etoposide

High Alert

Refractory testicular neoplasms (IV only) (used in combination with other chemotherapeutic agents in patients who have already received chemotherapy, surgery, or radiation).
Small cell lung carcinoma (PO and IV) (first-line therapy; used in combination with other chemotherapeutic agents).

Unlabeled Use:

Lymphomas and some leukemias.Uterine cancer.Brain tumors.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Pregnancy;
Lactation;
Known intolerance to ethyl alcohol or polysorbate 80 (IV only).

Use Cautiously in:

Patients with childbearing potential;
Active infections;
Decreased bone marrow reserve;
Renal/hepatic impairment (dose modification may be necessary);
Hypoalbuminemia;
Elderly (may be at increased risk of adverse effects);
Children (safety and effectiveness not established);
Other chronic debilitating illnesses.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension(IV)

Derm: alopecia, pruritis, rash, urticaria

Endo: sterility

GI: anorexia, diarrhea, nausea, vomiting, abdominal pain, stomatitis

Hemat: anemia, leukopenia, thrombocytopenia

Local: phlebitis at IV site

Neuro: drowsiness, fatigue, peripheral neuropathy

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.

Availability ⬆ ⬇

(Generic available)

Capsules: 50 mg
Injection: 20 mg/mL

Route/Dosage ⬆ ⬇

Other regimens are used

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

PO (Adults ): Dose ranges from 70 mg/m² daily for 4 days up to 100 mg/m² daily for 5 days (round dose to the nearest 50 mg); repeat at 3–4 wk intervals.
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.

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: Variably absorbed after oral administration (bioavailability ~50%). IV administration results in complete bioavailability.

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.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

(noted as effects on blood counts)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	7–14 days (granulocytes) 9–16 days (platelets)	20 days
IV	unknown	7–14 days (granulocytes) 9–16 days (platelets)	20 days

Patient/Family Teaching ⬆ ⬇

Instruct patient to take etoposide as directed, even if nausea or vomiting occurs. If vomiting occurs shortly after dose is taken, consult health care professional. If a dose is missed, do not take at all.
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.
Advise patient to use contraception.
Instruct patient not to receive any vaccinations without advice of health care professional.
Emphasize the need for periodic lab tests to monitor for side effects.

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Indications ⬇