Vinorelbine Ditartrate injection 10mg/ml Anticancer medicine
COMPOSITION:
Each vial contains vinorelbine tartrate equivalent to 10.0 mg vinorelbine.
PHARMACOLOGICAL ACTION:
Vinorelbine is a semi-synthetic vinca alkaloid, derived from vinblastine. Vinca alkaloids appear to exert its antitumor activity by binding to tubulin with high affinity, blocking the ability of the protein to polymerise into microtubules. The antitumor activity of vinorelbine is primarily due to inhibition of mitosis at metaphase through its interaction with tubulin, where it inhibits the polymerisation of tubulin.
Vinorelbine may also interfere with amino acid, cyclic AMP, and glutathione metabolism; cellular respiration; calmodulin-dependent Ca2+ transport ATPase activity and nucleic acid and lipid biosynthesis.
Pharmacokinetics
Vinorelbine exhibits triphasic pharmacokinetics after intravenous administration. It has a terminal half-life of between 28 and 44 hours and is metabolised in the liver. Vinorelbine and its metabolites are excreted primarily in faeces via the bile but also in urine.
The initial rapid decline in plasma concentration represents distribution of vinorelbine in peripheral compartments and its metabolism.
Mean plasma clearances ranges from 0.97 to 1.26 L/hr/kg and steady state volume distribution (Vss) values ranges from 25.4 to 40.1 L/kg.
The disposition of radiolabelled vinorelbine has been studied in a limited number of patients.
Approximately 18% of the administered dose was recovered in the urine and 46% in the faeces.
A study on the urinary excretion of vinorelbine indicated that 10.9% + 0.7% of a 30 mg/m2 intravenous dose was excreted unchanged in the urine.
Deacetylvinorelbine, a metabolite of vinorelbine, has been shown to possess antitumor activity. This metabolite has not been quantified in human plasma. The effects of renal of hepatic impairment on the disposition of vinorelbine have not been assessed.
The concurrent administration of cisplatin with vinorelbine does not influence the pharmacokinetics of vinorelbine.
INDICATIONS:
Vinorelbine is indicated in the palliative treatment of advanced inoperable Non-Small Cell Lung Cancer (NSCLC) as a single agent or in combination. Combination therapy proves to be more effective than monotherapy.
Vinorelbine is also indicated for the treatment of patients with metastatic breast cancer who have failed anthracycline first-line monotherapy for metastatic disease, or who have relapsed within 6 months of anthracycline-based adjuvant therapy.
WARNINGS
VINORELBINE IS FOR INTRAVENOUS USE ONLY.
Vinorelbine(vinorelbine tartrate) is a cytotoxic drug and should be administered only by physicians experienced with cancer chemotherapeutic drugs. Blood counts should be taken prior to each dose. The dosage should be discontinued or reduced on evidence of abnormal depression of the bone marrow (see table).
Vinorelbine is a moderate vesicant and can cause phlebitis or extravasation injury. The possibility of phlebitis may be increased by inadequate flushing of the vein after peripheral administration.
It is extremely important that the needle be properly positioned in the vein before Vinorelbineis injected. If leakage into surrounding tissue occurs during intravenous administration of Vinorelbine, it may cause severe irritation. The injection should be discontinued immediately and any of the remaining portion of the dose should then be introduced into another vein.
A low incidence of death (1%) due to neutropenic sepsis has been reported (see SIDE EFFECTS AND SPECIAL PRECAUTIONS). Bone marrow toxicity, specifically granulocytopenia, is dose-limiting. Complete blood counts with differentials should be performed and results reviewed prior to each dose of Vinorelbine. VINOREL should not be administered to patients with granulocyte counts <1 000 cells/mm3. Patients developing severe granulocytopenia should be monitored carefully for evidence of infection and/or fever (see DOSAGE AND DIRECTIONS FOR USE –Administration precautions).
| Granulocytes cells/mm3(cubic millimetres) on days of treatment | Dose of Vinorelbine(mg/m2) |
| + 1 500 | 30 |
| 1 000 to 1 499 | 15 |
| <1 000 | Do not administer. Repeat granulocyte count in one week. If granulocyte count is <1 000 cells/mm3 for three weeks discontinue Vinorelbine. |
Vinorelbine should be administered with caution to patients with hepatic insufficiency. The dose should be adjusted in patients who develop hyperbilirubinaemia during treatment with Vinorelbine.
INTERACTIONS
Concurrent use of Vinorelbine with other bone marrow depressants may increase the bone marrow depressant effect of Vinorelbine and radio therapy.
Acute pulmonary reaction has been reported with Vinorelbine use in conjunction with mitomycin.
Cautious administration of Vinorelbine is advised.
Concomitant or sequential use of paclitaxel and Vinorelbine may result in neuropathy and routine monitoring for neuropathy symptoms is recommended.
Due to the suppression of normal defence mechanisms by Vinorelbine, concurrent use of Vinorelbine with live virus vaccine may potentiate the replication of the vaccine virus, may increase the side effects of the vaccine virus, and/or may decrease the patient’s antibody response to the vaccine. Immunisation of these patients should be undertaken only with extreme caution after careful review of the patient’s haematological status and only with the knowledge and consent of the physician managing the Vinorelbine therapy.
DOSAGE AND DIRECTIONS FOR USE
Dosage
In single-agent therapy, the usual dose is 25 to 30 mg/m2 administered weekly. The dosage schedule for metastatic disease is 30 mg/m2 per week. In polychemotherapy, the dose and the frequency depend on the protocol.
Administration precautions
Patients receiving Vinorelbine should be under the supervision of a physician experienced in cancer chemotherapy. Patients and/or family members should be instructed to report any side effects.
Vinorelbine must be administered intravenously. Intrathecal administration of other vinca alkaloids has resulted in death. It is extremely important that the intravenous needle or catheter be properly positioned before any Vinorelbine is injected. Leakage into surrounding tissue during intravenous administration of Vinorelbine may cause considerable irritation, local tissue necrosis and/or thrombophlebitis (see WARNINGS).
If extravasation occurs, the injection should be discontinued immediately and any remaining portion of the dose should then be introduced into another vein. Local injection of hyaluronidase and the application of moderate heat to the area of leakage have been reported to help disperse drug and minimise discomfort associated with the extravasation of other vinca alkaloids.
Although venous irritation is a problem associated with peripherally administered vinorelbine, there is no need of central line placement. Inciden
