Vinblastine !

A vinca alkaloid used in Hodgkin lymphoma and testicular cancer. Unlike vincristine, its main toxicity is low white cells; it is fatal if given into the spine.

Updated 2026-11-01

Class: Microtubule inhibitors
Target: β-tubulin (vinca site, at the junction between tubulin dimers)
ATC code: L01CA01
WHO Model List of Essential Medicines

β-tubulin (vinca site, at the junction between tubulin dimers)Vinblastine

The structure shows vinblastine bound to bovine tubulin at the vinca site, between two tubulin dimers.

Target in 3D: β-tubulin (vinca site, at the junction between tubulin dimers). PDB structure 5J2T (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Vinblastine binds tubulin at the vinca site and blocks microtubule assembly, so the mitotic spindle cannot form and cells arrest in metaphase. Compared with vincristine it affects the bone marrow more and the nerves less.

Vinblastine binds tubulin at the vinca site
Microtubules cannot assemble
Metaphase arrest: tumour and marrow cells die

Pharmacokinetics

Absorption: Intravenous only.
Metabolism: Liver, by CYP3A; toxicity rises in hepatic insufficiency.

Indications

Generalised Hodgkin lymphoma (part of the ABVD regimen) and other lymphomas.
Advanced testicular carcinoma, in combination. Testicular cancer →
Kaposi sarcoma, Langerhans-cell histiocytosis and mycosis fungoides.
Breast cancer unresponsive to other therapy, and resistant choriocarcinoma. Breast cancer →

Adverse effects

Common

Leukopenia (the dose-limiting effect)
Hair loss, mouth sores
Constipation, jaw pain and pain in tumour sites
Absent sperm (aspermia)

Contraindications

Significant granulocytopenia not caused by the disease being treated
Uncontrolled bacterial infection
Any route other than intravenous

Key interactions

CYP3A inhibitors (e.g. erythromycin): Earlier and more severe toxicity.
Phenytoin: Combinations with vinblastine have lowered phenytoin levels and increased seizures.
Mitomycin: Acute bronchospasm and breathlessness.
Bleomycin: Raynaud phenomenon has been reported with the combination.

What is monitored

White cell count just before each dose
Signs of infection while counts are low
Bowel function and neurological symptoms

Administration and safety

Intravenous use only: given intrathecally it is usually fatal. The bag is labelled «for intravenous use only – fatal if given by other routes».
Dispensed diluted in a flexible plastic container, which lowers the risk of a fatal wrong-route error.
Vesicant: if leakage occurs, the injection is stopped and the rest given in another vein; local hyaluronidase and moderate heat help disperse the drug.
Hazardous drug: prepared and given following hazardous-drug handling procedures (impervious gloves, no skin contact) and disposed of as cytotoxic waste.

Nursing care

Confirm the intravenous route with a second nurse; it is never brought to an intrathecal procedure.
Blood count before each cycle; fever with neutropenia is treated as an emergency.
Bowel regimen from the start (fluids, fibre, stool softeners); ask about stools every day and report abdominal pain or no bowel movement.
Teaching: report fever, chills, sore throat, bleeding or bruising at once.

Pregnancy and breastfeeding

Can cause fetal harm; pregnancy is avoided during treatment.

Test yourself

Think of the answer, then tap the question to see it.

What is the dose-limiting toxicity of vinblastine, in contrast to vincristine?

Leukopenia (bone-marrow suppression); vincristine is limited by neurotoxicity.

In which classic Hodgkin lymphoma regimen does vinblastine appear?

ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine).

Which test is obtained just before each vinblastine dose?

A white blood cell count.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: DailyMed - VINBLASTINE SULFATE injection (DailyMed (U.S. National Library of Medicine), 2025); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 70 (McGraw Hill, 2023); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); eEML - Electronic Essential Medicines List (World Health Organization, 2025).

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Representative model, for educational purposes only.