vinorelbine

vinorelbine(vine-oh-rel-been) Navelbine

Classification vinorelbine

Therapeutic: antineoplastics
Pharmacologic: vinca alkaloids
Pregnancy Category D

Indications vinorelbine

Inoperable non–small-cell cancer of the lung in ambulatory patients (alone or with cisplatin).

Action of vinorelbine

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 of vinorelbine

Death of rapidly replicating cells, particularly malignant ones.

Pharmacokinetics vinorelbine

Absorption: IV administration results in complete bioavailability.

Distribution: Highly bound to platelets and lymphocytes.

Metabolism and Excretion: Mostlymetabolized by the liver. At least one metabolite is active. Large amounts eliminated in feces; 11% excreted unchanged by the kidneys.

Half-life: 28–44 hr.

Contraindications/Precautions of vinorelbine

Contraindicated in:

Hypersensitivity; Active infections;decrease bone marrow reserve; OB,

Lactation: Pregnancy or lactation.

Use Cautiously in

Impaired hepatic function (dose decrease recommended if total bilirubin 2 m g/dL);

Debilitated patients (increase risk of hyponatremia);

Granulocytopenic patients (temporarily

discontinue or reCanadian drug name. duce dose);

Pedi: Safety not established

OB: Instruct womenof childbearing potential to avoid pregnancy during treatment.

Adverse Reactions/Side Effects vinorelbine

CNS: fatigue .

Resp: shortness of breath.

CV: chest pain.

GI: constipation , nausea , abdominal pain, anorexia, diarrhea, transient increase in liver enzymes, vomiting.

Derm:alopecia , rashes. FandE:hyponatremia.

Hemat: anemia , neutropenia , thrombocytopenia.

Local: irritation at IV site, skin reactions, phlebitis.

MS: arthralgia, back pain, jaw pain, myalgia.

Neuro: neurotoxicity .

Misc: pain in tumor-containing tissue.

Interactions of vinorelbine

Drug-Drug:increase bone marrow depression with other antineoplastics or radiation therapy.

Concurrent use with cisplatin increase risk and severity of bone marrow depression..

Concurrent use with mitomycin or chest radiation increase 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.

NURSING IMPLICATIONS of vinorelbine

Assessment

Monitor BP, pulse, and respiratory rate during therapy. Note significant changes.
Acute shortness of breath and severe bronchospasm may occur infrequently shortly after administration.
Treatment with corticosteroids, bronchodilators, and supplemental oxygen may be required, especially in patients with a history of pulmonary disease.

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)

CNS dysfunction (decreased level of consciousness, agitation, hallucinations)

These symptoms may persist for months.
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.

Assess nutritional status. Mild to moderate nausea is common. An antiemetic may be used to minimize nausea and vomiting.

Monitor for symptoms of gout (increased uric acid, joint pain, edema).
Encourage patient to drink at least 2 L of fluid/day.

Allopurinol and alkalinization of urine may decrease uric acid levels.

Lab Test Considerations – Vinorelbine

CBC Monitoring
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.

Dose Adjustment
If granulocyte count is 1500/mm³, dose reduction or temporary interruption of vinorelbine may be warranted. If repeated episodes of fever and/or sepsis occur during granulocytopenia, future dose of vinorelbine should be modified.

Anemia and Thrombocytopenia
Vinorelbine may also cause mild to moderate anemia. Thrombocytopenia rarely occurs.

Liver Function Monitoring
Monitor liver function studies including:

AST (Aspartate Aminotransferase)

ALT (Alanine Aminotransferase)

LDH (Lactate Dehydrogenase)

Bilirubin

These should be checked prior to and periodically during therapy.

Renal Function Monitoring
Monitor renal function studies such as:

BUN (Blood Urea Nitrogen)

Creatinine

These tests help assess kidney health during treatment.

Uric Acid Monitoring
Vinorelbine may cause an increase in uric acid; monitor uric acid levels periodically during therapy.

Lab Potential Nursing Diagnoses

Risk for injury (Adverse Reactions)

Risk for infection

Safety Instructions and Administration of Vinorelbine

High Alert:

Fatalities have occurred with chemotherapeutic agents. Before administering vinorelbine, clarify all ambiguous orders. Double-check single, daily, and course-of-therapy dose limits. Have a second practitioner independently double-check the original order, dose calculations, and infusion pump settings.

Preparation and Handling:

Vinorelbine should be prepared in a biological safety cabinet.
Wear gloves, gown, and mask while handling the medication.
Dispose of intravenous (IV) equipment in specially designated containers.

Frequently assess the infusion site for redness, irritation, or inflammation. Vinorelbine is a vesicant, which means it can cause tissue damage if it leaks outside the vein. If extravasation occurs, stop the infusion immediately and restart the infusion at a different site to avoid damage to subcutaneous tissue.

