Vinorelbine Disease Interactions

Acute shortness of breath and bronchospasm, some severe and life-threatening, have been reported with the use of vinca alkaloids. These reactions were observed most often during combination therapy with mitomycin C, occurring within minutes to several hours after administration of the vinca alkaloid or up to 2 weeks following the mitomycin dose. Therapy with vinca alkaloids should be administered cautiously in patients with preexisting pulmonary dysfunction. Aggressive treatment may be necessary, including use of supplemental oxygen, bronchodilators, and/or corticosteroids. In patients who develop progressive dyspnea requiring chronic therapy, vinca alkaloid should not be readministered.

Vinorelbine is extensively metabolized by the liver. The pharmacokinetic disposition of vinorelbine in patients with hepatic impairment has not been assessed. Therapy with vinorelbine should be administered cautiously and the dosage reduced in patients with compromised hepatic function.

Vinorelbine induces myelosuppression manifested by neutropenia, anemia and thrombocytopenia. The use of vinorelbine may be contraindicated in patients with known infectious diseases. Patients should be instructed to immediately report any signs or symptoms suggesting infection such as fever, sore throat, or local infection. Close clinical monitoring of hematopoietic function is recommended.

The use of vinorelbine is contraindicated in patients with neutrophil counts < 1000/mm3. Vinorelbine induces dose-dependent myelosuppression, primarily neutropenia. Therapy with vinorelbine should be administered with extreme caution and dosage modification considered in patients whose bone marrow reserve may be depressed by prior chemotherapy or irradiation or whose marrow function is recovering from previous cytotoxic therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Close clinical monitoring of hematopoietic function is recommended.

Severe and fatal paralytic ileus, constipation, intestinal obstruction, necrosis, and perforation occur in patients receiving vinorelbine injection. Institute a prophylactic bowel regimen to mitigate potential constipation, bowel obstruction and/or paralytic ileus, considering adequate dietary fiber intake, hydration and routine use of stool softeners. Caution and monitoring is advised in patients with history of gastrointestinal issues.

Sensory and motor neuropathies, including severe neuropathies, occur in patients receiving vinorelbine. Monitor patients for new or worsening signs and symptoms of neuropathy, such as paresthesia, hyperesthesia, hyporeflexia and muscle weakness while receiving vinorelbine. Discontinue vinorelbine for CTCAE Grade 2 or greater neuropathy. Therapy with vinorelbine should be administered cautiously in patients with or predisposed to neuropathy.