vinorelbine

Contraindicated in:

Hypersensitivity;
Active infection;
↓bone marrow reserve;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Hepatic impairment (↓ dose if total bilirubin >2 mg/dL);
Debilitated patients (↑ risk of hyponatremia);
Granulocytopenia (temporarily discontinue or ↓ dose);
Rep: Women of reproductive potential;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

CV: chest pain

Derm: alopecia, rash

F and E: hyponatremia

GI: constipation, nausea, ↑liver enzymes, abdominal pain, anorexia, diarrhea, vomiting

Hemat: anemia, neutropenia, THROMBOCYTOPENIA

Local: irritation (at IV site), phlebitis

MS: arthralgia, back pain, jaw pain, myalgia

Neuro: fatigue, neurotoxicity

Resp: shortness of breath

Interactions ⬆ ⬇

Drug-drug:

↑bone marrow depression with other antineoplastics or radiation therapy.
Cisplatin↑ risk and severity of bone marrow depression.
Mitomycin or chest radiation↑ risk of pulmonary reactions.

Availability ⬆ ⬇

(Generic available)

Solution for injection: 10 mg/mL

Route/Dosage ⬆ ⬇

IV (Adults ): 30 mg/m² once weekly.

Hepatic Impairment

IV (Adults ): Total bilirubin 2.1–3 mg/dL: 15 mg/m² once weekly; Total bilirubin ≥3 mg/dL: 7.5 mg/m² once weekly.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Binds to a protein (tubulin) of cellular microtubules, where it interferes with microtubule assembly. Cell replication is stopped as a result (cell cycle-specific for M phase).

Therapeutic effects:

Death of rapidly replicating cells, particularly malignant ones.

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: vinca alkaloids

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Highly bound to platelets and lymphocytes.

Metabolism/Excretion: Mostly metabolized by the liver. ≥1 metabolite is active. Large amounts eliminated in feces; 11% excreted unchanged by the kidneys.

Half-Life: 28–44 hr.

Time/Action Profile ⬆ ⬇

( effect on WBCs)

ROUTE		ONSET		PEAK		DURATION
IV		unknown		7–10 days		7–15 days

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Instruct patient to notify health care provider immediately if redness, swelling, or pain at injection site occurs.
Instruct patient to report symptoms of neurotoxicity (numbness and tingling, pain, difficulty walking, persistent or severe constipation, abdominal pain). Advise patient to ↑ fluid intake, dietary fiber, and exercise to minimize constipation; stool softeners or laxatives may be used.
Advise patient to notify health care provider of signs and symptoms of urinary retention (difficulty urinating, weak stream, abdominal pain).
Advise patient to notify health care provider of fever; chills; sore throat; signs of infection; bleeding gums; bruising; petechiae; blood in urine, stool, or emesis; or mouth sores. Caution patient to avoid crowds and persons with known infections.
Discuss with patient the possibility of hair loss and explore coping strategies.
Emphasize the need for periodic lab tests to monitor for side effects.
Instruct patient not to receive any vaccinations without advice of health care provider.
Rep: May cause fetal harm. Advise women of reproductive potential to use effective contraception during therapy and ≥2 mo after last dose and to avoid breastfeeding during and for 9 days after last dose.

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Indications ⬇

Contraind./Precautions ⬆ ⬇