ETOPOSIDE

ETOPOSIDE
Trade names: Toposar®, VePesid®, Etopophos®
Other name: VP-16, Etoposide phosphate

Drug type:
Etoposide is an antineoplastic or cytotoxic chemotherapy drug. This medication is classified as a
"plant alkaloid" and "topoisomerase II inhibitor" or podophyllotoxins. Plant alkaloids are made
from plants, also known as topoisomerase inhibitors. The plant alkaloids are cell-cycle
specific. This means they attack the cells during various phases of division.
Topoisomerase inhibitors (such as etoposide) are drugs that interfere with the action of
topoisomerase enzymes (topoisomerase I and II). Topoisomerase enzymes control the
manipulation of the structure of DNA necessary for replication.
 Topoisomerase I inhibitors: Ironotecan, topotecan

 Topoisomerase II inhibitors: Amsacrine, etoposide, etoposide phosphate, teniposide
Indications:
 Testicular, bladder, prostate, lung, stomach, and uterine cancers.

 Hodgkin's and non-Hodgkin's lymphoma, mycosis fungoides, Kaposi's sarcoma, Wilm's
tumor, rhabdomyosarcoma, Ewing's sarcoma, neuroblastoma, brain tumors.
 It also may be given as high-dose therapy in bone marrow transplant setting.
Composition:
Generic: 50 mg
Solution, Intravenous:
[contains alcohol, usp, polyethylene glycol 300, polysorbate 80]
Generic: 100 mg/5 mL (5 mL); 500 mg/25 mL (25 mL); 1 g/50 mL (50 mL)
BEP regimen: 100 mg/m2 on days 1 to 4 every 3 weeks (in combination with bleomycin and
cisplatin) for at least 2 treatment cycles after a normal hCG level
Route:
 In tablet form by mouth.

 IV as a short infusion or as a continuous infusion over 24 hours.
 Etoposide is considered an irritant. If the medication escapes from the vein it can cause
tissue damage.
 The amount of etoposide given depends on many factors, including height and weight,
general health or other health problems, and the type of cancer or condition being
treated.
Action:
 Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle
specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle
non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at
which they divide, and the time at which a given drug is likely to be effective. This is
why chemotherapy is typically given in cycles.
Distribution
Poor penetration across the blood-brain barrier; CSF concentrations <5% of plasma
concentrations.
Excretion
Children: IV: Urine (~55% as unchanged drug) in 24 hours
Adults: IV: Urine (56%; 45% as unchanged drug) within 120 hours; feces (44%) within 120
hours
Half-Life Elimination
Terminal: IV: Normal renal/hepatic function: Children: 6 to 8 hours: Adults: 4 to 11 hours
Side Effects:
Important things to remember about the side effects of etoposide:
 Most people do not experience all of the side effects listed.

 Side effects are often predictable in terms of their onset and duration.
 Side effects are almost always reversible and will go away after treatment is complete.
 There are many options to help minimize or prevent side effects.
 There is no relationship between the presence or severity of side effects and the
effectiveness of the medication.
 The side effects of etoposide and their severity depend on how much of the drug is
given. In other words, high doses may produce more severe side effects.
The following side effects are common (occurring in greater than 30%) for patients taking
etoposide:
 Low white blood cell count. (This can increase risk for infection).
 Low platelet count (This can increase risk of bleeding).
Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which
there is low blood counts.
Onset: 5-7 days
Nadir: 7-14 days
Recovery: 21-28 days
 Hair loss
 Menopause (chemotherapy induced)
 Loss of fertility.
 Nausea and vomiting (especially at high-doses)
 Low blood pressure (if the drug is infused too fast)
These side effects are less common, meaning they occur in 10-29 percent of patients
receiving etoposide:
 Mouth sores (especially at high doses)

 Diarrhea (especially at high doses)
 Poor appetite
 skin reactions
Other side effects:
 Metallic taste during infusion of drug.

 Inflammation at injection site.
 Peripheral neuropathy may occur with repeated doses. This is a rare side effect but can be
irreversible.
Delayed effects:
 There is a slight risk of developing leukemia years after taking etoposide.
Special Populations: Renal Function Impairment
Total body clearance is reduced, AUC is increased.
Precautions: Avoid
 aspirin, products containing aspirin.

 immunization or vaccination
 pregnancy
 breast feed
Health education:
 Apply warm compresses if any pain, redness or swelling at the IV site.

 Drink at least two to three quarts of fluid every 24 hours.
 Try to avoid crowds or people with colds, and report fever or any other signs of infection
immediately.
 Wash hands often.
 To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with
1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of
water.
 Use an electric razor and a soft toothbrush to minimize bleeding.
 Avoid contact sports or activities that could cause injury.
 To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat
small, frequent meals.
 Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
 In general, drinking alcoholic beverages should be kept to a minimum or avoided
completely.
 Get plenty of rest.
 Maintain good nutrition.
 Periodic blood work to monitor complete blood count (CBC) as well as the function of
other organs (such as your kidneys and liver).

ETOPOSIDE

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ETOPOSIDE

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ETOPOSIDE

Trade names: Toposar®, VePesid®, Etopophos®

Other name: VP-16, Etoposide phosphate

 Topoisomerase I inhibitors: Ironotecan, topotecan

 Testicular, bladder, prostate, lung, stomach, and uterine cancers.

 In tablet form by mouth.

Important things to remember about the side effects of etoposide:

 Most people do not experience all of the side effects listed.

 Mouth sores (especially at high doses)

Other side effects:

 Metallic taste during infusion of drug.

 There is a slight risk of developing leukemia years after taking etoposide.

Special Populations: Renal Function Impairment

Total body clearance is reduced, AUC is increased.

 aspirin, products containing aspirin.

 Apply warm compresses if any pain, redness or swelling at the IV site.

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