etoposide phosphate

Contraindicated in:

Hypersensitivity;
OB: Pregnancy and lactation;
Known intolerance to dextran.

Use Cautiously in:

OB: Patients with childbearing potential (may ↓ fertility in men and women);
Active infections;
↓bone marrow reserve;
Renal/hepatic impairment (dosage modification may be necessary);
Hypoalbuminemia;
Geri: May be at ↑ risk of adverse effects;
Pedi: Safety and effectiveness not established;
Other chronic debilitating illnesses.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypertension, hypotension

Derm: alopecia, pruritis, rash, STEVENS-JOHNSON SYNDROME, urticaria

Endo: sterility

GI: anorexia, mucositis, nausea, vomiting, abdominal pain, constipation, diarrhea, taste alteration

Hemat: leukopenia, ANEMIA, THROMBOCYTOPENIA

Local: phlebitis at IV site

Neuro: malaise, dizziness

Misc: ANAPHYLAXISALLERGIC REACTIONS INCLUDING, fever

Interactions ⬆ ⬇

Drug-drug:

↑bone marrow depression with other antineoplastics or radiation therapy.
May alter immune response to live-virus vaccines and ↑ risk of adverse reactions.
Phenytoin, phenobarbital, carbamazepine, and valproic acid may ↓ levels
May ↑ risk of bleeding with warfarin.

Availability ⬆ ⬇

Powder for injection: 100 mg/vial (with dextran)

Route/Dosage ⬆ ⬇

Other regimens are used. Doses below are (and should always be) expressed as the desired etoposide dose).

Testicular Neoplasms

IV (Adults ): Dose ranges from 50–100 mg/m² daily for 5 days up to 100 mg/m² daily on days 1, 3, and 5; repeat at 3–4 wk intervals.

Small-Cell Carcinoma of the Lung

IV (Adults ): Dose ranges from 35 mg/m² daily for 4 days up to 50 mg/m² daily for 5 days; repeat at 3–4 wk intervals.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Damages DNA before mitosis (cycle-dependent and phase-specific).

Therapeutic effects:

Death of rapidly replicating cells, particularly malignant ones.

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: podophyllotoxin derivatives

Pharmacokinetics ⬆ ⬇

Absorption: After IV administration, etoposide phosphate is rapidly converted to etoposide.

Distribution: Rapidly distributed; poorly enters the CSF; probably crosses placenta; enters breast milk.

Protein Binding: 97%.

Metabolism/Excretion: Some metabolism by the liver with biliary excretion, 44% excreted in feces; 45% excreted unchanged by the kidneys.

Half-Life: 4–11 hr.

Time/Action Profile ⬆ ⬇

(noted as effects on blood counts)

ROUTE	ONSET	PEAK	DURATION
IV	unknown	12–19 days (granulocytes) 10–15 days (platelets)	21 days

Patient/Family Teaching ⬆ ⬇

Explain the purpose of etoposide phosphate to patient.
Advise patient to notify health care professional if fever; chills; sore throat or other signs of infection; bleeding gums; bruising; petechiae; or blood in urine, stool, or emesis occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor. Caution patient not to drink alcoholic beverages or take products containing aspirin or NSAIDs.
Instruct patient to notify health care professional if rapid heartbeat, difficulty breathing, abdominal pain, yellow skin/eyes, weakness, paresthesia, or gait disturbances occur.
Instruct patient to inspect oral mucosa for redness and ulceration. If mouth sores occur, advise patient to use sponge brush and rinse mouth with water after eating and drinking. Viscous lidocaine swishes may be used if pain interferes with eating. Stomatitis pain may require treatment with opioid analgesics.
Discuss with patient the possibility of hair loss. Explore coping strategies.
Instruct patient not to receive any vaccinations without advice of health care professional.
Rep: Advise patient to use contraception. May result in oligospermia, azoospermia, and permanent loss of fertility in male patients. May damage spermatozoa and testicular tissue, resulting in possible genetic fetal abnormalities. Males with female sexual partners of reproductive potential should use condoms during therapy and for at least 4 mo after final dose. May cause infertility, premature menopause, and amenorrhea in female patients. Recovery of menses and ovulation is related to age at treatment. Advise females of reproductive potential to use effective contraception during therapy and for at least 6 mo after final dose.
Emphasize the need for periodic lab tests to monitor for side effects.

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Indications ⬇

Contraind./Precautions ⬆ ⬇