Home Drug Guide Vorinostat

Drug Guide

Generic Name

Vorinostat

Brand Names Zolinza

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Histone deacetylase inhibitor

FDA Approved Indications

  • Cutaneous manifestations of cutaneous T-cell lymphoma (CTCL) in patients with persistent, recurrent, or progressive disease after prior systemic therapies

Mechanism of Action

Vorinostat inhibits histone deacetylases (HDACs), leading to an accumulation of acetylated histones and other proteins, which results in an open chromatin structure and modulation of gene expression, ultimately inducing cell cycle arrest, apoptosis, and differentiation in cancer cells.

Dosage and Administration

Adult: 400 mg orally once daily with or without food, in 14-day cycles (14 days on, 14 days off).

Pediatric: Not approved for pediatric use.

Geriatric: No specific dosage adjustment based solely on age, but caution in elderly with comorbidities.

Renal Impairment: Use with caution; no specific dose adjustment recommended.

Hepatic Impairment: No specific recommendations; use caution.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed, crosses blood-brain barrier.

Metabolism: Primarily metabolized in the liver via glucuronidation and hydrolysis.

Excretion: Excreted mainly in feces and urine.

Half Life: approximately 2 hours.

Contraindications

  • Hypersensitivity to vorinostat or any component of the formulation.

Precautions

  • Use with caution in patients with bleeding disorders, thrombocytopenia, leukopenia, or impaired hepatic function. Monitor blood counts regularly.

Adverse Reactions - Common

  • Fatigue (Common)
  • Diarrhea (Common)
  • Nausea (Common)
  • Muscle weakness (Common)

Adverse Reactions - Serious

  • Serious infections (Less common)
  • Thrombocytopenia and leukopenia leading to bleeding or infection risk (Less common)
  • QT prolongation and cardiac arrhythmias (Less common)
  • Pulmonary embolism (Rare)

Drug-Drug Interactions

  • Anticoagulants (e.g., warfarin), drugs affecting blood counts, QT-prolonging agents.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor complete blood counts (CBC), liver function tests, and for signs of bleeding, infection, or cardiac arrhythmias.

Diagnoses:

  • Risk for bleeding, Infection, Fatigue related to medication effects.

Implementation: Administer as prescribed, monitor labs regularly, educate patient about signs of side effects.

Evaluation: Assess for therapeutic response and adverse effects, ensure labs remain within safe ranges.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report signs of infection, unusual bleeding, fatigue, or cardiac symptoms.
  • Avoid excessive sun exposure and inform about potential side effects.

Special Considerations

Black Box Warnings:

  • Myelosuppression (neutropenia, thrombocytopenia, anemia).
  • Potential for severe and fatal infections.

Genetic Factors: None specifically identified.

Lab Test Interference: None.

Overdose Management

Signs/Symptoms: Severe thrombocytopenia, neutropenia, infections, bleeding, arrhythmias.

Treatment: Supportive care, including blood product transfusions if needed, monitor cardiac status, and provide symptomatic management.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable when stored properly; check expiration date before use.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.