Nurses Compass
Drug Guide
Vorinostat
Classification
Therapeutic: Antineoplastic agent
Pharmacological: Histone deacetylase inhibitor
FDA Approved Indications
- Cutaneous manifestations of cutaneous T-cell lymphoma (CTCL) in patients with persistent, recurrent, or progressive disease after prior systemic therapies
Mechanism of Action
Vorinostat inhibits histone deacetylases (HDACs), leading to an accumulation of acetylated histones and other proteins, which results in an open chromatin structure and modulation of gene expression, ultimately inducing cell cycle arrest, apoptosis, and differentiation in cancer cells.
Dosage and Administration
Adult: 400 mg orally once daily with or without food, in 14-day cycles (14 days on, 14 days off).
Pediatric: Not approved for pediatric use.
Geriatric: No specific dosage adjustment based solely on age, but caution in elderly with comorbidities.
Renal Impairment: Use with caution; no specific dose adjustment recommended.
Hepatic Impairment: No specific recommendations; use caution.
Pharmacokinetics
Absorption: Well absorbed orally.
Distribution: Widely distributed, crosses blood-brain barrier.
Metabolism: Primarily metabolized in the liver via glucuronidation and hydrolysis.
Excretion: Excreted mainly in feces and urine.
Half Life: approximately 2 hours.
Contraindications
- Hypersensitivity to vorinostat or any component of the formulation.
Precautions
- Use with caution in patients with bleeding disorders, thrombocytopenia, leukopenia, or impaired hepatic function. Monitor blood counts regularly.
Adverse Reactions - Common
- Fatigue (Common)
- Diarrhea (Common)
- Nausea (Common)
- Muscle weakness (Common)
Adverse Reactions - Serious
- Serious infections (Less common)
- Thrombocytopenia and leukopenia leading to bleeding or infection risk (Less common)
- QT prolongation and cardiac arrhythmias (Less common)
- Pulmonary embolism (Rare)
Drug-Drug Interactions
- Anticoagulants (e.g., warfarin), drugs affecting blood counts, QT-prolonging agents.
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor complete blood counts (CBC), liver function tests, and for signs of bleeding, infection, or cardiac arrhythmias.
Diagnoses:
- Risk for bleeding, Infection, Fatigue related to medication effects.
Implementation: Administer as prescribed, monitor labs regularly, educate patient about signs of side effects.
Evaluation: Assess for therapeutic response and adverse effects, ensure labs remain within safe ranges.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Report signs of infection, unusual bleeding, fatigue, or cardiac symptoms.
- Avoid excessive sun exposure and inform about potential side effects.
Special Considerations
Black Box Warnings:
- Myelosuppression (neutropenia, thrombocytopenia, anemia).
- Potential for severe and fatal infections.
Genetic Factors: None specifically identified.
Lab Test Interference: None.
Overdose Management
Signs/Symptoms: Severe thrombocytopenia, neutropenia, infections, bleeding, arrhythmias.
Treatment: Supportive care, including blood product transfusions if needed, monitor cardiac status, and provide symptomatic management.
Storage and Handling
Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).
Stability: Stable when stored properly; check expiration date before use.