Dosing & Uses
Dosage Forms & Strengths
Non-small Cell Lung Carcinoma
- 25 mg/m² IV qWeek with IV cisplatin 100 mg/m² q4Weeks OR
- 30 mg/m² IV qWeek with cisplatin 120 mg/m² on Days 1 & 29 & then q6Weeks
Breast Cancer (Off-label)
Dilute IV concentration 0.5-2 mg/mL
Infuse over 6-10 minutes to reduce toxicity
Hematologic toxicity (Granulocyte Count)
- >1500 cells/mm³: 100 % of dose
- 1000-1499 cells/mm³: Decrease dose 50%
- < 1000 cells/mm³: Do not administer
- Grade > 2: Discontinue
Dose adjustment not necessary
Hepatic Insufficiency (total bilirubin)
- <2 mg/dL: 100% of dose
- 2.1-3 mg/dL: Decrease dose 50%
- >3 mg/dL: Decrease dose 75%
Safety & efficacy not established
Serious - Use Alternative
Significant - Monitor Closely
Elev AST (67%)
Peripheral neuropathy (25%)
Chest pain (5%)
Hemorrhagic cystitis (1%)
Black Box Warnings
The drug should be administered under the supervision of an experienced cancer chemotherapy physician in a facility equipped to diagnose and manage complications
Severe granulocytopenia may occur
The needle should be properly positioned in the vein before this product is injected. Leakage to surrounding tissue during IV administration may cause considerable irritation. Immediately discontinue the injection, and introduce any remaining portion of the dose into another vein. Local injection of hyaluronidase and the application of moderate heat to the area of leakage will help disperse the drug and may minimize the discomfort and possibility of cellulitis.
Intrathecal use may be fatal
Acute bacterial infection, ANC <1000/mm³, intrathecal (IT) administration, intestinal obstruction, paralytic ileus, pregnancy, lactation
Likely fatal if given intrathecally
Bone marrow depression, neuropathy, myopathy, neuromuscular disease, neurotoxic agents, ototoxic agents, pulmonary disease, hepatic impairment
Pregnancy & Lactation
Pregnancy Category: D
Lactation: not known if excreted in breast milk; do not nurse
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Semi-synthetic vinca alkaloid; inhibits mitosis at metaphase by depolymerizing microtubules; specific for S ans M phases; may also inhibit nucleic acid and protein synthesis by blocking glutamic acid use
Half-Life: 28-44 hr
Peak Plasma: 234-1160 ng/mL
Plasma clearance: 0.97-1.26 L/hr/kg
Protein Bound: 80-92%
Vd: 25-40 L/kg
Metabolism: CYP3A isoenzymes
Metabolites: vinorelbine N-oxide, deacetylvinorelbine
Clearance: 0.97-1.26 L/hr/kg
Excretion: Feces (46%); urine (18%)
Y-site: acyclovir, allopurinol, aminophylline, amphotericin B, ampho B cholesteryl sulfate, ampicillin, cefazolin, cefoperazone, cefotetan, ceftriaxone, cefuroxime, co-trimoxazole, fluorouracil, furosemide, ganciclovir, methylprednisolone sodium succinate, mitomycin, piperacillin, sodium bicarbonate, thiotepa
Solution: D5W, NS
Y-site (partial list): buprenorphine, cisplatin, cyclophosphamide, diphenhydramine, gemcitabine, fluconazole, granisetron, hydromorphone, imipenem-cilastatin, lorazepam, meperidine, morphine, ondansetron, KCl, vancomycin, zidovudine
May be diluted in syringe or bag
Syringe: dilute to 1.5-3 mg/mL in NS or D5W
IV Bag: dilute to 0.5-2 mg/mL in NS, 1/2NS, D5W, D5/½NS, LR or Ringer's
For IV use only; fatal if given intrathecally
Administer IV over 6-10 min through sidearm of free-flowing IV closest to IV bag
Then flush with 75-125 mL of one of the IV fluids
Mix 250 U hyaluronidase with 6 mL NS
Inject hyaluronidase solution subcutaneously through 6 clockwise injections into infiltrated area using a 25-gauge needle
Change needle with each new injection
Apply heat immediately for 1 hr
Give QID for 3-5 days
Application of cold or hydrocortisone is contraindicated
Store intact vials under refrigeration protected from light
Diluted solution may be stored in polypropylene syringes for 24 hr under normal light at 5-30°C
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
|1||This drug is available at the lowest co-pay. Most commonly, these are generic drugs.|
|2||This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.|
|3||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.|
|4||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|5||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|6||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|NC||NOT COVERED – Drugs that are not covered by the plan.|
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.