ETOPOSIDE
(e-toe-po'side)
Etopophos, Toposar, VePesid, VP-16
Classifications: antineoplastic; mitotic inhibitor
Prototype: Vincristine
Pregnancy Category: D
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50 mg capsules; 20 mg/mL injection; 100 mg lyophilized powder for injection
Semisynthetic derivative of May apple plant. Produces cytotoxic action by unclear mechanism. Primary action is by arresting
G2 (resting or premitotic) phase of cell cycle; also acts on S phase of DNA synthesis. High doses cause lysis of cells entering
mitotic phase, and lower doses inhibit cells from entering prophase.
Antineoplastic effect is due to its ability to arrest mitosis (cell division).
Treatment of refractory testicular neoplasms, in patients who have already received appropriate surgical, chemotherapeutic,
and radiation therapy; for treatment of choriocarcinoma in women and small cell carcinoma of the lung.
Hodgkin's and non-Hodgkin's lymphomas, acute myelogenous (nonlymphocytic) leukemia.
Severe bone marrow depression; severe hepatic or renal impairment; existing or recent viral infection, bacterial infection;
intraperitoneal, intrapleural, or intrathecal administration. Safety during pregnancy (category D), lactation, or in children
is not established.
Impaired kidney or liver function; gout.
Testicular Carcinoma
Adult: IV 50–100 mg/m2/d for 5 consecutive days q3–4wk for 3–4 courses or 100 mg/m2 on days 1, 3, and 5 q3–4wk for 3–4 courses PO Twice the IV dose rounded to the nearest 50 mg
Small Cell Lung Carcinoma
Adult: IV 35 mg/m2/d for 4 consecutive days to 50 mg/m2/d for 5 consecutive days q3–4wk PO Twice the IV dose rounded to the nearest 50 mg
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Oral
- Oral dose is usually in the range of 70–100 mg/m2 daily, rounded to nearest 50 mg.
- Refrigerate capsules at 2°–8° C (36°–46° F) unless otherwise directed. Do not freeze.
Intravenous
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Note: Wear disposable surgical gloves when preparing or disposing of etoposide. Wash immediately with soap and water if skin comes
in contact with drug.
PREPARE: IV Infusion: Each 100 mg must be diluted with 250–500 mL of D5W or NS to produce final concentrations of 0.2–0.4 mg/mL.
ADMINISTER: IV Infusion: Give by slow IV infusion over 30–60 min to reduce risk of hypotension and bronchospasm. Before administration, inspect
solution for particulate matter and discoloration. Solution should be clear and yellow. If crystals are present, discard.
INCOMPATIBILITIES Y-site:
Amphotericin B,
cefepime,
chlorpromazine,
filgrastim,
idarubicin,
imipenem-cilastatin,
methylprednisolone,
mitomycin,
prochlorperazine.
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- Diluted solutions with concentration of 0.2 mg/mL are stable for 96 h, and the 0.4 mg/mL solutions are stable for 48 h under
normal room fluorescent light in glass or plastic (PVC) containers.
Body as a Whole: Hypersensitivity (sweating, chills, fever, coryza, tachycardia; throat, back and general body pain; abdominal cramps, flushing,
substernal chest pain, dyspnea, bronchospasm, pulmonary edema, anaphylactoid reaction). CNS: Peripheral neuropathy, paresthesias, weakness, somnolence, unusual tiredness, transient confusion. CV: Transient hypotension; thrombophlebitis with extravasation. GI:
Nausea, vomiting, dyspepsia, anorexia, diarrhea, constipation, stomatitis. Hematologic:
Leukopenia (principally granulocytopenia), thrombocytopenia,
severe myelosuppression, anemia, pancytopenia, neutropenia.
Respiratory: Pleural effusion, bronchospasm. Skin:
Reversible alopecia (can progress to total baldness); radiation recall dermatitis; necrosis, pain at IV site.
Drug:
anticoagulants, antiplatelet agents, nsaids, aspirin may increase risk of bleeding.
Absorption: Approximately 50% absorbed from GI tract. Peak: 1–1.5 h. Distribution: Variable penetration into CSF. Metabolism: Probably metabolized in liver. Elimination: 44–60% excreted in urine, 2–16% excreted in feces over 3 d. Half-Life: 5–10 h.
Assessment & Drug Effects
- Check IV site during and after infusion. Extravasation can cause thrombophlebitis and necrosis.
- Be prepared to treat an anaphylactoid reaction (see Appendix F). Stop infusion immediately if the reaction occurs.
- Monitor vital signs during and after infusion. Stop infusion immediately if hypotension occurs.
- Lab tests: Perform baseline all prior to and at regular intervals during therapy, and before each subsequent treatment course.
Tests include: CBC with differential; liver and kidney function tests (AST, ALT, serum bilirubin, LDH, BUN, serum creatinine).
- Withhold therapy when an absolute neutrophil count is below 500/mm3 or a platelet count below 50,000/mm3.
- Be alert to evidence of patient complaints that might suggest development of leukopenia (see Appendix F), infection (immunosuppression),
and bleeding.
- Protect patient from any trauma that might precipitate bleeding during period of platelet nadir particularly. Withhold invasive
procedures if possible.
Patient & Family Education
- Learn possible adverse effects of etoposide, such as blood dyscrasias, alopecia, carcinogenesis, before treatment begins.
- Make position changes slowly, particularly from lying to upright position because transient hypotension after therapy is possible.
- Inspect mouth daily for ulcerations and bleeding. Avoid obvious irritants such as hot or spicy foods, smoking, alcohol.
- Do not breast feed while taking this drug without consulting physician.
1%)
Canadian drug name; 
Prototype drug