Vinorelbine

CLINICAL USE

Treatment of advanced breast cancer (where other anthracyclines have failed) Non-small cell lung cancer

DOSE IN NORMAL RENAL FUNCTION

Oral: 60–80 mg/m2 once weekly for 3 weeks IV: 25–30 mg/m2 once a week Maximum 60 mg per dose

PHARMACOKINETICS

Molecular weight : 1079.1 (as tartrate)

%Protein binding : 13.5 (78% bound to platelets)

%Excreted unchanged in urine : 18.5

Volume of distribution (L/kg) : >40

half-life – normal/ESRD (hrs) : 28–44

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function and monitor closely

10 to 20 : Dose as in normal renal function and monitor closely

<10 : Dose as in normal renal function and monitor closely

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD : Unlikely to be dialysed. Dose as in normal renal function and monitor closely

HD : Unlikely to be dialysed. Dose as in normal renal function and monitor closely

HDF/high flux : Unknown dialysability. Dose as in normal renal function and monitor closely

CAV/VVHD : Unknown dialysability. Dose as in normal renal function and monitor closely

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Antipsychotics: avoid concomitant use with clozapine (increased risk of agranulocytosis)

ADMINISTRATION

Reconstition

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Route

Oral, IV bolus, infusion

Rate of Administration

Bolus: 5–10 minutes Infusion: 20–30 minutes

Comments

Dilute bolus in

20 to 50 : mL with sodium chloride 0.9% Dilute infusion in 125 mL with sodium chloride 0.9% Stable for 24 hours at 2–8°C

OTHER INFORMATION

Widely distributed in the body, mostly in spleen, liver, kidneys, lungs, thymus; moderately in heart, muscles; minimally in fat, brain, bone marrow. High levels are found in both normal and malignant lung tissues, with slow diffusion out of tumour tissue Metabolism appears to be hepatic. Excretion is mainly by the biliary route (18.5% appears in the urine) Flush line with saline after infusion Dose-limiting toxicity is mainly neutropenia In patients where >75% of the liver volume has been replaced by metastases, it is empirically suggested that the dose be reduced by a third, with close haematological follow-up .

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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