4-(acetyloxy)-6,7-didehydro-15-((2R,6R,8S) -4-ethyl-1,3,6,7,8,9-hexahydro- 8-(methoxycarbonyl)-2,6-methano- 2H-azecino(4,3-b)indol-8-yl)-3-hydroxy- 16-methoxy-1-methyl-,methyl ester, (2beta,3beta,4beta,5alpha,12R,19alpha)- aspidospermidine-3-carboxylic acid

Distribution
Vd is 25 to 40.1 L/kg.

Metabolism
One metabolite, deacetylvinorelbine, has been shown to possess antitumor activity.

Elimination
T ½ is 28 to 44 h. Mean plasma clearance is about 1 to 1.26 L/h/kg. Substantial hepatic elimination in humans, with large amounts recovered in feces after IV administration.

Special Populations
Hepatic Function Impairment

Based on experience with other anticancer vinca alkaloids, dosage adjustments are recommended for patients with impaired hepatic function taking vinorelbine.

Cisplatin
Incidence of granulocytopenia increases when vinorelbine is used in combination with cisplatin.

CYP-450 3A enzyme inhibitors (eg ketoconazole, itraconazole, macrolides)
May increase vinorelbine serum levels and toxicity.

Mitomycin
Acute pulmonary reactions were noted when vinca alkaloids were given with mitomycin.

Paclitaxel
Monitor for signs and symptoms of neuropathy with concomitant use of vinorelbine and paclitaxel.

Radiation
Radiation recall reactions may occur.