Vinorelbine (Intravenous)

Vinorelbine is one of the antineoplastic group of drugs and is used to treat mesothelioma (cancer of the outer covering of the lungs), non-small-cell lung cancer, ovarian cancer, Hodgkin's disease and advanced breast cancer by the action of stopping the division process that cells undergo called mitosis.

Overview

Given by injection in an IV directly to the veins of cancer patients, Vinorelbine is used for the treatment of non-small-cell lung cancer, mesothelioma (cancer of the outer covering of the lungs) as well as occasionally used for ovarian cancer, advanced breast cancer, and Hodgkin's disease as determined by the specialist treating physician. Vinorelbine may be used in conjunction with other cancer drugs as recommended by healthcare professionals.

When used for breast cancer, Vinorelbine is typically relied upon when chemotherapy regimen has failed to make the cancer respond or when a relapse has occurred. In non-small-cell lung cancer, Vinorelbine is called upon as the first-line treatment especially when the cancer is in an advanced stage of development.

How does it work?

Cancer is the result of cells multiplying in an abnormal, uncontrollable way. Normal cells stop dividing when they come in contact with cells like themselves; cancerous cells no longer have this ability and grow uncontrollably. The cancerous cells spread and destroy tissues in their path if not stopped. Vinorelbine stops the multiplication of these mutant cells with an active chemotherapy ingredient.

Healthy, normal cells divide and change in a continuous process as do cancerous cells. Each cell divides into two daughter cells that grow and divide again. Vinorelbine uses chemicals to interrupt this division cycle and stop the cells from multiplying and spreading. Called vinca alkaloids, drugs like Vinorelbine work by stopping the cancerous cells from getting to the life cycle stage of division (known as mitosis).

Unfortunately, Vinorelbine also stops the mitosis of healthy, normal cells and especially targets those that multiply quickly such as those cells found in hair and blood cells. Though this leads to unfortunate risks and worrisome side effects, the benefits of stopping aggressive forms of cancer using Vinorelbine are obvious and, for the most part, worth the risk.

Tests during treatment

Blood tests will be taken from patients prior to starting Vinorelbine and follow up tests are taken throughout the treatment regime. Levels of blood platelets, as well as white blood cell counts, are taken and the effectiveness of your liver and kidneys are also monitored.

Conditions Treated

  • Mesothelioma
  • non-small-cell lung cancer
  • ovarian cancer
  • breast cancer
  • Hodgkin's disease

Type of medicine

  • Chemotherapy

Side Effects

Side effects of Vinorelbine are those that directly affect or cause interference with the growth and division of cells, particularly those that are fast growing such as blood cells and hair cells. Most commonly, the side effects of Vinorelbine include:

  • Tiredness
  • Weakness
  • Hair loss
  • Low blood platelet count
  • Constipation
  • Appetite loss
  • Nausea and vomiting
  • Low resistance to infection

It is important to remember that not all patients experience all or any of the side effects that are possible on Vinorelbine. With that in mind, patients rarely reported are the following side effects:

  • Pain at the medication site
  • Numbness in fingers and toes
  • Diarrhea
  • Unusual bleeding or bruising
  • Black, tarry stools or blood in urine
  • Mouth sores
  • Hypersensitivity to cold
  • Problems with balance

If you experience any of the following side effects while on Vinorelbine, you should immediately report them to your healthcare provider as they could be signs of serious health issues:

  • Fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher
  • Chills
  • Other signs of infection

There are self-care steps you can take to provide some relief of side effects. If you experience pain, redness or swelling at the IV site, apply a warm compress and notify your healthcare provider. Keep your bowels moving by drinking plenty of fluids, especially water. Wash your hands often and avoid contact with those who have cold or flu symptoms. Avoid activities that could cause injury or bruising.

Dosage

Doses of Vinorelbine will be different depending on the patient and their vital statistics as well as the type of cancer that they have and the stage of which it has spread. As Vinorelbine is only administered by a physician, you will be monitored carefully as to the effectiveness of the drug on the cancer you have as well as your side effects.

Typical recommended dosage of Vinorelbine as a single agent is 30 milligrams infused over 6 to 10 minutes once per week. When used in combination with the chemotherapy drug Cisplatin, different infusions are recommended as per doctor instruction. In combination with Cisplatin 100 milligrams, the dose of Vinorelbine is 25 milligrams over 6 to 10 minutes on days 1, 8, 15 and 21 of a 28-day cycle. In combination with Cisplatin 120 milligrams, the recommended dose of Vinorelbine is 30 milligrams over 6 to 10 minutes once per week in a combination on days 1 and 29 then every 6 weeks.

Oral formulation of Vinorelbine is available in some European countries but has not been approved for use in the US or Australia. The cautions with taking this drug in oral form include not taking it with hot beverages, not sucking or chewing on the tablets and following all instructions provided by the physician and pharmacist as to when and how to take this drug.

Interactions

There are over 1,000 drugs that may interact with Vinorelbine, so patients should disclose any existing medications to their health care provider. Some of these drugs include:

  • Naproxen
  • Dexamethasone
  • Meperidine
  • Fentanyl
  • Cyclobenzaprine
  • Interferon alfa-2b
  • Lyrica
  • Palonosetrol
  • Lorazepam
  • Bevacizumab
  • Sulfamethoxazole
  • Trimethoprim
  • Diphenhydramine
  • Celecoxib
  • Prochloraperazine
  • Pregabalin
  • Filgrastim
  • Oxycodone
  • Clopidogrel
  • Ondansetron

As these drugs are fairly common, patients should disclose any medications to their health care providers prior to starting treatment with Vinorelbine or any other drug treatment regime.

