The effect of kidney dysfunction on the disposition of vinorelbine has not been studied, but dose reduction is not indicated because of the low degree of renal excretion. In patients with liver metastases changes only occurred in the mean clearance of vinorelbine when over 75 % of the liver was affected. In 6 cancer patients with moderate liver dysfunction (bilirubin ≤ 2 x ULN and aminotransferases ≤ 5 x ULN) treated with up to 25 mg/m² and 8 cancer patients with severe liver dysfunction (bilirubin > 2 x ULN and/or aminotransferases > 5 x ULN) treated with up to 20 mg/m², mean total clearance in the two groups were similar to that in patients with normal liver function. These data may however not be representative for patients with reduced capacity to eliminate the active substance via the liver and therefore caution is recommended in patients with severe hepatic impairment and careful monitoring of haematological parameters required (see sections and ).
--- Stress is often mentioned by CSS patients around the time of their diagnosis, and in a way this seems related to the adrenal glands as well. A patient in another support group reported reading in "The Stress of Life" by Dr. H. Seyle:.... "the adrenal glands are the processors of stress in our bodies. A person's stress resistance will vary with the competence of his adrenals. Continually stressing them, finally depletes them. When we become exhausted by life, on a mental or physical level, our adrenal glands often fail to keep up, and illness ensues".