vinorelbine

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

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.

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.

Availability ⬆ ⬇

(Generic available)

Solution for injection: 10 mg/mL

Assessment ⬆ ⬇

Monitor BP, HR, and respiratory rate during therapy. If acute shortness of breath and severe bronchospasm occur, treat with corticosteroid, bronchodilator, and supplemental oxygen as clinically indicated.
Assess frequently for signs of infection (sore throat, temperature, cough, mental status changes), especially when nadir of granulocytopenia is expected.
Monitor neurologic status. Assess for paresthesia (numbness, tingling, pain), loss of deep tendon reflexes (Achilles reflex is usually first involved), weakness (wrist drop or footdrop, gait disturbances), cranial nerve palsies (jaw pain, hoarseness, ptosis, visual changes), autonomic dysfunction (constipation, ileus, difficulty voiding, orthostatic hypotension, impaired sweating), and CNS dysfunction (↓ level of consciousness, agitation, hallucinations). The incidence of neurotoxicity associated with vinorelbine is less than that of other vinca alkaloids.
Monitor intake and output and daily weight for significant discrepancies. If ↓ urine output with hyponatremia occurs, it may indicate SIADH and usually responds to fluid restriction.
Assess nutritional status. If nausea or vomiting occurs, use an antiemetic to minimize symptoms.
Monitor for signs/symptoms of gout (↑ uric acid, joint pain, edema). Encourage patient to drink ≥2 liters of fluid per day. Allopurinol or alkalinization of urine may be used to ↓ uric acid levels.

Lab Test Considerations:

Monitor CBC prior to each dose and routinely during therapy. The nadir of granulocytopenia usually occurs 7–10 days after vinorelbine administration, and recovery usually follows within 7–15 days. If granulocytes <1500 cells/mm³,↓ dose or hold vinorelbine. If repeated fevers and/or sepsis occur during granulocytopenia, modify future dose of vinorelbine. May also cause mild to moderate anemia. Thrombocytopenia rarely occurs.
- Monitor liver function (AST, ALT, LDH, bilirubin) and renal function (BUN, serum creatinine) before starting and periodically during therapy. May ↑ uric acid; monitor periodically during therapy.

Implementation ⬆ ⬇

High Alert: Fatalities have occurred with chemotherapeutic agents. Before administering, clarify all ambiguous orders; double-check single, daily, and course-of-therapy dose limits; have second practitioner independently double-check original order, dose calculations, and infusion pump settings.
Solution should be prepared in a biologic cabinet. Wear gloves, gown, and mask while handling medication. Discard IV equipment in specially designated containers.

IV Administration:

