Vinblastine sulfate (velban, others) is given intravenously; special precautions must be taken against subcutaneous extravasation, since this may cause painful ulceration. The drug should not be injected into an extremity with impaired circulation. After a single dose of 0.3 mg/kg of body weight, myelosuppression reaches its maximum in 7-10 days. If a moderate level of leukopenia (~3000 cells/mm3) is not attained, the weekly dose may be increased gradually by increments of 0.05 mg/kg. In regimens designed to cure testicular cancer, vinblastine is used in doses of 0.3 mg/kg every 3 weeks.

The most important clinical use of vinblastine is with bleomycin and cisplatin (see below) in the curative therapy of metastatic testicular tumors, although it has been supplanted by etoposide or ifosfamide in this disease. It is a component of the standard curative ABVD regimen for Hodgkin's disease (adriamycin, bleomycin, vinblastine, and dacarbazine). It also is active in Kaposi's sarcoma, neuroblastoma, and histiocytosis X, and in carcinoma of the breast and choriocarcinoma.

The nadir of the leukopenia that follows the administration of vinblastine usually occurs within 7-10 days, after which recovery ensues within 7 days. Other toxic effects of include neurological manifestations as described above. GI disturbances including nausea, vomiting, anorexia, and diarrhea may be encountered. The syndrome of inappropriate secretion of antidi-uretic hormone has been reported. Loss of hair, stomatitis, and dermatitis occur infrequently. Extravasation during injection may lead to cellulitis and phlebitis. Local injection of hyaluronidase and application of moderate heat to the area may be of help by dispersing the drug.

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