Navelbine Injection Drug Interactions

Acute pulmonary reaction have been reported with Navelbine and other anticancer vinca alkaloids use in conjunction with mitomycin.
Although the Pharmacokinetics of vinorelbine are not influenced by the concurrent administration of cisplatin, the incidence of granulocytopenia with Navelbine used in combination with cisplatin is significantly higher than with single agent Navelbine.
Patients who receive Navelbine and paclitaxel either concomitantly or sequentially, should be monitored for signs and symptoms of neuropathy. Administration of Navelbine to patients with prior or concomitant radiation therapy may result in radio-sensitizing effect.
Based on the available limited information, it is conceivable that interaction may occur with other drugs which are metabolised via the cytochrome CYP3A4. Concurrent administration of Vinorelbine tartrate with an inhibitor of this metabolic pathway may cause an earlier onset and/or increased severity of side effects.
As vinca-alkaloids are known as substrates for P-glycoprotein and in the absence of specific study, caution is recommended when Navelbine is used with strong inhibitors or inducers of cytochrome CYP3A4. Hence, the use of this medicine with phenytoïn, fosphenytoïn, itraconazole or posaconazole is not recommended. As CYP3A4 is mainly involved in the metabolism of vinorelbine, combination with strong inhibitors of this isoenzyme could increase blood concentration of vinorelbine and combination with strong inducers of this isoenzyme could decrease blood concentration of vinorelbine.
Use of this medicine with live attenuated vaccines is not recommended (for yellow fever vaccine, see Contraindications), because of a risk of generalised vaccine disease (could be fatal). This risk is increased in patients already immunodepressed by their underlying disease. It is recommended to use an inactivated when exists (poliomyelitis).
Exacerbation of convulsions can be observed with phenytoin resulting from the decrease of phenytoin digestive absorption by cytotoxic drug or risk of toxicity enhancement or loss of efficacy of the cytotoxic drug due to increased hepatic metabolism by phenytoin.
With oral anticoagulant, there is an increased thrombotic and haemorrhagic risk in case of tumoral diseases. There is an eventuality of interaction between oral anticoagulants and anticancer chemotherapy. Increased frequency of the INR (International Normalised Ratio) monitoring is required.
Concomitant use with immunosuppressive medicines (ciclosporine, tacrolimus, everolimus, sirolimus) should be taken into consideration because of an excessive immunodepression with risk of lymphoproliferation.
As with all vinca-alkaloids, a concomitant use with itraconazole increases neurotoxicity of vinca-alkaloids due to the decrease of their hepatic metabolism, therefore this combination is not recommended.
The combination of Navelbine with other drugs with known bone marrow toxicity is likely to exacerbate the myelosuppressive adverse effects.