etoposide (Rx)

Brand and Other Names:VePesid, Toposar, more...Etopophos, vp 16
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 50mg

injectable solution

  • 20mg/mL

powder for injection

  • 100mg
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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

Dosage Forms & Strengths

capsule

  • 50mg

injectable solution

  • 20mg/mL

powder for injection

  • 100mg
more...

AML Induction (Off-label)

<3 years: 3.3 mg/kg/day IV continuous infusion for 4 days  

≥3 years: 100 mg/m²/day IV continuous infusion for 4 days 

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Interactions

Interaction Checker

and etoposide

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            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

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            Warnings

            Black Box Warnings

            The drug should be administered under the supervision of an experienced cancer chemotherapy physician

            Severe myelosuppression, which could result in bleeding and infection, may occur

            Contraindications

            Hypersensitivity to etoposide or teniposide

            Cautions

            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

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            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.

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            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%)

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            Administration

            IV Incompatibilities (Etoposide)

            Y-site: cefepime, filgrastim, idarubicin

            IV Incompatibilities (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 conc 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

            IV Compatibilities (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 & 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/mLInfuse 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 lineEtoposide should be Y-sited into the port most proximal to ptAttach 0.22 micron filter to line after Y-site & before entry into pt

            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 e high potential for precipitation
            • Monitor for crystallization

            Etopophos

            • Infuse over 5-210 min

            Extravasation Management

            Tx necessary only if large amount of conc soln extravasates

            Terminate injection or infusion immediately & aspirate back as much as possible

            Apply warm pack for 15-20 min QID & elevate

            May cause phlebitis, urticaria or redness

            Storage

            Store intact vials at room temp & protected from light

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.