a serious medical emergency. Overdose intensifies all known side effects, particularly neurotoxicity, and can be life-threatening. There is no specific antidote for vincristine overdose. Treatment is supportive and may include folinic acid (leucovorin) infusion, which has been used in some cases to mitigate toxicity. If you suspect an overdose, contact your healthcare team immediately.
What Are the Side Effects of Oncovin?
Like all chemotherapy medications, vincristine can cause side effects, though not everyone will experience them. Side effects are generally dose-dependent. The most common side effect is hair loss (alopecia). The most clinically significant side effect is peripheral neuropathy, which is the dose-limiting toxicity of vincristine and may require dose reduction or discontinuation.
Side effects of vincristine can range from mild and transient to severe and potentially life-threatening. Your oncology team will monitor you closely throughout treatment and adjust your dose or treatment plan as needed. It is important to report any new or worsening symptoms promptly.
Common Side Effects
- Hair loss (alopecia) – the most common side effect, usually reversible
- Low white blood cell count (leukopenia)
- Low platelet count (thrombocytopenia)
- Loss of deep tendon reflexes
- Numbness and tingling in fingers and toes (peripheral neuropathy)
- Difficulty coordinating movements (ataxia)
- Cranial nerve effects
- Foot drop
- Nerve function impairment
- Partial paralysis (paresis)
- Eye muscle paralysis (ocular paresis)
- Constipation
- Impaired bowel function
- Abdominal pain
- Vocal cord paralysis
- High or low blood pressure
- Bone pain, jaw pain, sore throat
- Local reactions at the injection site
Uncommon Side Effects
- Seizures (particularly in children)
- Severe allergic reaction (hypersensitivity with fever, rash, swelling, low blood pressure)
- Nausea and vomiting
- Mouth sores (stomatitis)
- Diarrhoea
- Difficulty emptying the bladder (bladder atony)
- Painful urination (dysuria)
- Fever
- Loss of appetite
- Headache
Rare Side Effects
- Low sodium levels due to syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- Transient or permanent blindness
- Skin rash
- Cellulitis (skin infection)
- Partial or complete deafness
- Seizures followed by coma (in children)
Paralytic ileus (complete bowel obstruction due to loss of muscle tone in the intestine) may occur in up to 1 in 10 patients and represents a serious complication that requires immediate medical attention. Signs include severe constipation, abdominal bloating, nausea and vomiting. Prophylactic use of laxatives is commonly recommended during vincristine therapy.
Myocardial infarction (heart attack) has been reported in patients receiving vincristine in combination with other chemotherapy agents, particularly when treatment was initiated after mediastinal radiation therapy. This is a rare but serious complication that oncologists consider when designing treatment plans.
In patients receiving vincristine together with mitomycin, breathing difficulties (dyspnoea) have been reported. If you experience shortness of breath during or after treatment, seek medical attention immediately.
Fertility effects: Azoospermia (absence of sperm in semen) and amenorrhoea (absence of menstruation) have been reported in adolescent and young adult patients treated with multi-agent chemotherapy regimens including vincristine. These effects may be temporary or permanent depending on the cumulative doses of all agents used. Fertility preservation options should be discussed with your oncologist before commencing treatment.
Seek immediate medical attention if you experience severe constipation or abdominal bloating (possible paralytic ileus), difficulty breathing, signs of severe allergic reaction (fever, widespread rash, facial swelling, low blood pressure), sudden visual changes, or any symptoms that concern you during treatment.
How Should Oncovin Be Stored?
Oncovin must be stored in a refrigerator at 2°C to 8°C (36°F to 46°F). It should be kept out of the reach and sight of children. The product should not be used after the expiry date stated on the label. As a hospital-administered medication, storage is managed by your healthcare facility's pharmacy.
Oncovin solution for injection is a clear, colourless liquid supplied in glass vials containing 1 ml or 2 ml. The solution must be stored under refrigerated conditions (2°C–8°C) at all times to maintain its chemical stability and sterile integrity.
After first opening, the product demonstrates chemical and physical stability for up to 14 days at 2°C–8°C. From a microbiological standpoint, in-use storage should not exceed 14 days under these conditions. Once diluted for infusion (to concentrations between 0.01 mg/ml and 0.1 mg/ml in 5% glucose or 0.9% sodium chloride solution), the product is stable for up to 3 days at 2°C–8°C or at room temperature (up to 25°C). However, from a microbiological perspective, diluted solutions should ideally be used immediately.
Vincristine must not be mixed with other medications and should not be diluted with solutions that alter its pH. Any unused solution or waste material should be disposed of according to local requirements for cytotoxic waste.
What Does Oncovin Contain?
