PARALYTIC ILEUS AS A SIDE EFFECT OF VINCRISTINE AND ITRACONAZOLE TREATMENT

  • Samo Zver Klinični oddelek za hematologijo Klinični center Zaloška 7 1525 Ljubljana
  • Tadej Dovšak Klinični oddelek za hematologijo Klinični center Zaloška 7 1525 Ljubljana
Keywords: acute lymphoblastic leukemia, lymphoproliferative disease, vincristin, itrakonazole, paralytic ileus

Abstract

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.

Downloads

Download data is not yet available.

References

Hoelzer D. Acute lymphoblastic leukemia in adults. In: Hoffman R, Benz EJ, Shatil SJ. Hematology: basic principles and practice. 3rd ed. New York: Churchill Livingstone, 2000: 1089–105.

Bussel JB. Overview of idiopathic thrombocytopenic purpura: new approach to refractory patients. Semin Oncol 2000; 6 (Suppl 12): 91–8.

Ferrara F, Copia C, Annunziata M, Spasiano A, Di Grazia C, Palmieri S. Vincristine as salvage treatment for refractory thrombotic thrombocytopenic purpura. Ann Hematol 1999; 78: 521–6.

AMA Council report. Guidelines for handling of parenteral antineoplastics. JAMA 1985; 253: 1590–2.

Peltier AC, Russell JW. Recent advances in drug induced neuropathies. Curr Opin Neurol 2002; 15: 633–8.

Ikehara O. Vincristine-induced paralytic ileus: role of fiberoptic colonoscopy and prostaglandin F2 alpha. Am J Gastroenterol 1992; 87: 207–10.

Gillics J, Hung KA, Fitzsimmons E, Soutar R. Severe vincristine toxicity in combination with itraconazole. Clin Lab Haematol 1998; 20: 123–4.

Kamalluddin M, McNally P, Bretnach F, Webb D, O’Dell E, Scanlon P, Butler K, O’Meara A. Potentiation of vincristine toxicity by itraconazole in children with lymphoid malignancies. Acta Paediatr 2001; 90: 1204–7.

Gonzales FJ, Korzekwa KR. Cytochromes P450 expression systems. Ann Rev Pharmacol Toxicol 1995; 35: 369–90.

GlaxoSmithKline. Oncology prescribing guide. Montvale: Thomson medical economics, 2002: 456–649.

Rang HP, Dale MM, Ritter JM. Pharmacology. Edinbourgh, London, New York, Philadelphia, Sydney, Toronto. Churchill Livingstone, 1999: 416–26.

Zver S. Invazivne glivične okužbe – naše izkušnje pri diagnostiki in zdravljenju. Med Razgl 2000; 39 (Suppl 5): 213–20.

Morris G, Kokki MH, Anderson K, Richardson MD. Sampling of aspergillus spores in the air. J Hosp Infect 2000; 44: 81–92.

Prentice HG, Caillot D, Dupont B. Oral and intravenous itraconasol for systemic fungal infections in neutropenic haematological patients: meeting report. Acta Hematol 1999; 101: 56–62.

How to Cite
1.
Zver S, Dovšak T. PARALYTIC ILEUS AS A SIDE EFFECT OF VINCRISTINE AND ITRACONAZOLE TREATMENT. ZdravVestn [Internet]. 1 [cited 16Sep.2019];72(9). Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/1866
Section
Professional Article