Treatment of Extravasation:

Apply warm compresses over the affected area immediately for 30 to 60 minutes, then alternate on and off every 15 minutes for one day to increase systemic absorption of the drug.
Inject hyaluronidase 150 units diluted in 1 to 2 mL of 0.9% sodium chloride solution (1 mL for each milliliter extravasated) through the existing IV cannula or subcutaneously if the needle has been removed. This enhances absorption and dispersion of the extravasated drug.

Intravenous (IV) Administration of Vinorelbine

pH: 3.5

Direct IV Administration:

Diluent: Dilute vinorelbine with 0.9% sodium chloride solution (NaCl) or 5% dextrose in water (D5W).

Concentration: 1.5 to 3 mg/mL.

Rate: Infuse over 6 to 10 minutes into the Y-site closest to the bag of a free-flowing IV line or into a central line.

After administration, flush the vein with at least 75 to 125 mL of 0.9% NaCl or D5W, administered over 10 minutes or more.

Intermittent Infusion:

Diluent: Dilute vinorelbine with 0.9% NaCl, D5W, 0.45% NaCl, D5/0.45% NaCl, Ringer’s solution, or lactated Ringer’s injection.

The solution should be colorless to pale yellow. Do not administer solutions that are discolored or contain particulate matter.

The diluted solution is stable for 24 hours at room temperature.

Concentration: 0.5 to 2 mg/mL.

Rate: Infuse over 6 to 10 minutes (up to 30 minutes) into the Y-site closest to the bag of a free-flowing IV line or into a central line.

After administration, flush the vein with at least 75 to 125 mL of 0.9% NaCl or D5W, administered over 10 minutes or more.

Y-Site Compatibility: vinorelbine

amikacin, aztreonam, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, carboplatin, carmustine, cefotaxime, ceftazidime, chlorpromazine, cimetidine, cisplatin, clindamycin, cyclophosphamide, cytarabine, dacarbazine, dactinomycin, daunorubicin, dexamethasone sodium phosphate, diphenhydramine, doxorubicin, doxorubicin liposome, doxycycline, droperidol, enalaprilat, etoposide, famotidine, filgrastim, floxuridine, fluconazole, f ludarabine, gemcitabine, gentamicin, granisetron, haloperidol, hydrocortisone, hydromorphone, idarubicin, ifosfamide, imipenem/cilastatin, lorazepam, mannitol, mechlorethamine, melphalan, meperidine, mesna, methotrexate, metoclopramide, metronidazole, mitoxantrone, morphine, nalbuphine, ondansetron, oxaliplatin, potassium chloride, prochlorperazine, promethazine, ranitidine, streptozocin, teniposide, ticarcillin/clavulanate, tobramycin, vancomycin, vinblastine, vincristine, zidovudine.

Y-Site Incompatibility:

acyclovir, allopurinol, aminophylline, amphotericin B, amphotericin B cholesteryl sulfate, ampicillin, cefazolin, ceftriaxone, cefuroxime, fluorouracil, furosemide, ganciclovir, lansoprazole, methylprednisolone, mitomycin, sodium bicarbonate, thiotepa, trimethoprim/ sulfamethoxazole.

Patient/Family Teaching of vinorelbine

Instruct patient to report symptoms of neurotoxicity (paresthesia, pain, difficulty walking, persistent constipation).

Inform patient that increased fluid intake, dietary fiber, and exercise may minimize constipation. Stool softeners or laxatives may be necessary. Patient should be advised to report severe constipation or abdominal discomfort, as this may be a sign of ileus, which may occur as a consequence of neuropathy

Advise patient to notify health care professional if fever; chills; sore throat; signs of infection; bleeding gums; bruising; petechiae; blood in urine, stool, or emesis; or mouth sores occur.

Caution patient to avoid crowds and persons with known infections.

Advise patient that this medication may have teratogenic effects. Contraception should be used during and for at least 2 mo after therapy is concluded.

Discuss with patient the possibility of hair loss and explore coping strategies.

Instruct patient not to receive any vaccinations without advice of health care professional.

Emphasize the need for periodic lab tests to monitor for side effects.

Evaluation/Desired Outcomes of vinorelbine

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

Refe

Mayo Clinic - Vinorelbine

https://www.mayoclinic.org/drugs-supplements/vinorelbine-injection-route/description/drg-20067092

WebMD - Vinorelbine

https://www.webmd.com/drugs/2/drug-13001/vinorelbine-intravenous/details

Drugs.com - Vinorelbine

https://www.drugs.com/mtm/vinorelbine.html

National Cancer Institute (NCI) - Vinorelbine

https://www.cancer.gov/about-cancer/treatment/drugs/vinorelbine

MedlinePlus - Vinorelbine

https://medlineplus.gov/druginfo/meds/a693001.html

One1pharma

vinorelbine - Navelbine uses _side effects

Vinorelbine