Vincristine Sulfate for Injection USP 1mg



Package leaflet: Information for the patient

Vincristine Sulphate 1 mg/ml Injection

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

- Keep this leaflet. You may need to read it again.

- If you have any further questions, ask your doctor or pharmacist.

- This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.

- If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet (see section 4).

What is in this leaflet

1. What Vincristine Sulfate Injection is and what it is used for

2. What you need to know before you take Vincristine Sulfate Injection

3. How to take Vincristine Sulfate Injection

4. Possible side effects

5. How to store Vincristine Sulfate Injection

6. Contents of the pack and other information

1. What Vincristine Sulfate Injection is and What it is used for

Vincristine sulphate is an anti-cancer medicine. Treatment with an anti-cancer medicine is sometimes called cancer chemotherapy.

Vincristine Sulphate Injection is used in the treatment of cancers of the blood (eg. leukaemia or lymphomas), breast, head and neck or lung. It may be used to treat multiple myeloma (a cancer of plasma cells) and it may also be used in the treatment of some cancers in children. It may be used in a blood disorder known as idiopathic thrombocytopenic purpura (ITP) after other treatments have not been successful.

Vincristine Sulphate Injection may be given alone or in combination with other anticancer medicines.

2. What you need to know you take Vincristine Sulfate Injection

Vincristine Sulphate Injection must never be injected intrathecally (into the spine).

Do not use Vincristine Sulphate Injection

• if you have shown signs of hypersensitivity (severe allergy) to vincristine, benzyl alcohol or mannitol in the past

• if you have Charcot-Marie-Tooth syndrome (disease which causes weaknessin the leg muscles)

• if you have an infection that is not being treated

Tell your doctor if any of the above applies to you before this medicine is used

Premature babies or babies less than 4 weeks old must not receive Vincristine Sulphate Injection 5 mg/5 ml (see ‘Important information about one of the ingredients of Vincristine Sulphate Injection’ below).

Take special care with Vincristine Sulphate Injection

• to make sure that this medicine is only given to you through a vein (it should not be given by any other route). If you notice any pain during, or soon after the injection is given, tell your doctor or nurse immediately

• if you have a mental or nervous system disorder

• if you have liver trouble

• if you have kidney cancer

• if you are having radiotherapy

• if you have breathing problems

• if you have a low white blood cell count, measured on blood test

• if you have an infection

Tell your doctor if any of the above applies to you before this medicine is used.

Special care is also needed if this medicine is given to the elderly or children between 4 weeks and 3 years old.

Tell your doctor if you are taking, have recently taken or might take any other medicines.

Use of the following medicines may make the side effects of vincristine sulphate worse:

• isoniazid (medicine used to treat tuberculosis)

• mitomycin-C (anti-cancer medicine)

• itraconazole (a medicine used to treat fungal infections)

• L-asparaginase (used for treating some types of cancer)

• dactinomycin (used for treating some types of cancer)

• some anti-cancer drugs (eg containing platinum) that may cause problems with hearing or balance

• medicines which cause problems with passing water (urine). These should be stopped before you start treatment with vincristine

• medicines which cause problems with your nervous system e.g. walking difficulties, pins and needle or numbness

Phenytoin (medicine used to control fits) may not work as well when vincristine sulphate is used, so blood levels of phenytoin will need to be monitored.

Methotrexate used in the treatment of cancer may work better when used with vincristine.

Please tell your doctor if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.

Pregnancy, breast-feeding and fertility

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine.

Women of childbearing potential should use appropriate contraception methods during treatment with vincristine sulphate.

Driving and using machines

Do not drive or use machines if you experience any side effect which may lessen your ability to do so.

Important information about one of the ingredients of Vincristine Sulphate Injection

This medicine contains benzyl alcohol. This means that this medicine must not be given to premature babies or neonates. It may cause toxic reactions and allergic reactions in infants and children up to 3 years old.

Vincristine Sulphate Injection contains Latex

The vial stopper contains dry natural rubber (a derivative of latex), which may cause allergic reactions.

3. How to take Vincristine Sulfate Injection

This medicine is given by infusion (drip) into a vein.

Vincristine sulphate is an irritant, if it accidentally gets into your eye tell your doctor or nurse immediately so that it may be washed out.

You may be given medicines to prevent constipation during treatment with vincristine sulphate.

Dosage

Your doctor will work out the correct dose of vincristine sulphate for you and how often it must be given.

The dose will depend on your medical condition, your size and how well your liver is working. Your doctor will tell how well your liver is working using a blood sample.

Vincristine sulphate is usually given once a week.

If you are given too much or too little Vincristine Sulphate Injection

This medicine will be given to you in a hospital, under the supervision of a doctor. It is unlikely that you will be given too little or too much, however, tell your doctor or nurse if you have any concerns.

4. Possible Side Effect

Like all medicines, vincristine sulphate can have side effects, although not everybody gets them.

If any of the following happen, tell your doctor immediately:

• severe allergic reaction – you may experience a sudden itchy rash (hives),

• swelling of the hands, feet, ankles, face, lips, mouth or throat (which may cause difficulty in swallowing or breathing), and you may feel you are going to faint. pain or swelling at the injection site during or immediately after the injection

• severe chest pains possibly radiating to the jaw or arm, sweating,

• breathlessness and nausea severe breathing problems or shortness of breath

• Symptoms suggestive of sepsis – these may include a high fever or low temperature, shivering, fast heartbeat, rapid breathing, feeling faint, skin changes (cold, clammy and mottled or pale), altered mental state such as confusion or disorientation, decreased urination, nausea, vomiting etc. The presence of a few or several of these symptoms coupled with a rapid deterioration of general condition might indicate sepsis and immediate medical attention should be sought.