Great caution will be taken for patients who are also known to be taking drugs that inhibit drug metabolism such as CYP3A inhibitors. Taking these drugs with Vinorelbine may cause side effects to be acuter or happen earlier in treatment than anticipated. These drugs include:

  • Atazanavir
  • Clarithromycin
  • Indinavir
  • Itraconazole
  • Ketoconazole
  • Nefazodone
  • Nelfinavir
  • Ritonavir
  • Saquinavir
  • Telithromycin

Warnings

The use of Vinorelbine can compromise a patient's immune system due to the effect it has on blood cells. For this reason, it is advised that patients not receive any immunizations or vaccinations without consulting your doctor. As Vinorelbine will have lowered the body's resistance, there is a chance that an inoculation will give the patient the infection that it's meant to prevent. Special attention should be given to those who have recently had a vaccine for yellow fever, which is a live vaccine. Similar live vaccines are measles, mumps, rubella, MMR, oral polio, oral typhoid and chicken pox. No live vaccines should be given within six months of a course of Vinorelbine treatment.

Over and above this, other persons living in the same household as the patient on Vinorelbine are advised not to receive the oral poliovirus vaccine as there is a chance they could pass it on via contact. If anyone in the household has gotten the oral poliovirus within the past several months, keep away from them physically and stay out of the same room they are in if possible or wear a protective mask that covers the mouth and nose completely.

Antifungal medications such as itraconazole and ketoconazole while being treated with Vinorelbine may increase the side effects already present due to the reduction or breakdown of the drug by the body. Certain antibiotics and anticonvulsant medications could do the same and, potentially, render Vinorelbine ineffective completely.

As the Vinorelbine patient can have a lowered white blood cell count, chances of getting an infection are high. At the same time, blood platelet count is lowered, which can make blood clotting difficult. For these reasons, the risk of infection or bleeding should be eliminated or greatly reduced by avoiding people with infections such as fever, chills, cough or body aches.

Contact your doctor if you experience bloody stools, blood in your urine or red pinpoint spots appearing on the skin. Keep hands away from eyes, nose, and mouth unless you've washed your hands recently. Avoid cutting yourself when shaving or cutting nails and avoid sports activities that could result in bruising or other injuries.

Teeth and gums can be especially sensitive when using Vinorelbine, so listen to doctor recommendations of other methods of oral health and take care when using a regular toothbrush, dental floss or picks.

When receiving an IV infusion of Vinorelbine, there is a small risk of the drug leaking onto the skin, which can cause irritation and scarring. If you notice this during your treatment, you should alert a health care professional immediately so that assistance can be given.

As with any drug, it is of utmost importance to disclose any and all medications that you are taking before starting on a Vinorelbine treatment regime. This includes any prescription or non-prescription medication that you are taking or may take as well as any herbal or holistic remedies, as these can also interfere with the effectiveness or cause unwanted side-effects. Along the same line, check with your healthcare professional or pharmacist before beginning any new medicines while you are being treated with Vinorelbine.

Your doctor should also be informed of any other health issues you have or have had in the past as well as any family history of illnesses or diseases of any kind. For example, those patients who have suppressed bone marrow function as a result of other treatments or medications may create a dangerous situation for themselves by starting treatment of Vinorelbine.

Becoming pregnant while being treated by Vinorelbine is not advised as the drug may harm the baby while in the womb. It is important not to father a child or become pregnant for at least three months after treatment with Vinorelbine. Indeed, there is a risk of infertility after being treated for Vinorelbine, so speak with your healthcare professional about storing sperm or eggs before starting treatment.

Breastfeeding mothers should stop during treatment with Vinorelbine, as the drug may be found in your breast milk and cause harm to your child.

Storage

Vinorelbine should be stored in a refrigerator at a temperature of 36 to 46 degrees Fahrenheit (2 to 8 degrees Celsius) and protected from light. This drug should absolutely not be frozen. Disposal of any unused Vinorelbine should be undertaken with great care as it is cytotoxic. Follow special handling and disposal procedures.

Summary

Vinorelbine is an injected chemotherapy drug that works by stopping cell division during mitosis. Vinorelbine has no capacity for stopping the mitosis of only cancer cells, so therefore healthy cells are also affected by the active ingredients. Used to treat advanced breast cancer, non-small-cell lung cancer, mesothelioma (cancer of the outer covering of the lung) as well as ovarian cancer and Hodgin's disease, Vinorelbine is administered during IV infusion therapy in doses of approximately 30 milligrams administered in several treatments as part of a regime.

Patients treated with Vinorelbine may experience several side effects including hair loss, low white blood cell counts, low blood platelet counts, weakness, tiredness and weight loss. Due to the low white blood cell count when being treated by Vinorelbine, patients are advised to eliminate risk of infection and viral disease by avoiding those treated with live, oral vaccines and avoiding live vaccinations themselves for at least 6 months.

Due to the low platelet count in the blood, patients are also advised to avoid injury possible from playing sports, using razors or nail clippers or other sharp objects as their blood will not clot as normal. Prior to starting this treatment, patients are advised to inform their health care providers of any prescription or non-prescription medications they are taking or are about to take, including herbal remedies or vitamins. Patients are also advised to disclose their full medical history including any diseases they have already been treated for or family history of any hereditary conditions they might have.

Vinorelbine is to be administered only by a physician under IV infusion in a hospital setting. Continuous monitoring of the patient, their response to the drug and any side effects reported are kept as record during treatment. Vinorelbine in the form of a pill to take orally is available in some European countries but not approved in the US or Australia.

This medication is not suitable for breastfeeding mothers or women who are pregnant or wish to become pregnant. Men who are looking to father a child within three months of taking Vinorelbine are also advised not to take the drug or to weigh their options for treatment.

Resources
Last Reviewed:
December 26, 2017
Last Updated:
April 05, 2018
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