Dosing & Uses
Dosage Forms & Strengths
capsule
- 50mg
injectable solution
- 20mg/mL
powder for injection
- 100mg
Testicular Cancer
50-100 mg/m²/day IV on days 1-5, OR
100 mg/m²/day IV on days 1, 3, 5
Repeat q3-4week
Small-Cell Lung Cancer
35 mg/m²/day IV for 4 days, OR
50 mg/m²/day IV for 5 days; repeat q3-4week
Monitor
CBC, Hgb, LFTs, renal function
Administration
Equivalent IV doses for etoposide & etoposide phosphate
PO: 2 times IV dose, rounded to nearest 50 mg
Renal Impairment
CrCl >50 mL/min: Dose adjustment not necessary
CrCl 15-50 mL/min: 75% of regular dose
CrCl < 15 mL/min: Not studied; consider further dose reductions
Hepatic Impairment
Not studied
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Adverse Effects
>10%
Leukopenia (60-91%)
Nausea and Vomiting (30-40%)
Thrombocytopenia (28-41%)
Alopecia (20-90%)
Anorexia (13%)
Diarrhea (13%)
Leukopenia (60-91%)
Anemia (≤33%)
1-10%
Pancytopenia (7%)
Stomatitis (6%)
Hepatic toxicity (3%)
Type 1 hypersensitivity (2%)
Orthostatic hypotension (1-2%)
Peripheral neuropathy (1-2%)
Frequency Not Defined
Malaise
Shivering
Asthenia
Fever
Mucous membrane inflammation
Hyperuricemia
Local soft tissue toxicity has been reported following extravasation; see section on IV information for extravasation management
Postmarketing Reports
Extravasation
Acute renal failure
Warnings
Contraindications
Hypersensitivity to etoposide or teniposide
Cautions
Therapy causes myelosuppression that results in thrombocytopenia and neutropenia; fatalinfections and bleeding have occurred; obtain complete blood counts prior to each cycle and more frequently as clinically indicated; withhold further treatment if platelet <50,000/mm³ or ANC <500/mm³
Use caution in hepatic impairment
Do NOT inject rapidly (may cause hypotension); infuse over at least 30-60 min
Injection site reactions may occur during administration; monitor closely
Avoid pregnancy
May result in oligospermia, azoospermia, and permanent loss of fertility; sperm counts have been reported to return to normal levels in some men, and in some cases has occurred several years after end of therapy; 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 months after final dose
May cause infertility in females of reproductive potential and result in amenorrhea; premature menopause can occur; recovery of menses and ovulation is related to age at treatment; advise females of reproductive potential to use effective contraception during treatment for at least 6 months after final dose
Occurrence of acute leukemia with or without a preleukemic phase reported in rare instances in patients treated with etoposide alone or in association with other neoplastic agents; risk of development of preleukemic or leukemic syndrome unclear
Prescriber must consider benefits versus risk of therapy; if severe reactions occur, dose should be reduced or discontinued and appropriate corrective measures taken; reinstitution of therapy should be carried out with caution, and with adequate consideration of further need for drug and alertness as to possible recurrence of toxicity
Patients with low serum albumin may be at increased risk for etoposide associated toxicities
Anaphylactic reaction manifested by chills, fever, tachycardia, bronchospasm, dyspnea, and hypotension reported; higher rates of anaphylactic-like reactions reported in children who received infusions of etoposide at concentrations higher than those recommended; the role that concentration of infusion (or rate of infusion) plays in development of anaphylactic-like reactions is uncertain; treatment is symptomatic; infusion should be terminated immediately, followed by administration of pressor agents, corticosteroids, antihistamines, or volume expanders at the discretion of the physician
Reversible cases of acute renal failure reported with administration of high dose (2220 mg/m²) with total body irradiation used for hematopoietic stem cell transplantation; the formulation contains dextran 40, which has been associated with acute renal failure when administered in high doses
Pregnancy & Lactation
Pregnancy
Based on animal data and its mechanism of action, etoposide can cause fetal harm when administered to a pregnant woman; etoposide, the active moiety of etoposide phosphate is teratogenic in mice and rats advise pregnant women of potential hazard to a fetus; advise women of childbearing potential to avoid becoming pregnant
Advise females of reproductive potential to use effective contraception during treatment and for 6 months after final dose In females of reproductive potential, may cause infertility and result in amenorrhea; premature menopause can occur; recovery of menses and ovulation is related to age at treatment
Lactation
