Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 10mg/mL
Dosage Forms & Strengths
injectable solution
- 10mg/mL
Acute Lymphoblastic Leukemia
165 mg/m² IV, in combo with cytarabine 300 mg/m² IV, twice/week for 8-9 doses, OR
250 mg/m² IV, in combo with vincristine 1.5 mg/m² IV, once/week for 4-8 weeks
Slow infusion (30-60 min)
Down syndrome patients: Decrease dose by half
Withhold treatment if platelets <50 K/mm³ or ANC <500/mm³
Monitor: BP
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Adverse Effects
>10%
Alopecia (31%)
Nausea (29%)
Vomiting (29%)
Neutropenia (95%)
Thrombocytopenia (85%)
Infection (12%)
1-10%
Hypersensitivity (5%)
Fever (3%)
Bleeding (5%)
Alopecia (9%)
Rash (3%)
Frequency Not Defined
Arrhythmia
Headache
Weakness
Renal dysfunction
Neuropathy
Tissue necrosis
Warnings
Black Box Warnings
The drug should be administered under the supervision of an experienced cancer chemotherapy physician in a facility equipped to diagnose and manage complications
Severe myelosuppression with resulting infection or bleeding may occur
Hypersensitivity reactions including anaphylaxis-like symptoms may occur with initial dosing or with repeated exposure to teniposide. Epinephrine, with or without corticosteroids and antihistamines, has been used to treat reaction symptoms.
Contraindications
Hypersensitivity to teniposide or castor oil
Platelets <50,000/mm³ or ANC <500/mm³
Cautions
Hypersensitivity reaction variably manifested by chills, fever, urticaria, tachycardia, bronchospasm, dyspnea, hypertension or hypotension, rash, and facial flushing may occur with any dose
Acute CNS depression and metabolic acidosis observed in patients receiving high-dose investigational infusions who were pretreated with antiemetic drugs; thought to be caused by the antiemetic depressant and the alcohol content of high-dose teniposide
Extravasation may cause local tissue necrosis or thrombophlebitis
Pregnancy & Lactation
Pregnancy Category: D; animal studies observed a decreased sperm count and genetic damage to sperm
Lactation: not known if excreted in breast milk
Pregnancy Categories
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Pharmacology
Mechanism of Action
Semisynthetic podophyllotoxin derivative
Inhibits topoisomerase II to cause DNA strand breaks, preventing mitosis
Absorption
Peak Plasma: 14.3 mcg/mL
Distribution
Protein Bound: >99%
Vd: 8-44 L/m² (adults); 3-11 L/m² (children)
Metabolism
Hepatic (major)
Elimination
Half-Life: 5 hr (children)
Clearance: 7-17 mL/min/sq.meter
Excretion: Urine (44%); feces (<10%)
Administration
IV Incompatibilities
Y-site: idarubicin
Additive, Syringe, Y-site: heparin
IV Preparation
Must be diluted with either D5W or NS to a final concentration of 0.1, 0.2, 0.4 or 1 mg/mL
To prevent extraction of the plasticizer DEHP, prepare solutions in non-DEHP-containing containers such as glass or polyolefin
PVC is not recommended
Administer 1 mg/mL solutions within 4 hr of preparation to reduce potential for precipitation
Precipitation may occur at any concentration
IV Administration
Irritant
Slow IV infusion over >30 min
Rapid infusion may cause hypotension or incr nausea & vomiting
Flush thoroughly before & after administration
Incompatible with heparin
Do not use in-line filter during IV infusion
Storage
Store ampules in refrigerator
Images
Patient Handout
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
