Vincristine is associated with which of the following adverse effects?

• A. Cardiac toxicity
• B. Nephrotoxicity
• C. Hepatotoxicity
• D. Peripheral neuropathies

Answer: (D)

Vincristine’s hallmark adverse effect is peripheral neuropathy. As a vinca alkaloid, it inhibits tubulin polymerization, blocking mitosis. In neurons, microtubules are essential for axonal transport, so disrupting them leads to distal axonal degeneration and neuropathy. Clinically this presents with sensory and motor symptoms such as numbness, paresthesias, weakness, decreased reflexes, and autonomic signs like constipation or ileus. Cardiac toxicity and nephrotoxicity are more characteristic of other drugs (cardiac toxicity with some anthracyclines; nephrotoxicity with platinum agents), and hepatotoxicity is not the primary concern with vincristine.