There is no information regarding presence of etoposide in human milk or its effects on breastfed infant milk production; because of potential for serious adverse reactions in nursing infants, advise women not to breastfeed during treatment with etoposide
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
Appears to inhibit or alter DNA replication, induces G2-phase arrest & preferentially kills cells in G2 & late S phases
Pharmacokinetics
Bioavailability: 25-75%
Protein bound: 94-98%
Vd: 7-17 L/m²
Metabolism: Liver
Half-Life: 4-11 hr
Peak plasma time: 1 hr
Peak plasma concentration: 4.7 mcg/mL
Clearance: 13.4 mL/min
Excretion: Urine (35%)
Administration
IV Incompatibilities
Etoposide
- Y-site: cefepime, filgrastim, idarubicin
Etoposide PO4
- Y-site: amphotericin B, cefepime, chlorpromazine, imipenem-cilastatin, methylprednisolone, mitomycin, prochlorperazine
IV Compatibilities
Etoposide
- Additive: carboplatin, cisplatin, cisplatin/cyclophosphamide, cytarabine/daunorubicin, doxorubicin/vincristine (may lose some compatibility at high concentration of all 3 drugs), floxuridine, fluorouracil, hydroxyzine, ifosfamide, mitoxantrone, ondansetron
- Y-site: allopurinol, amifostine, aztreonam, cladribine, doxorubicin liposomal, fludarabine, melphalan, methotrexate, mitoxantrone, ondansetron, paclitaxel, piperacillin-tazobactam, sargramostim, NaHCO3, teniposide, thiotepa, topotecan, vinorelbine
Etoposide PO4
- Additive: doxorubicin/vincristine
- Y-site (partial list): acyclovir, amikacin, ampicillin, ampicilin-sulbactam, most cephalosporins (except cefepime), cisplatin, ciprofloxacin, clindamycin, cytarabine, cyclophosphamide, dactinomycin, daunorubicin, diphenhydramine, dobutamine, dopamine, doxorubicin, droperidol, fluconazole, fluorouracil, furosemide, heparin, idarubicin, linezolid, MgSO4, methotrexate, metoclopramide, mitoxantrone, morphine, ondansetron, paclitaxel, KCl, NaHCO3, vancomycin, vinblastine, vincristine, zidovudine
IV Preparation
VePesid, Toposar & equivalents
- Concs >0.4 mg/mL are very unstable
- Lower dose regimens (<1 g/dose): doses may be diluted in 100-1000 mL of D5W or NS
- High dose regimens (>1 g/dose): draw total dose into an empty Viaflex container and add appropriate amount of diluent for a final concentration of 1 mg/mL
-
High dose, 2-Channel Pump Method
- Instill all of the etoposide dose into one Viaflex container for a concentration of 20 mg/mL
- Infuse this into one channel (any 2-channel infusion pump that does not require a hard plastic cassette)
- Infuse indicated diluent (D5W or NS) at least 20x infusion rate of etoposide to simulate a 1 mg/mL concentration in the line
- Etoposide should be Y-sited into the port most proximal to patient
- Attach 0.22 micron filter to line after Y-site and before entry into patient
Etopophos
- Reconstitute to 10-20 mg/mL with any one of: D5W; NS; SWI; BWI; bacteriostatic NS
- May be further diluted down to 0.1 mg/mL with NS or D5W
IV Administration
VePesid, Toposar & equivalents
- Administer lower doses IVPB over at least 30 min to minimize the risk of hypotensive reactions
- Administer high doses via 2-channel pump method; in-line 0.22 micron filter should be attached to ALL etoposide infusions due to the high potential for precipitation
- Monitor for crystallization
Etopophos
- Infuse over 5-210 min
Extravasation Management
Treatment necessary only if large amount of conc soln extravasates
Terminate injection or infusion immediately and aspirate back as much as possible
Apply warm pack for 15-20 min QID and elevate
May cause phlebitis, urticaria or redness
Storage
Store intact vials at room temp and protected from light
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Toposar intravenous - | 20 mg/mL vial |  | |
| Toposar intravenous - | 20 mg/mL vial |  | |
| Toposar intravenous - | 20 mg/mL vial |  | |
| etoposide intravenous - | 20 mg/mL vial |  | |
| etoposide intravenous - | 20 mg/mL vial |  | |
| etoposide intravenous - | 20 mg/mL vial |  | |
| etoposide intravenous - | 20 mg/mL vial |  | |
| etoposide intravenous - | 20 mg/mL vial |  | |
| etoposide intravenous - | 20 mg/mL vial |  | |
| etoposide intravenous - | 20 mg/mL vial |  | |
| etoposide intravenous - | 20 mg/mL vial |  | |
| etoposide intravenous - | 20 mg/mL vial |  | |
| etoposide oral - | 50 mg capsule |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
etoposide intravenous
ETOPOSIDE - INJECTION
(e-TOE-poe-side)
COMMON BRAND NAME(S): Toposar
WARNING: This medication may cause certain severe blood and bone marrow problems (low red blood cells/white blood cells/platelets). This can affect your body's ability to stop bleeding or fight infection. Tell your doctor right away if you develop unusual tiredness, signs of infection (such as sore throat that doesn't go away, fever, chills), or easy bruising/bleeding (such as black stools, bloody vomit).
