PARALYTIC ILEUS AS A SIDE EFFECT OF VINCRISTINE AND ITRACONAZOLE TREATMENT
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.
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.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.