Home Drug Guide Vinorelbine Tartrate

Drug Guide

Generic Name

Vinorelbine Tartrate

Brand Names Navelbine

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Vinca alkaloid

FDA Approved Indications

Non-small cell lung cancer (NSCLC)
Breast cancer (adjuvant and metastatic)

Mechanism of Action

Vinorelbine inhibits microtubule polymerization by binding to tubulin, disrupting mitotic spindle formation, thereby arresting cell division in metaphase and inducing apoptosis.

Dosage and Administration

Adult: Typically 25 mg/m^2 IV on days 1 and 8 of a 21-day cycle, but regimens vary based on indication and patient response.

Pediatric: Use is investigational; dosing based on body surface area with close monitoring.

Geriatric: Adjustments based on renal and hepatic function; monitor closely due to increased sensitivity.

Renal Impairment: Use with caution; may require dose adjustment based on degree of impairment.

Hepatic Impairment: Reduce dose in patients with hepatic dysfunction due to decreased metabolism.

Pharmacokinetics

Absorption: Administered intravenously; no oral absorption.

Distribution: Widely distributed, crosses the blood-brain barrier.

Metabolism: Metabolized in the liver via CYP3A4 enzymes.

Excretion: Excreted primarily in feces; small amount in urine.

Half Life: Approximately 40-50 hours.

Contraindications

Hypersensitivity to vinorelbine or other vinca alkaloids.
Severe myelosuppression.
Pregnancy (category D).

Precautions

Monitor blood counts regularly.
Assess hepatic and renal function before and during treatment.
Use caution in patients with infections or other comorbidities.

Adverse Reactions - Common

Myelosuppression (neutropenia, thrombocytopenia, anemia) (Very common)
Nausea and vomiting (Common)
Alopecia (Common)
Peripheral neuropathy (Uncommon)

Adverse Reactions - Serious

Severe neutropenia leading to infection (Possible)
Thrombocytopenia leading to bleeding (Possible)
Severe hypersensitivity reactions (Rare)

Drug-Drug Interactions

CYP3A4 inhibitors (azole antifungals, macrolides) increase vinorelbine levels.
CYP3A4 inducers (rifampin, carbamazepine) decrease efficacy.

Drug-Food Interactions

Grapefruit juice may increase plasma levels.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood counts frequently, especially ANC.

Diagnoses:

Risk for infection due to myelosuppression.
Risk for bleeding due to thrombocytopenia.

Implementation: Administer IV as scheduled, monitor for signs of infection, bleeding, and peripheral neuropathy.

Evaluation: Assess blood counts, neurological status, and patient response to therapy.

Patient/Family Teaching

Report any signs of infection, unusual bleeding, or severe neuropathy.
Follow instructions for managing side effects.
Avoid live vaccines during therapy.

Special Considerations

Black Box Warnings:

Severe neutropenia leading to infection and death. Cannot be used in pregnancy due to teratogenicity.

Genetic Factors: CYP3A4 genetic polymorphisms can affect metabolism.

Lab Test Interference: May cause falsely low serum cholinesterase levels.

Overdose Management

Signs/Symptoms: Severe myelosuppression, neurotoxicity.

Treatment: Supportive care including growth factor support, blood and platelet transfusions, symptomatic management.

Storage and Handling

Storage: Store vials under refrigeration at 2-8°C.

Stability: Stable for specified period per manufacturer instructions.