The anti-neoplastic drug Navirel is used exclusively under the supervision of a doctor - an oncologist who has experience in chemotherapeutic treatment. The method of administration and dose determine the administration of vinorelbine intravenously and only in the form of infusions. Intrathecal use of the drug is strictly contraindicated.
With non-small cell lung cancer. In the case of treatment as a treatment course based on the single use of Navirel, the dosage for adult patients is prescribed from 25 to 20 mg per square meter. The drug is administered to the patient once a week.
If complex therapy is used, together with other cytostatic agents, the exact amount of vinorelbine administered is determined in accordance with the treatment protocol. Primarily, Navirel is prescribed in the same dosages as with monotherapy (25-30 mg / sq. M body surface area). The gap between the drug inputs is adjusted and can be chosen as the first and fifth days of the treatment course, and the first and the eighth. This criterion is determined by the attending physician. Duration of chemotherapy is usually three weeks.
In the case of malignant tumors of the breast, laden with metastasis and widespread, vinorelbine is preferably administered in an amount of 25 to 30 mg / sq. M. Of the body surface of the patient once a week.
The maximum permissible single dose administered was 35.4 mg / m 2.
The antitumor agent should be administered to the patient very carefully, by bolus infusion (within five to ten minutes), immediately after dilution in 50 mg / ml 5% glucose solution or 0.9% sodium chloride solution in an amount of 20-50 ml. And also by short intravenous penetration (twenty to thirty minutes) after dilution in 125 ml of 0.9% sodium chloride solution or 5% glucose solution 50 mg / ml. After completion of the procedure for the administration of cytotoxic agents, it is necessary to rinse the vein with 0.9% sodium chloride solution.
If there is a history of a patient with breast cancer of moderate pathological damage of the liver (metastases occupy less than 75% of the liver volume), the clearance of vinorelbine does not change. That is, for such patients there is no pharmacokinetic justification for decreasing the dosage of Navirela.
If there is extensive metastasis in the patient's liver (that is, more than 75% of the body volume is replaced by a malignant tumor), the real effect of the reduced amount of drug elimination by the liver has not been investigated. Therefore, in this situation, it was suggested empirically to reduce the number of injected Navirela by a third. It is necessary to carefully monitor hematologic toxicity.
If the patient's kidneys have undergone pathological damage, then there is no pharmacokinetic justification for reducing the amount of vinorelbine taken.
Restriction or reduction of the injected dose of the drug may be neutropenia, due to the toxicity of the antitumor agent. On the 8th-12th day after the application of Navirel, a decrease in the level of neutrophils is observed, but it is determined shortly and does not show a tendency to accumulation in the body.
If the neutrophil count is less than 2,000 / mm 3 and / or the platelet count is less than 75,000 / mm 3, then treatment should be deferred until their level is restored. It is expected that the introduction of the drug is delayed in the first week in approximately 35% of treatment courses. The maximum, single-entry, the amount of the drug is 60 mg.
Clinical experience did not reveal significant differences in the results and features of complications for elderly patients, although it is impossible to exclude in some of them a greater sensitivity and the effect of concomitant age pathologies. Age does not affect the pharmacological kinetics of the active substance Navirela.
When using anticancer drugs, special precautions must be taken.
If Navirel is sprayed under pressure, there is a risk of severe irritation and even the formation of a corneal ulcer. It is very important to avoid contact of the drug with the eyes. If the product gets into the eyes, they must be rinsed immediately with an isotonic solution of sodium chloride or under a lot of water. After the preparation of the solution, any surface that is in contact with the pharmacological preparation must be wiped, and hands and face washed.
Preparation and administration of vinorelbine is carried out only by experienced personnel, who can work with similar substances. Before the procedure, you need to wear protective clothing: wear disposable gloves, goggles and clothing. If the solution spills, it must be carefully collected and the place well washed. The unused medicinal product must be destroyed in accordance with the standards for the disposal of toxic chemical compounds.
- The antitumor drug should be administered intravenously very carefully. Before the infusion of vinorelbine, it is necessary to check that the cannula is precisely located in the ulnar vein. Extravasation of a pharmacological preparation in the course of intravenous administration can cause severe local irritation. In this situation, the infusion is immediately stopped, the affected vein is washed with 0.9% sodium chloride solution, and the remaining drug is injected into the vein of the other arm. In the case of extravasation, glucocorticosteroids can be given intravenously to reduce the risk of phlebitis.
- Treatment therapy should begin with the definition of hematological indicators (setting the number of leukocytes, hemoglobin, granulocytes and platelets before each new injection). If the number of neutrophils is less than 2000 / mm 3 and / or the platelet count is less than 75,000 / mm 3, treatment should be postponed until their level is restored and the patient needs constant monitoring.
- If the patient shows signs or symptoms suggestive of an infection, a thorough examination should be carried out immediately.
- If there is a significant lesion of the liver, the dose should be reduced (but do it only by a doctor - oncologist): caution and mandatory careful monitoring of hematological parameters is recommended.
- In the case of kidney damage, there is no need to adjust the dose through a low level of renal excretion.
- No one is prescribed for radiation therapy in parallel with radiotherapy if the treatment site includes a liver.
- Powerful inhibitors or inducers of CYP3A4 should be used with caution because of the risk of changes in vinorelbine concentration.
- As a rule, this drug is not recommended for use in combination with live atenuovaniemi vaccines.
- As a rule, this drug is not recommended to be used in combination with itraconazole and phenytoin.
- Vinorelbine may have a genotoxic effect. Therefore, men who are being treated are not recommended to conceive a child during the entire treatment period, and also during the next six months after the end of treatment.
- In order to avoid bronchospasm, especially with concomitant use with mitomycin C, it is necessary to consider appropriate precautions. Patients who are treated as outpatients need to be informed that they need to see a doctor in case of dyspnea.
- It is recommended to carefully measure the dosage of the drug administered if a history of the patient is diagnosed with ischemic heart disease.
- Since treatment with antitumor drugs can lead to irreversible infertility, men who wish to experience the joy of paternity in the future, it is advisable to be safe and apply to the cryopreservation of sperm even before the beginning of the treatment course.
- When using Navirela in medical therapy, the possibility of its influence on the quality of reaction and attention in the case of working with driving mechanisms and when driving vehicles.