navel

Navelbine

vinorelbine

(vine-oh-rel-been) ,

Navelbine

(trade name) Pregnancy Category: D

Indications

Action

Pharmacokinetics

Time/action profile (effect on WBCs)

ROUTE	ONSET	PEAK	DURATION
IV	unknown	7–10 days	7–15 days

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• fatigue (most frequent)

Respiratory

• shortness of breath

Cardiovascular

• chest pain

Gastrointestinal

• constipation (most frequent)
• nausea (most frequent)
• abdominal pain
• anorexia
• diarrhea
• transient ↑ in liver enzymes
• vomiting

Dermatologic

• alopecia (most frequent)
• rashes

Fluid and Electrolyte

• hyponatremia

Hematologic

• anemia (most frequent)
• neutropenia (most frequent)
• thrombocytopenia

Local

• irritation at IV site (most frequent)
• skin reactions
• phlebitis

Musculoskeletal

• arthralgia
• back pain
• jaw pain
• myalgia

Neurologic

• neurotoxicity (most frequent)

Miscellaneous

• pain in tumor-containing tissue

Interactions

Drug-Drug interaction

↑ bone marrow depression with other antineoplastics or radiation therapy.Concurrent use with cisplatin ↑ risk and severity of bone marrow depression.Concurrent use with mitomycin or chest radiation ↑ risk of pulmonary reactions.

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Monitor BP, pulse, and respiratory rate during therapy. Note significant changes. Acute shortness of breath and severe bronchospasm may occur infrequently shortly after administration. Treatment with corticosteroids, bronchodilators, and supplemental oxygen may be required, especially in patients with a history of pulmonary disease.
• Assess frequently for signs of infection (sore throat, temperature, cough, mental status changes), especially when nadir of granulocytopenia is expected.
• Monitor neurologic status. Assess for paresthesia (numbness, tingling, pain), loss of deep tendon reflexes (Achilles reflex is usually first involved), weakness (wrist drop or footdrop, gait disturbances), cranial nerve palsies (jaw pain, hoarseness, ptosis, visual changes), autonomic dysfunction (constipation, ileus, difficulty voiding, orthostatic hypotension, impaired sweating), and CNS dysfunction (decreased level of consciousness, agitation, hallucinations). These symptoms may persist for months. The incidence of neurotoxicity associated with vinorelbine is less than that of other vinca alkaloids.
• Monitor intake and output and daily weight for significant discrepancies.
• Assess nutritional status. Mild to moderate nausea is common. An antiemetic may be used to minimize nausea and vomiting.
• Monitor for symptoms of gout (increased uric acid, joint pain, edema). Encourage patient to drink at least 2 L of fluid/day. Allopurinol and alkalinization of urine may decrease uric acid levels.
• Lab Test Considerations: Monitor CBC prior to each dose and routinely during therapy. The nadir of granulocytopenia usually occurs 7–10 days after vinorelbine administration and recovery usually follows within 7–15 days. If granulocyte count is <1500/mm³, dose reduction or temporary interruption of vinorelbine may be warranted. If repeated episodes of fever and/or sepsis occur during granulocytopenia, future dose of vinorelbine should be modified. May also cause mild to moderate anemia. Thrombocytopenia rarely occurs.
  • Monitor liver function studies (AST, ALT, LDH, bilirubin) and renal function studies (BUN, creatinine) prior to and periodically during therapy. May cause ↑ uric acid; monitor periodically during therapy.

Potential Nursing Diagnoses

Risk for injury (Adverse Reactions)
Risk for infection (Adverse Reactions)

Implementation

• high alert: Fatalities have occurred with chemotherapeutic agents. Before administering, clarify all ambiguous orders; double check single, daily, and course-of-therapy dose limits; have second practitioner independently double check original order, dose calculations, and infusion pump settings.
• Solution should be prepared in a biologic cabinet. Wear gloves, gown, and mask while handling medication. Discard IV equipment in specially designated containers.
  • Assess infusion site frequently for redness, irritation, or inflammation. Vinorelbine is a vesicant. If extravasation occurs, infusion must be stopped and restarted elsewhere to avoid damage to subcut tissue. Treatment of extravasation includes application of warm compresses applied over the area immediately for 30–60 min, then alternating on/off every 15 min for 1 day to increase systemic absorption of the drug. Hyaluronidase 150 units diluted in 1–2 mL of 0.9% NaCl, 1 mL for each mL extravasated, should be injected through existing IV cannula or subcut if the needle has been removed to enhance absorption and dispersion of the extravasated drug.

