1. Aschenbrenner, Diane S. MS, RN


* The labeling for vinca alkaloid chemotherapy drugs is being revised to remove instructions for their administration with use of a syringe. This revision is in response to inadvertent intrathecal administration of vinca alkaloids, which is normally fatal.



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Vinca alkaloid chemotherapeutic drugs, such as vincristine sulfate, vinblastine sulfate, and vinorelbine tartrate, are well known to have neurologic adverse effects, even when administered correctly. These neuromuscular effects include sensory impairment, cranial nerve manifestations (including paralysis of muscles controlled by these nerves), pain, blindness, vestibular and auditory damage, pain, and convulsions. There is no antidote for neurologic adverse effects. Because of their high level of neurotoxicity, accidental intrathecal administration of vinca alkaloids is usually fatal. Those who have inadvertently received vinca alkaloids intrathecally have experienced intense, progressive myeloencephalopathy; paralysis of limbs and respiratory muscles; loss of deep tendon reflexes; autonomic instability (with hypertension, tachycardia, and excessive sweating); coma; and death.1 The deaths suffered by victims of this medication error are painful.2


Accidental use of the wrong route of administration for vinca alkaloids can occur when a syringe is used. Although the Food and Drug Administration (FDA) added a warning to vinca alkaloids' labeling to administer these drugs only intravenously, the label has included instructions on administration using a syringe. As of March 2019, a total of 135 deaths had occurred worldwide from inadvertent intrathecal administration of vinca alkaloids, four in the preceding three months, prompting the Institute for Safe Medication Practices to call on the FDA to further revise the labeling.2 The FDA has now acted on that recommendation and is removing these instructions from vinca alkaloid drug labels, only listing administration via intravenous infusion bags.


Nurses should ensure that they follow best practices for administering these and other potentially toxic drugs to prevent medication errors.


To read the FDA News Release alerting providers to the labeling changes regarding vinca alkaloids, go to




1. Saha AS, et al Clinical presentation of inadvertent intrathecal vincristine masquerading Guillain-Barre Syndrome. Indian J Hematol Blood Transfus 2016;32(Suppl 1):59-61. [Context Link]


2. Institute for Safe Medication Practices. ISMP calls on FDA-no more syringes for vinca alkaloids! ISMP Medication Safety Alert! Acute Care 2019;24(5). [Context Link]