Vincristine/Strong CYP3A4 Inhibitors Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Your medicine may slow down how quickly your body processes your cancer medicine.

What might happen:

The amount of cancer medicine in your blood may increase and cause more side effects than expected and some expected side effects to be more severe.

What you should do about this interaction:

Make sure your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. Your doctor may want to change your medicine or the timing of your cancer medicine.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

View Reference
  • 1.Marqibo (vincristine sulfate) US prescribing information. Talon Therapeutics, Inc July, 2020.
  • 2.Kaletra (lopinavir/ritonavir tablets) US prescribing information. Abbott Laboratories December, 2019.
  • 3.US Food and Drug Administration (FDA). Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers. Available at: https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and- drug-interactions-table-substrates-inhibitors-and-inducers. Updated 11/14/2017.
  • 4.This information is based on an extract from the Certara Drug Interaction Database (DIDB) Platform, Copyright Certara 1999-2023..
  • 5.Moriyama B, Henning SA, Leung J, Falade-Nwulia O, Jarosinski P, Penzak SR, Walsh TJ. Adverse interactions between antifungal azoles and vincristine: review and analysis of cases. Mycoses 2012 Jul;55(4):290-7.
  • 6.Takahashi N, Kameoka Y, Yamanaka Y, Ubukawa K, Saito K, Fujishima M, Fujishima N, Saito H, Hirokawa M, Scott SA, Sawada K. Itraconazole oral solution enhanced vincristine neurotoxicity in five patients with malignant lymphoma. Intern Med 2008;47(7):651-3.
  • 7.Pana ZD, Roilides E. Risk of azole-enhanced vincristine neurotoxicity in pediatric patients with hematological malignancies: old problem - new dilemma. Pediatr Blood Cancer 2011 Jul 15;57(1):30-5.
  • 8.Jain S, Kapoor G. Severe life threatening neurotoxicity in a child with acute lymphoblastic leukemia receiving posaconazole and vincristine. Pediatr Blood Cancer 2010 May;54(5):783.
  • 9.Leveque D, Santucci R, Pavillet J, Herbrecht R, Bergerat JP. Paralytic ileus possibly associated with interaction between ritonavir/lopinavir and vincristine. Pharm World Sci 2009 Dec;31(6):619-21.
  • 10.Harnicar S, Adel N, Jurcic J. Modification of vincristine dosing during concomitant azole therapy in adult acute lymphoblastic leukemia patients. J Oncol Pharm Pract 2009 Sep;15(3):175-82.
  • 11.Porter CC, Carver AE, Albano EA. Vincristine induced peripheral neuropathy potentiated by voriconazole in a patient with previously undiagnosed CMT1X. Pediatr Blood Cancer 2009 Feb;52(2):298-300.
  • 12.Ariffin H, Omar KZ, Ang EL, Shekhar K. Severe vincristine neurotoxicity with concomitant use of itraconazole. J Paediatr Child Health 2003 Nov; 39(8):638-9.
  • 13.Sathiapalan RK, El-Solh H. Enhanced vincristine neurotoxicity from drug interactions: case report and review of literature. Pediatr Hematol Oncol 2001 Dec;18(8):543-6.
  • 14.Jeng MR, Feusner J. Itraconazole-enhanced vincristine neurotoxicity in a child with acute lymphoblastic leukemia. Pediatr Hematol Oncol 2001 Mar; 18(2):137-42.
  • 15.Gillies J, Hung KA, Fitzsimons E, Soutar R. Severe vincristine toxicity in combination with itraconazole. Clin Lab Haematol 1998 Apr;20(2):123-4.
  • 16.Murphy JA, Ross LM, Gibson BE. Vincristine toxicity in five children with acute lymphoblastic leukaemia. Lancet 1995 Aug 12;346(8972):443.
  • 17.Kobayashi R, Suzuki D, Yasuda K, Kobayashi K. Itraconazole for invasive fungal infection with pediatric malignancies. Pediatr Int 2010 Oct; 52(5):707-10.
  • 18.Whittle AM, Ali S. Primary prophylaxis with voriconazole in patients receiving induction chemotherapy on the MRC adult acute lymphoblastic leukaemia trial (UK-ALL XII) to avoid itraconazole-enhanced vinca neurotoxicity. Int J Lab Hematol 2008 Apr;30(2):173-4.
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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.