PARALYTIC ILEUS AS A SIDE EFFECT OF VINCRISTINE AND ITRACONAZOLE TREATMENT
Keywords:
acute lymphoblastic leukemia, lymphoproliferative disease, vincristin, itrakonazole, paralytic ileusAbstract
Background. Vincristin is an important and frequently used chemoterapeutic drug in the treatment of malignant lymphoproliferative disease. Among its side effects are well known bone marrow supression and polyneuropathia. But common physicians are not familiar with vincristine bowel peristaltics inhibitory effect.
Patient and methods. This study presents 64-years old patient with acute lymphoblastic leukemia (ALL) who was treated with chemotherapy which included vincristine. Two weeks after the treatment started paralytic ileus developed which was later sucessfully treated with laxatives and prokynetic drugs. Secondary causes for ileus development were excluded. Literature data was reviewed and a higher incidence of paralytic ileus in vincristine treated patients was found, especially when they are given concomitant itraconazole. Our patient received concommitant itraconazole as a part of antifungal prophylaxis against invasive aspergillosis which is a perceived routine on hematological departments.
Conclusions. Vincristine treated patients should be carefully observed regarding bowel peristaltics and obstipation. If obstipation or even paralytic ileus developes, we must stop vincristine therapy. All patients receiving vincristine must receive fluconazol instead of itraconazol as a part of antifungal prophylaxis.
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