Each millilitre of Oncovin solution contains 1 mg of vincristine sulfate as the active ingredient, along with preservatives, mannitol and water for injections. The solution has a pH of 3.5 to 5.5.
The complete list of ingredients in Oncovin solution for injection is as follows:
- Active substance: Vincristine sulfate 1 mg per ml
- Other ingredients: Methylparahydroxybenzoate (E218), propylparahydroxybenzoate (E216), mannitol, and water for injections. Acetic acid and sodium acetate trihydrate may have been added to adjust the acidity (pH)
Methylparahydroxybenzoate (E218) and propylparahydroxybenzoate (E216) are preservatives that may cause allergic reactions (possibly delayed) and, in rare cases, bronchospasm (tightening of the airways). Patients with known hypersensitivity to these preservatives should inform their healthcare team before receiving Oncovin.
Oncovin is supplied in glass vials in pack sizes of 1 ml and 2 ml. Not all pack sizes may be marketed in all countries. The solution is clear and colourless. Do not use the solution if it appears cloudy, discoloured, or if the vial shows signs of damage.
The marketing authorisation holder is STADA Nordic ApS, Herlev, Denmark. The manufacturer is STADA Arzneimittel AG, Bad Vilbel, Germany.
Frequently Asked Questions About Oncovin
Oncovin (vincristine) is a chemotherapy medication used in combination with other cancer drugs to treat acute lymphoblastic leukaemia (ALL), Hodgkin and non-Hodgkin lymphoma, and small cell lung cancer. It belongs to the vinca alkaloid class and works by inhibiting cell division through disruption of microtubule formation. It is also used off-label for several other cancers including Wilms tumour, neuroblastoma and rhabdomyosarcoma.
Vincristine must only be given intravenously (into a vein) because intrathecal administration (injection into the spinal canal) is almost invariably fatal. This is one of the most critical safety warnings in all of oncology. Hospitals have implemented strict safety protocols, including clearly labelled syringes and mandatory separate preparation areas, to prevent this catastrophic medication error.
The most common side effect of vincristine is hair loss (alopecia), which affects the majority of patients but is usually reversible after treatment ends. Other common side effects include peripheral neuropathy (numbness, tingling and pain in hands and feet), constipation, jaw pain, bone pain, loss of deep tendon reflexes and local reactions at the injection site. Peripheral neuropathy is the dose-limiting toxicity and may require dose reduction.
Vincristine is administered as an intravenous injection by a healthcare professional experienced in cancer treatment, typically over about 1 minute. It may be given through a multi-way tap during an ongoing infusion or as a direct intravenous push. The dosage is calculated based on your body surface area, and single doses in adults usually do not exceed 2 mg to minimise the risk of severe neurotoxicity.
Yes, vincristine may affect fertility. In male patients, azoospermia (absence of sperm in semen) has been reported, particularly when used in combination with other chemotherapy agents. In female patients, amenorrhoea (absence of menstruation) may occur. These effects may be temporary or permanent. Women of childbearing potential should use effective contraception during treatment. Discuss fertility preservation options (such as sperm banking or egg freezing) with your doctor before starting treatment.
If vincristine leaks outside the vein (extravasation), the infusion must be stopped immediately as it causes severe tissue irritation and potential damage. Any remaining dose should be given in a different vein. Local application of warmth can help disperse the leaked drug and reduce discomfort. You should notify your healthcare team immediately if you experience burning, pain or swelling at the injection site during or after administration.
References
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List. Geneva: World Health Organization; 2023. Available from: who.int/publications
- European Medicines Agency (EMA). Vincristine sulfate – Summary of Product Characteristics. London: European Medicines Agency; 2024. Available from: ema.europa.eu
- National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Acute Lymphoblastic Leukemia. Version 2.2024. Plymouth Meeting, PA: NCCN; 2024.
- European Society for Medical Oncology (ESMO). ESMO Clinical Practice Guidelines: Hodgkin Lymphoma. Annals of Oncology. 2024;35(1):1–15. doi:10.1016/j.annonc.2023.10.005
- British National Formulary (BNF). Vincristine sulfate: Drug monograph. London: BMJ Group and Pharmaceutical Press; 2025. Available from: bnf.nice.org.uk
- Gidding CE, Kellie SJ, Kamps WA, de Graaf SS. Vincristine revisited. Critical Reviews in Oncology/Hematology. 1999;29(3):267–287. doi:10.1016/S1040-8428(98)00023-7
- Mora E, Smith EM, Donohoe C, Hertz DL. Vincristine-induced peripheral neuropathy in pediatric cancer patients. American Journal of Cancer Research. 2016;6(11):2416–2430.
- U.S. Food and Drug Administration (FDA). Vincristine Sulfate Injection – Prescribing Information. Silver Spring, MD: FDA; 2024. Available from: fda.gov
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