Vesicant: Vinorelbine is a vesicant. If extravasation occurs, immediately stop infusion. Leave needle/cannula in place temporarily but do not flush the line. Gently aspirate extravasated solution; then remove needle/cannula. Elevate patient’s extremity and apply dry warm compresses for 20 min 4 times day for 1–2 days. Initiate hyaluronidase antidote by injecting 1–6 mL (150 units/mL) into existing IV line; usual dose is 1 mL for each 1 mL of extravasated drug. If needle/cannula has been removed, inject SUBQ in a clockwise manner around area of extravasation, or administer 1 mL as five separate 0.2-mL injections SUBQ into extravasation site; may repeat several times over next 3–4 hr.
IV Push: Diluent: Dilute vinorelbine with 0.9% NaCl or D5W. Concentration: 1.5–3 mg/mL.
Intermittent Infusion: Diluent: Dilute vinorelbine with 0.9% NaCl, D5W, 0.45% NaCl, D5/0.45% NaCl, Ringer’s, or lactated Ringer’s injection. Solution should be colorless to pale yellow. Do not administer if discolored or contains particulates. Diluted solution is stable for 24 hr at room temperature. Concentration: 0.5–2 mg/mL.
Y-Site Compatibility:
- amikacin
- amiodarone
- anidulafungin
- argatroban
- arsenic trioxide
- atracurium
- aztreonam
- bleomycin
- bumetanide
- buprenorphine
- butorphanol
- calcium chloride
- calcium gluconate
- carboplatin
- carmustine
- caspofungin
- cefotaxime
- ceftazidime
- chlorpromazine
- ciprofloxacin
- cisatracurium
- cisplatin
- clindamycin
- cyclophosphamide
- cyclosporine
- cytarabine
- dacarbazine
- dactinomycin
- daptomycin
- daunorubicin hydrochloride
- dexamethasone
- dexmedetomidine
- dexrazoxane
- digoxin
- diltiazem
- diphenhydramine
- dobutamine
- docetaxel
- dopamine
- doxorubicin hydrochloride
- doxorubicin liposomal
- doxycycline
- droperidol
- enalaprilat
- ephedrine
- epinephrine
- epirubicin
- ertapenem
- erythromycin
- etoposide
- etoposide phosphate
- famotidine
- fentanyl
- filgrastim
- floxuridine
- fluconazole
- fludarabine
- fosphenytoin
- gemcitabine
- gentamicin
- glycopyrrolate
- granisetron
- haloperidol
- hydralazine
- hydrocortisone
- hydromorphone
- idarubicin
- ifosfamide
- imipenem/cilastatin
- insulin, regular
- irinotecan
- isoproterenol
- labetalol
- leucovorin
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- meropenem
- mesna
- methadone
- methotrexate
- metoclopramide
- metoprolol
- metronidazole
- midazolam
- milrinone
- mitoxantrone
- morphine
- moxifloxacin
- nalbuphine
- naloxone
- nitroglycerin
- norepinephrine
- octreotide
- ondansetron
- oxaliplatin
- paclitaxel
- palonosetron
- pamidronate
- pemetrexed
- pentamidine
- phentolamine
- phenylephrine
- plicamycin
- potassium acetate
- potassium chloride
- potassium phosphates
- procainamide
- prochlorperazine
- promethazine
- propranolol
- rituximab
- sodium acetate
- sodium phosphates
- succinylcholine
- sufentanil
- tacrolimus
- theophylline
- tigecycline
- tirofiban
- tobramycin
- topotecan
- trastuzumab
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- voriconazole
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- acyclovir
- allopurinol
- aminophylline
- amphotericin B deoxycholate
- amphotericin B liposomal
- ampicillin
- cefazolin
- cefepime
- cefotetan
- cefoxitin
- ceftriaxone
- cefuroxime
- dantrolene
- diazepam
- fluorouracil
- foscarnet
- furosemide
- ganciclovir
- ketorolac
- methohexital
- methylprednisolone
- mitomycin
- nafcillin
- nitroprusside
- pantoprazole
- phenobarbital
- phenytoin
- piperacillin/tazobactam
- sodium bicarbonate
- trimethoprim/sulfamethoxazole

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.

Evaluation/Desired Outcomes ⬆ ⬇

Decrease in size or spread of malignancy without detrimental side effects.

US Brand Names ⬆ ⬇

Code ⬆

NDC Code

25021- Sagent Pharmaceuticals
- 25021-204- Vinorelbine
  - 25021-204-01- 1 VIAL in 1 CARTON (25021-204-01) / 1 mL in 1 VIAL

25021- Sagent Pharmaceuticals
- 25021-204- Vinorelbine
  - 25021-204-05- 1 VIAL in 1 CARTON (25021-204-05) / 5 mL in 1 VIAL

45963- Actavis Pharma, Inc.
- 45963-607- Vinorelbine
  - 45963-607-55- 1 VIAL, SINGLE-DOSE in 1 CARTON (45963-607-55) / 1 mL in 1 VIAL, SINGLE-DOSE

45963- Actavis Pharma, Inc.
- 45963-607- Vinorelbine
  - 45963-607-56- 1 VIAL, SINGLE-DOSE in 1 CARTON (45963-607-56) / 5 mL in 1 VIAL, SINGLE-DOSE

62158- Hubei Honch Pharmaceutical Co., Ltd.
- 62158-0001-
  - 62158-0001-1- 500 g in 1 BAG (62158-0001-1)

66529- Jiangsu Hansoh Pharmaceutical Group Co., Ltd.
- 66529-0001-
  - 66529-0001-1- 500 g in 1 BAG (66529-0001-1)

66529- Jiangsu Hansoh Pharmaceutical Group Co., Ltd.
- 66529-0012-
  - 66529-0012-1- 1400 g in 1 BOTTLE (66529-0012-1)

69910- Minakem High Potent SA
- 69910-0004-
  69910-0004-0- 1200 g in 1 CONTAINER (69910-0004-0)

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