Кроме того, винбластин может применяться при лечении хориокарциномы (после неэффективности других методов лечения) и рака молочной железы (после неэффективности других методов лечения)
Противопоказания
повышенная чувствительность к винбластину,
выраженное угнетение функции костного мозга,
беременность и период кормления грудью,
бактериальные и вирусные инфекции
С осторожностью: при предварительной или одновременной миелосупрессивной химиотерапии и лучевой терапии, а также в пожилом возрасте, при лейкопении, тромбоцитопении и поражении печени.
Применение при беременности и в период грудного вскармливания
Винбластин противопоказан к применению при беременности. В случае необходимости применения в период лактации следует прекратить грудное вскармливание.
При применении у женщин детородного возраста рекомендуется использовать надежные методы контрацепции.
В экспериментальных исследованиях установлен тератогенный эффект винбластина.
Способ применения и дозы
Устанавливают индивидуально, в зависимости от показаний и стадии заболевания, состояния системы кроветворения, схемы противоопухолевой терапии.
Побочное действие
Со стороны ЦНС и периферической нервной системы: невропатия, невриты периферических нервов, головная боль, депрессия, судороги.
Со стороны системы кроветворения: лейкопения, гранулоцитопения, тромбоцитопения, анемия.
Со стороны пищеварительной системы: анорексия, тошнота, рвота, боли в животе, паралитическая непроходимость кишечника, запор, диарея, язвенный стоматит, геморрагический энтероколит.
Со стороны сердечно-сосудистой системы: повышение АД, развитие инфаркта миокарда, нарушения мозгового кровообращения, усиление симптоматики болезни Рейно.
Со стороны дыхательной системы: острая дыхательная недостаточность, бронхоспазм.
Со стороны репродуктивной системы: азооспермия, аменорея.
Прочие: алопеция, боли в костях.
Взаимодействие с другими лекарственными средствами
При одновременном применении с ингибиторами активности изофермента CYP3A возможно более раннее появление и/или усугубление тяжести побочных эффектов винбластина.
При одновременном применении с винбластином возможно снижение концентрации фенитоина в плазме крови и уменьшение его противосудорожной активности, по-видимому, за счет уменьшения абсорбции, повышения скорости метаболизма и элиминации фенитоина.
При одновременном применении винбластина в высоких дозах с интерфероном альфа-n1 возможна тяжелая миелодепрессия.
Особые указания
С осторожностью применяют винбластин у пациентов с ветряной оспой (в т.ч. недавно перенесенной или после контакта с заболевшими), опоясывающим герпесом, другими острыми инфекционными заболеваниями, подагрой, нефролитиазом (в т.ч. в анамнезе). У пациентов с нарушением функции печени повышен риск возникновения токсических эффектов винбластина.
С осторожностью применять на фоне лечения препаратами, угнетающими активность изофермента CYP3A.
Максимальная депрессия кроветворения (в первую очередь снижение количества лейкоцитов в периферической крови) достигается через 5-10 дней после прекращения применения винбластина. Нормализация количества лейкоцитов в периферической крови отмечается через 7-14 дней. Развитие тромбоцитопении (менее 200 000/мкл) наиболее вероятно у пациентов, получавших предшествующую противоопухолевую или лучевую терапию. Нормализация числа тромбоцитов отмечается, как правило, через несколько дней после отмены винбластина.
Риск развития лейкопении при применении винбластина повышен у больных с кахексией и язвенными поражениями кожных покровов, поэтому пациентам с вышеуказанными состояниями его назначать не рекомендуют. У пациентов с метастазами в костный мозг выраженное снижение числа лейкоцитов и тромбоцитов было отмечено после применения винбластина в средних дозах. В этих случаях дальнейшее применение винбластина не показано.
В процессе терапии следует контролировать активность трансаминаз печени и ЛДГ, уровень билирубина и концентрацию мочевой кислоты в плазме крови.
В период лечения не рекомендуется проведение вакцинации пациентов и членов их семей.
Внутриоболочечное введение винбластина может привести к летальному исходу. При случайном попадании в глаза может возникнуть сильное воспаление.
Условия хранения
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