• Intravenous Administration

• pH: 3.5.
• Diluent: Dilute vinorelbine with 0.9% NaCl or D5W.Concentration: 1.5–3 mg/mL.
• Rate: Infuse over 6–10 min into Y-site closest to bag of a free-flowing IV or into a central line.
  • Flush vein with at least 75–125 mL of 0.9% NaCl or D5W administered over 10 min or more following administration of vinorelbine.
• Intermittent Infusion: Diluent: Dilute vinorelbine with 0.9% NaCl, D5W, 0.45% NaCl, D5/0.45% NaCl, Ringer’s or lactated Ringer’s injection. Solution should be colorless to pale yellow. Do not administer solutions that are discolored or contain particulate matter. Diluted solution is stable for 24 hr at room temperature.Concentration: 0.5–2 mg/mL.
• Rate: Infuse over 6–10 min (up to 30 min) into Y-site closest to bag of a free-flowing IV or into a central line.
  • Flush vein with at least 75–125 mL of 0.9% NaCl or D5W administered over 10 min or more following administration of vinorelbine.
• Y-Site Compatibility: amikacin, aztreonam, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, carboplatin, carmustine, cefotaxime, ceftazidime, chlorpromazine, cimetidine, cisplatin, clindamycin, cyclophosphamide, cytarabine, dacarbazine, dactinomycin, daunorubicin, dexamethasone sodium phosphate, diphenhydramine, doxorubicin, doxorubicin liposome, doxycycline, droperidol, enalaprilat, etoposide, famotidine, filgrastim, floxuridine, fluconazole, fludarabine, gemcitabine, gentamicin, granisetron, haloperidol, hydrocortisone, hydromorphone, idarubicin, ifosfamide, imipenem/cilastatin, lorazepam, mannitol, mechlorethamine, melphalan, meperidine, mesna, methotrexate, metoclopramide, metronidazole, mitoxantrone, morphine, nalbuphine, ondansetron, oxaliplatin, potassium chloride, prochlorperazine, promethazine, ranitidine, streptozocin, teniposide, ticarcillin/clavulanate, tobramycin, vancomycin, vinblastine, vincristine, zidovudine
• Y-Site Incompatibility: acyclovir, allopurinol, aminophylline, amphotericin B, amphotericin B cholesteryl sulfate, ampicillin, cefazolin, ceftriaxone, cefuroxime, fluorouracil, furosemide, ganciclovir, lansoprazole, methylprednisolone, mitomycin, sodium bicarbonate, thiotepa, trimethoprim/sulfamethoxazole

Patient/Family Teaching

• Instruct patient to report symptoms of neurotoxicity (paresthesia, pain, difficulty walking, persistent constipation).
• Inform patient that increased fluid intake, dietary fiber, and exercise may minimize constipation. Stool softeners or laxatives may be necessary. Patient should be advised to report severe constipation or abdominal discomfort, as this may be a sign of ileus, which may occur as a consequence of neuropathy.
• Advise patient to notify health care professional if fever; chills; sore throat; signs of infection; bleeding gums; bruising; petechiae; blood in urine, stool, or emesis; or mouth sores occur.
• Caution patient to avoid crowds and persons with known infections.
• Advise patient that this medication may have teratogenic effects. Contraception should be used during and for at least 2 mo after therapy is concluded.
• Discuss with patient the possibility of hair loss and explore coping strategies.
• Instruct patient not to receive any vaccinations without advice of health care professional.
• Emphasize the need for periodic lab tests to monitor for side effects.

Evaluation/Desired Outcomes

• Decrease in the size or spread of malignancy without detrimental side effects.