etoposide phosphate

Contraindicated in:

Hypersensitivity;
Known intolerance to dextran;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

;
Active infection;
↓bone marrow reserve;
Hypoalbuminemia;
Renal impairment (dosage modification may be necessary);
Hepatic impairment (dosage modification may be necessary);
Rep: Women of reproductive potential and men with female partners of reproductive potential;
Pedi: Safety and effectiveness not established in children;
Geri: Older adults may be at ↑ risk of adverse effects.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypertension, hypotension

Derm: alopecia, pruritus, rash, STEVENS-JOHNSON SYNDROME (SJS), urticaria

Endo: infertility

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

Hemat: leukopenia, ANEMIA, THROMBOCYTOPENIA

Local: phlebitis at IV site

Neuro: malaise, dizziness, dysgeusia

Misc: fever, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

↑risk of 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 and effectiveness.
May ↑ risk of bleeding with warfarin.

Availability ⬆ ⬇

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

Route/Dosage ⬆ ⬇

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

Testicular Neoplasms

IV (Adults ): 50–100 mg/m² once daily on Days 1–5 of each 21–day or 28–day cycle OR100 mg/m² once daily on Days 1, 3, and 5 of each 21–day or 28–day cycle.

Renal Impairment

IV (Adults ): CCr 15–50 mL/min: Administer 75% of recommended dose.

Small-Cell Carcinoma of the Lung

IV (Adults ): 35 mg/m² once daily for 4 days of each 21–day or 28–day cycle OR50 mg/m² once daily for 5 days of each 21–day or 28–day cycle. Adjuvant therapy for limited-stage disease, initiated within 8 wk of resection, should consist of 4 cycles of etoposide plus cisplatin or carboplatin. For extensive-stage disease, 4 to 6 cycles of chemotherapy are recommended

Renal Impairment

IV (Adults ): CCr 15–50 mL/min: Administer 75% of recommended dose.

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 to tissues; poorly enters the CSF.

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 ⬆ ⬇

(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 and side effects of etoposide phosphate to patient. Do not stop receiving drug without consulting health care provider. If an appointment is missed, reschedule as soon as possible. Advise patient to read Patient Information before starting and periodically during therapy in case of changes.
Explain need for continued medical follow-up to monitor progress and assess effectiveness and possible side effects of medication. Periodic lab tests will be needed.
Advise patient to notify health care professional if fever; chills; sore throat or other signs/symptoms of infection. Caution patient to avoid crowds and persons with known infections.
Tell patient to report and seek treatment for signs/symptoms of bleeding such as weakness, fast heart beat, trouble breathing, dizziness, pale skin, tiredness, obvious bleeding in urine, stool, mouth, gums, or nose. Instruct patient to use soft toothbrush and electric razor. Caution patient not to drink alcoholic beverages or take products containing aspirin or NSAIDs.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
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: May cause fetal harm. Advise women of reproductive potential to avoid pregnancy and breastfeeding during therapy during therapy. May cause infertility, premature menopause, and amenorrhea in women; recovery of menses and ovulation is related to age at treatment. May result in oligospermia, azoospermia, and permanent loss of fertility in men; may also damage spermatozoa and testicular tissue, resulting in possible genetic fetal abnormalities. Advise women of reproductive potential to use effective contraception during therapy and for ≥6 mo after final dose. Men with female sexual partners of reproductive potential should use condoms during therapy and for ≥4 mo after final dose.

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Indications ⬇

Contraind./Precautions ⬆ ⬇