USES: Etoposide is used to treat testicular cancer and certain forms of lung cancer (such as small cell lung cancer). Etoposide works by slowing the growth of cancer cells.
HOW TO USE: This medication is given by slow injection into a vein by a health care professional. It is given as directed by your doctor, usually over 30 to 60 minutes every day or every other day for a total of 3 to 5 doses. This cycle may be repeated every 3 to 4 weeks.This medication may cause low blood pressure. Tell your doctor or other health care professional if you feel dizzy. Your injection may need to be stopped or given more slowly.The dosage is based on your medical condition, body size, and response to treatment. Your doctor will check your blood counts to make sure you can receive your next cycle. Keep all regular medical and laboratory appointments.
SIDE EFFECTS: See also Warning and How to Use sections.Nausea, vomiting, diarrhea, dizziness, tiredness, weakness, changes in taste, loss of appetite, and pain/redness at the injection site may occur. Nausea and vomiting can be severe. In some cases, your doctor may prescribe medication to prevent or relieve nausea and vomiting. Eating several small meals, not eating before treatment, or limiting activity may help lessen some of these effects. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Temporary hair loss may occur. Normal hair growth should return after treatment has ended.Pain or sores in the mouth and throat may occur. Brush your teeth carefully/gently, avoid using mouthwash that contains alcohol, and rinse your mouth frequently with cool water mixed with baking soda or salt. It may also be best to eat soft, moist foods.Many people using this medication may have serious side effects. However, you have been prescribed this drug because your doctor has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.Tell your doctor right away if you have any serious side effects, including: numbness/tingling of arms/legs, sudden vision changes, eye pain, stomach/abdominal pain, yellowing eyes/skin, dark urine, painful/difficult swallowing, redness/swelling of your veins.This medication may lower your ability to fight infections. This may make you more likely to get a serious (rarely fatal) infection or make any infection you have worse. Tell your doctor right away if you have any signs of infection (such as sore throat that doesn't go away, fever, chills, cough).Although etoposide may be used to treat certain leukemias, it may rarely cause acute leukemia. Ask your doctor for more details.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing, fast heartbeat, seizures.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using etoposide, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood problems (such as low red blood cells/white blood cells/platelets), liver disease, kidney disease, previous radiation/chemotherapy treatment, heart problems.Etoposide can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Consult your doctor if you have been exposed to an infection or for more details.Tell your health care professional that you are using etoposide before having any immunizations/vaccinations. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Daily use of alcohol while using this medicine may increase your risk for stomach bleeding. Ask your doctor or pharmacist about how much alcohol you may safely drink.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Children may be more sensitive to the side effects of this drug, especially allergic effects.Older adults may be more sensitive to the side effects of this drug, especially drowsiness, weakness, mouth/throat sores, loss of appetite, low white blood cells, and dehydration.This medication can affect fertility in both males and females. Ask your doctor for more details.Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using etoposide. Etoposide may harm an unborn baby. Women should ask about reliable forms of birth control while using this medication and for 6 months after stopping treatment. Men should ask about reliable forms of birth control while using this medication and for 4 months after stopping treatment. If you or your partner becomes pregnant, talk to your doctor right away about the risks and benefits of this medication.This medication passes into breast milk. Because of the possible risk to the infant, breast-feeding while using etoposide is not recommended. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Lab and/or medical tests (such as complete blood count, kidney/liver function) should be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule.
STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).
Information last revised December 2022. Copyright(c) 2022 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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