These are serious side effects. You may need urgent medical attention. All of these serious side effects are rare.

If any of the following happen, tell your doctor as soon as possible:

• convulsions (fits)

• deafness or hearing loss

• worsening eyesight

• pain (may involve the side of the face, jaw, throat, neck, bones or muscles)

• dizziness

• fever, sore throat, skin rashes, or sores on your body and mouth ulcers (may indicate a drop in white blood cells)

• significant weight loss

• numbness or pins and needles

• difficulty in walking

• muscle weakness or muscle wasting

• difficulty with speech

• unusual eye movements

• problems with passing water (more or less urine than normal, or pain when passing urine)

• mild breathing problems

• raised or lowered blood pressure

• headache

• tiredness

• unexpected bruises

• stomach cramps, constipation or diarrhea

• being sick or feeling sick

• hair loss

• soreness around the injection site after the injection

• infections with germs

• loss of appetite

Vincristine sulphate may lead to changes in your blood cells, including a type of anaemia in which red blood cells are destroyed (haemolytic anaemia). Your doctor may take blood samples to monitor for these and also to check how well your liver is working.

There have been reports of other malignancies (cancers) occurring at a later date after vincristine has been used in combination with other anti-cancer drugs. This happens rarely.

Effects on fertility

Treatment with vincristine sulphate may permanently reduce fertility in men and women. Tell your doctor if you have concerns.

Reporting of side effects

If you get any side effects, talk to your doctor or nurse. This includes any possible side effects not listed in this leaflet. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Vincristine Sulfate Injection

Keep this medicine out of the sight and reach of children

Expiry

This medicine must not be used after the expiry date which is stated on the vial label and carton after 'EXP'. Where only a month and year is stated, the expiry date refers to the last day of that month.

Storage Conditions

Store in a refrigerator (2ºC - 8 ºC). The vials should be kept in the outer carton, in order to protect from light.

Medicines should not be disposed of via waste water or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

6. Contents of the pack and Future Information

What Vincristine Sulfate Injection contain

The active substance is vincristine sulphate. Each millilitre (ml) of solution contains 1 milligram (mg) of vincristine sulphate. The other ingredients are mannitol, benzyl alcohol and Water for Injections.

What Vincristine Sulfate Injection look like and contents of the pack

Vincristine Sulphate Injection is a colourless solution which comes in glass containers called vials.

Each Sterile lyophilized vial contains

Vincristine Sulfate USP 1 mg

Mannitol USP 100 mg

Sodium Hydroxide USNF q.s.

Sulfuric Acid USNF q.s.

It may be supplied in packs containing 5 x 5 mg/5 ml vials.

Manufactured in India by:

TAJ PHARMACEUTICALS LTD.

Mumbai, India

at SURVEY NO. 188/1, 190/1TO 4,

ATHIYAWAD , DABHEL, DAMAN- 396210

(INDIA)

Mfg. Lic. No: DD/xxxxxxx/2018-A

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Important Safety Information

“This preparation is for intravenous use only. It should be administered by individuals experienced in the administration of vincristine sulfate injection. The intrathecal administration of vincristine sulfate injection (vincristine sulfate) usually results in death. Syringes containing this product should be labeled, using the auxiliary sticker provided, to state “FATAL IF GIVEN INTRATHECALLY. FOR INTRAVENOUS USE ONLY.”
"Extemporaneously prepared syringes containing this product must be packaged in an overwrap which is labeled “DO NOT REMOVE COVERING UNTIL MOMENT OF INJECTION. FATAL IF GIVEN INTRATHECALLY. FOR INTRAVENOUS USE ONLY.”"
"Treatment of patients following intrathecal administration of vincristine sulfate injection has included immediate removal of spinal fluid and flushing with Lactated Ringer's, as well as other solutions and has not prevented ascending paralysis and death. In one case, progressive paralysis in an adult was arrested by the following treatment initiated immediately after the intrathecal injection:"
"1. As much spinal fluid was removed as could be safely done through lumbar access."
"2. The subarachnoid space was flushed with Lactated Ringer's solution infused continuously through a catheter in a cerebral lateral ventricle at the rate of 150 mL/h. The fluid was removed through a lumbar access."
"3. As soon as fresh frozen plasma became available, the fresh frozen plasma, 25 mL, diluted in 1 L of Lactated Ringer's solution was infused through the cerebral ventricular catheter at the rate of 75 mL/h with removal through the lumbar access. The rate of infusion was adjusted to maintain a protein level in the spinal fluid of 150 mg/dL."
"4. Glutamic acid, 10 g, was given intravenously over 24 hours followed by 500 mg 3 times daily by mouth for 1 month or until neurological dysfunction stabilized. The role of glutamic acid in this treatment is not certain and may not be essential."
"Pregnancy Category D - Vincristine sulfate can cause fetal harm when administered to a pregnant woman. When pregnant mice and hamsters were given doses of vincristine sulfate that caused resorption of 23% to 85% of fetuses, fetal malformations were produced in those that survived. Five monkeys were given single doses of vincristine sulfate between days 27 and 34 of their pregnancies; 3 of the fetuses were normal at term, and 2 viable fetuses had grossly evident malformations at term. In several animal species, vincristine sulfate can induce teratogenesis as well as embryo death at doses that are nontoxic to the pregnant animal. There are no adequate and well-controlled studies in pregnant women. If this drug is used during pregnancy or if the patient becomes pregnant while receiving this drug, she should be apprised of the potential hazard to the fetus. Women of child-bearing potential should be advised to avoid becoming pregnant."