vinorelbine tartrate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
vinorelbine tartrate: clinical details
Prescribing considerations
- Treatment should be supervised by a clinician experienced in cytotoxic chemotherapy.
- Review performance status, infection risk, cardiovascular history, hepatic function, bowel function, concomitant medicines and vaccination plans.
- Oral absorption may be unreliable after significant gastric or small-bowel resection or with disease substantially affecting absorption.
- Avoid concomitant radiotherapy when the treatment field includes the liver.
- Ensure secure venous access before intravenous administration and manage suspected extravasation according to local cytotoxic-extravasation policy.
Contraindications and cautions
- Hypersensitivity to vinorelbine, another vinca alkaloid or a formulation excipient
- Neutropenia, thrombocytopenia or severe current or recent infection at the product-defined thresholds
- Concomitant yellow-fever vaccination
- Breastfeeding
- For oral vinorelbine: significant malabsorption, previous major gastric or small-bowel resection, or requirement for long-term oxygen therapy
Monitoring
- Full blood count, including neutrophils and platelets, before each administration
- Clinical assessment for infection and febrile neutropenia
- Liver function and hepatic impairment
- Bowel function, particularly with constipation or concomitant opioids
- Neurological toxicity, respiratory symptoms and cardiovascular symptoms
- Infusion site and venous patency during intravenous administration
- INR more frequently when oral anticoagulants are used
Clinical pharmacology
Vinorelbine is a semisynthetic vinca alkaloid that inhibits tubulin polymerisation and microtubule dynamics. It is extensively distributed, metabolised mainly through CYP3A4 and eliminated predominantly through the biliary route; renal elimination is low.
Formulation and product differences
- Soft capsules are swallowed whole with water and food may reduce nausea; they contain small quantities of ethanol and sorbitol.
- The oral formulation has greater reported nausea and vomiting than the intravenous formulation and depends on intact gastrointestinal absorption.
- The concentrate is for intravenous infusion only after dilution and must be prepared by trained staff using cytotoxic-handling precautions.
- Intravenous treatment adds risks of phlebitis, extravasation injury and formulation-specific pulmonary reactions.
vinorelbine tartrate preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 10 mg/mL
Capsule
Route: Oral
Strengths: 20 mg, 30 mg, 80 mg
vinorelbine tartrate interactions
The oncology team should review prescription, non-prescription and herbal products, as clinically important interactions include:
Yellow-fever vaccine
Concomitant use is contraindicated because immunosuppression creates a risk of severe, potentially fatal vaccine infection.
Other live attenuated vaccines
Generally avoid because vinorelbine-related immunosuppression can cause disseminated vaccine infection.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.