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Vinorelbine

(vin-o- rel-been)

Trade/other name(s): Navelbine, vinorelbine tartrate

Why would this drug be used?

This drug is used to treat non-small cell lung cancer. Your doctor may also use it to treat other types of cancer, such as breast cancer.

How does this drug work?

Vinorelbine is a type of chemotherapy drug known as a vinca alkaloid. It is thought to work by interfering with the cancer cells when they are dividing into 2 cells. This eventually leads to cell death. Because cancer cells divide more rapidly than normal cells, they are more likely than normal cells to be affected by this drug.

Before taking this medicine

Tell your doctor…

  • If you are allergic to any medicines, dyes, additives, or foods.
  • If you have any type of liver disease (including hepatitis). This drug is cleared from the body mainly by the liver. Reduced liver function might result in more drug than expected staying in the body, which could lead to worse side effects. Your doctor may need to adjust your dose.
  • If you have any other medical conditions such as kidney disease, heart disease, diabetes, gout, high blood pressure, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.
  • If you have ever had numbness or tingling, or weakness of the hands or feet. This drug can cause this problem or make it worse, and your doctor will want to watch you closely.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause problems with the fetus if it is taken at the time of conception or during pregnancy. Men and women who are taking this drug should use some kind of birth control during treatment. It is important to check with your doctor about what kinds of birth control can be used with this medicine. In pregnant women, treatment with this drug should be used only if the potential benefit to the mother outweighs the risk to the fetus.
  • If you are breast-feeding. While no studies have been done, this drug may pass into breast milk and affect the baby. Breast-feeding is not recommended during treatment with this drug.
  • If you think you might want to have children in the future. This drug can affect fertility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Some other chemotherapy drugs, including mitomycin and paclitaxel, may raise the risk of certain side effects from this drug if used at the same time.

These drugs may cause earlier or more severe side effects if taken while being treated with vinorelbine:

  • the anti-depressant drug nefazodone (Serzone)
  • antibiotics erythromycin, clarithromycin
  • anti-fungal antibiotics such as ketoconazole and itraconazole
  • certain blood pressure medicines such as diltiazem and verapamil
  • HIV drugs such as indinavir, ritonavir, nelfinavir, amprenavir, and others

There may be more drugs that interact with vinorelbine. Check with your doctor, nurse, or pharmacist about your other medicines, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether some foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Vinorelbine is given as an injection in a vein, usually over 6 to 10 minutes. Tell the nurse if you feel pain, burning, or discomfort in the vein when the injection is given. The dose and how often you get the medicine depend on your weight, your blood counts, how well your liver is working, and the type of cancer being treated. This medicine may be given along with other chemotherapy drugs.

Precautions

In some cases during an intravenous (IV) infusion, the drug may leak out of the vein and under the skin, where it may damage the tissue. This may cause pain, blisters, or even open sores or scarring. Tell the nurse right away if you notice redness, pain, or swelling at or near the IV site.

You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor may give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor.

This drug may increase your risk of constipation, which in some cases can be severe. Your doctor will likely prescribe a laxative or similar medicine to help prevent this from happening. Let your doctor know if constipation starts, especially if you have pain.

This drug may cause damage to certain nerves in the body, which can lead to a condition called peripheral neuropathy. This can cause numbness, weakness, pain, or feelings of tingling or burning, usually in the hands or feet. These are sometimes related to being exposed to hot or cold temperatures. These symptoms can sometimes progress to include trouble walking or holding things in your hands. Let your doctor know right away if you notice any of these symptoms. If they are severe enough, this drug may need to be stopped or the dose reduced until they get better.

In rare cases, patients have developed severe lung disease during treatment, usually about a week after this drug. Call your doctor right away if you notice any possible symptoms of lung problems, such as shortness of breath or a new cough.

This drug may increase liver enzyme levels in your blood. Your doctor will likely check your liver function with blood tests on a regular basis. The drug may need to be stopped if the changes are severe. If you have liver metastasis or other liver problems before starting treatment, the doctor may need to monitor you more closely.

Your doctor will likely test your blood before and during your treatment, to check for the effects of the drug on blood counts or on blood chemistry levels. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether. Keep all your appointments for doctor visits and lab tests.

This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

This drug may lower your red blood cell count. If this occurs, it is usually a few months after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you to feel weak or tired all the time. Your doctor may give you medicines to help prevent or treat this condition, or you may need to get blood transfusions.

In rare cases, this drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body’s ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor’s OK. This drug may affect your immune system, which could make vaccinations ineffective, or could even lead to serious infections. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • constipation*
  • nausea and/or vomiting*
  • feeling tired
  • feeling weak
  • low white blood cell count with increased risk of infection*
  • low red blood cell count (anemia)*
  • abnormal blood tests which suggest that the drug is affecting the liver or kidneys (Your doctor will discuss the importance of this finding, if any.)*

Less common

  • pain or redness at the infusion site*
  • numbness, tingling, or pain in the hands, feet, or elsewhere*
  • loss of appetite
  • diarrhea
  • hair loss or thinning, including face and body hair

Rare

  • low blood platelet count with increased risk of bleeding*
  • shortness of breath
  • allergic reaction (may include rash, fever, rapid heart rate, shortness of breath, throat swelling, dizziness)
  • pain or trouble urinating
  • jaw pain
  • muscle or joint pain
  • skin rash
  • severe lung disease with shortness of breath and cough*
  • death due to infection, lung disease, damage to intestines, or other problems

*See "Precautions" section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 1994.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 12/18/2009
Last Revised: 12/18/2009