VINORELBINE TARTRATE

VINORELBINE TARTRATE
(vin-o-rel'been)
Navelbine
Classifications: antineoplastic agent; mitotic inhibitor;
Therapeutic: antineoplastic

Prototype: Vincristine
Pregnancy Category: D

Availability

10 mg/mL injection

Action

A semisynthetic vinca alkaloid with antineoplastic activity. Inhibits polymerization of tubules into microtubules, which disrupts mitotic spindle formation.

Therapeutic Effect

Arrests mitosis at metaphase, thereby inhibiting cell division in cancer cells.

Uses

Non-small cell lung cancer.

Unlabeled Uses

Breast cancer, ovarian cancer, Hodgkin's disease.

Contraindications

Hypersensitivity to vinorelbine, infection; severe bone marrow suppression; pregnancy (category D), lactation.

Cautious Use

Hypersensitivity to vincristine or vinblastine; leukopenia or other indicator(s) of bone marrow suppression; chickenpox or herpes zoster infection; hepatic insufficiency; pulmonary disease; preexisting neurological or neuromuscular disorders. Safety and efficacy in children are not established.

Route & Dosage

Non-Small Cell Lung Cancer, Breast Cancer
Adult: IV 30 mg/m2 weekly

Hepatic Impairment
Bilirubin 2.1–3 mg/dL: use 50% of dose; >3 mg/dL: use 25% of dose

Administration

Intravenous
  • Use caution to prevent contact with skin, mucous membranes, or eyes during preparation.

PREPARE: Direct: Dilute each 10 mg in a syringe with either 2 or 5 mL of D5W or NS to yield 3 mg/mL or 1.5 mg/L, respectively.  IV Infusion: Dilute the required dose in an IV bag with D5W, NS, or RL to a final concentration of 0.5–2 mg/mL (example: 10 mg diluted in 19 mL yields 0.5 mg/mL).  

ADMINISTER: IV Infusion: Give diluted solution over 6–10 min into the side port closest to an IV bag with free-flowing IV solution; follow by flushing with at least 75–125 mL of IV solution over 10 min. Take every precaution to avoid extravasation. If suspected, discontinue IV immediately and begin in a different site.  

INCOMPATIBILITIES Solution/additive: Acyclovir, aminophylline, amphotericin B, ampicillin, cefazolin, cefoperazone, ceforanide, cefotaxime, cefotetan, ceftazidime, ceftriaxone, cefuroxime, fluorouracil, furosemide, ganciclovir, methylprednisolone, mitomycin, piperacillin, sodium bicarbonate, thiotepa, trimethoprim–sulfamethoxazole. Y-site: Acyclovir, allopurinol, aminophylline, amphotericin B, amphotericin B cholesteryl complex, ampicillin, cefazolin, cefoperazone, cefotetan, ceftriaxone, cefuroxime, fluorouracil, furosemide, ganciclovir, methylprednisolone, mitomycin, piperacillin, sodium bicarbonate, thiotepa, trimethoprim-sulfamethoxazole.

  • Store at 2°–8° C (36°–46° F).

Adverse Effects (≥1%)

CNS: Decreased deep tendon reflexes, paresthesia, fatigue, asthenia, peripheral neuropathy, myalgia, jaw pain. Hematologic: Anemia, neutropenia, granulocytopenia, thrombocytopenia. GI: Paralytic ileus, constipation, nausea, vomiting, diarrhea, stomatitis, mucositis, hepatotoxicity (elevated LFT). Body as a Whole: Pain on injection, venous pain, thrombophlebitis, alopecia, myalgia, muscle weakness.

Interactions

Drug: Increased severity of granulocytopenia in combination with cisplatin; increased risk of acute pulmonary reactions in combination with mitomycin; paclitaxel may increase neuropathy.

Pharmacokinetics

Distribution: 60–80% bound to plasma proteins (including platelets and lymphocytes); sequestered in tissues, especially lung, spleen, liver, and kidney, and released slowly. Metabolism: In liver (CYP3A4). Elimination: Primarily in bile and feces (50%), 10% in urine. Half-Life: 42–45 h.

Nursing Implications

Assessment & Drug Effects

  • Withhold drug and notify physician if the granulocyte count is <1000 cells/mm3.
  • Montior for neurological dysfunction including parestheia, decreased deep tendon reflexes, weakness, constipation, and paralytic ileus.
  • Lab tests: Monitor CBC with differential throughout therapy and on the day of treatment prior to each infusion. Monitor kidney and liver functions, and serum electrolytes periodically.
  • Monitor for S&S of infection, especially during period of granulocyte nadir 7–10 d after dosing.

Patient & Family Education

  • Be aware of potential and inevitable adverse effects.
  • Women should use reliable forms of contraception to prevent pregnancy.
  • Notify physician of distressing adverse effects, especially symptoms of leukopenia (e.g., chills, fever, cough) and peripheral neuropathy (e.g., pain, numbness, tingling in extremities).
  • Report changes in bowel habits as soon as manifested.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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