Etoposide

Product: 
Etoposide
Formalary: 
Specialty Formalary
Category: 
Oncology
Trade Name: 
Etopophos
Packing: 
Capsule
Potency: 
25mg, 50mg, 100mg
In Treatment of: 
Etoposide is used as a form of chemotherapy for cancers such as Kaposi’s sarcoma, Ewing's sarcoma, lung cancer, testicular cancer, lymphoma, nonlymphocytic leukemia, and glioblastoma multiforme. It is often given in combination with other drugs (such as bleomycin in treating testicular cancer). It is also sometimes used in a conditioning regimen prior to a bone marrow or blood stem cell transplant.
Adverse Effects: 
Etoposide may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: 1. nausea 2. vomiting 3. sores in the mouth and throat 4. stomach pain 5. diarrhea 6. constipation 7. loss of appetite or weight 8. unusual tiredness or weakness 9. pale skin 10. fainting 11. dizziness 12. hair loss 13. pain, burning, or tingling in the hands or feet 14. eye pain 15. vision problems Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, stop taking etoposide and call your doctor immediately or get emergency medical treatment: 1. rash 2. hives 3. itching 4. difficulty breathing or swallowing 5. fast, irregular, or pounding heartbeat 6. seizures 7. yellowing of the skin or eyes Etopside may increase the risk that you will develop other cancers. Talk to your doctor about the risks of taking this medication. Etoposide may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
Contraindication: 
Etoposide is contraindicated in patients who have demonstrated a previous hypersensitivity to etoposide or any component of the formulation.
Special Precaution: 
Before taking etoposide, 1. tell your doctor and pharmacist if you are allergic to etoposide, any other medications, or any of the ingredients in etoposide capsules. Ask your pharmacist for a list of the ingredients. 2. tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: cisplatin (Platinol), cyclosporine (Gengraf, Neoral, Sandimmune). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with etoposide, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. 3. tell your doctor if you have or have ever had kidney disease. 4. tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. You should not become pregnant or breast-feed while you are taking etoposide. If you become pregnant while taking etoposide, call your doctor. Etoposide may harm the fetus.
Interaction: 
Caution should be exercised when administering ETOPOPHOS (etoposide phosphate) with drugs that are known to inhibit phosphatase activities (e.g., levamisole hydrochloride). High-dose cyclosporin A resulting in concentrations above 2000 ng/mL administered with oral etoposide has led to an 80% increase in etoposide exposure with a 38% decrease in total body clearance of etoposide compared to etoposide alone. Laboratory Tests Periodic complete blood counts should be done during the course of ETOPOPHOS (etoposide phosphate) treatment. They should be performed prior to each cycle of therapy and at appropriate intervals during and after therapy. Renal Impairment In patients with impaired renal function, the following initial dose modification should be considered based on measured creatinine clearance: MEASURED CREATININE CLEARANCE > 50 ML/MIN 15-50 ML/MIN etoposide 100% of dose 75% of dose Subsequent etoposide dosing should be based on patient tolerance and clinical effect. Equivalent dose adjustments of ETOPOPHOS (etoposide phosphate) should be used. Data are not available in patients with creatinine clearances < 15 mL/min and further dose reduction should be considered in these patients.
Dosages: 
Usual Adult Dose for Testicular Cancer (In combination with other approved chemotherapeutic agents) Initial dose: 50 to 100 mg/m² IV once a day on days 1 through 5 or 100 mg/m2 IV once a day on days 1,3 and 5. Usual Adult Dose for Small Cell Lung Cancer (In combination with other approved chemotherapeutic agents) Initial dose: 35 to 50 mg/m2 IV once a day for 4 to 5 days or 70 to 100 mg/m2 orally once a day for 4 to 5 days. Usual Adult Dose for Hodgkin's Disease (In combination with other chemotherapeutic agents as a part of the BEACOPP and EVA regimens) 100 mg/m2/day on days 1, 2, and 3 Total Dose/Cycle = 300 mg/m2 (In combination with other chemotherapeutic agents as a part of the mini-BEAM regimen) 75 mg/m2/day on days 2 through 5 Total Dose/Cycle = 300 mg/m2 (In combination with other chemotherapeutic agents as a part of the Stanford V regimen) 60 mg/m2/day on days 15 and 16 Total Dose/Cycle = 120 mg/m2 Usual Adult Dose for Ovarian Cancer For use in the treatment of epithelial ovarian cancer: 50 mg/m2 daily on days 1 through 21 For use in the treatment of germ cell ovarian cancer: (In combination with other approved chemotherapeutic agents as a part of the BEP regimen) 100 mg/m2 IV on days 1 through 5 Usual Geriatric Dose for Testicular Cancer The manufacturer has stated that clinical studies of etoposide for the treatment of refractory testicular tumors did not include sufficient numbers of patients aged 65 years or over to determine if they respond differently from younger patients. Usual Pediatric Dose for Malignant Disease Note: Oral doses are twice the IV doses listed below. Oral doses are to be administered once a day if <=400 mg. Divided doses are recommended if the dose exceeds 400 mg/day. 60 to 150 mg/m2/day IV for 2 to 5 days every 3 to 6 weeks. Remission induction for AML: 150 mg/m2/day IV for 2 to 3 days for 2 to 3 cycles. Intensification/Consolidation for AML: 250 mg/m2/day IV for 3 days, courses 2 to 5. Brain Tumor: 150 mg/m2/day IV on days 2 and 3. Neuroblastoma: 100 mg/m2/day IV over 1 hour on days 1 through 5 of the cycle, repeated every 4 weeks. High-dose conditioning regimen for allogenic BMT: 60 mg/kg/dose IV as a single dose. BMT conditioning regimen used in patients with rhabdomyosarcoma or neuroblastoma: IV continuous infusion: 160 mg/m2/day for 4 days. Renal Dose Adjustments CrCl less than 10 mL/min: Recommended to administer 50% of the normal dose. CrCl 10 to 50 mL/min: Recommended to administer 75% of the normal dose. Liver Dose Adjustments Bilirubin 1.5 to 3 mg/dL or AST 60 to 180 units: Recommended to administer 50% of the normal dose. Bilirubin 3 to 5 mg/dL or AST greater than 180 units: Recommended to administer 25% of the normal dose. Bilirubin greater than 5 mg/dL: Recommended not to use. Dose Adjustments The oral dose is twice the IV dose rounded to the nearest 50 mg and given in 2 divided doses if greater than 400 mg. Dosages of etoposide may vary based on specific indication for use and choice of cytotoxic agents coadministered. Reference to specific protocols is recommended. Dosages should be modified to take into account the myelosuppressive effects of other drugs in the combination or the effects of prior X-ray therapy or chemotherapy which may have compromised bone marrow reserve. Precautions Patients must be frequently observed for myelosuppression both during and after therapy. Dose-limiting bone marrow suppression is the most significant toxicity. The platelet count, hemoglobin, white blood cell count, and differential should be obtained at the start of therapy and prior to each subsequent dose. A platelet count less than 50,000 mm3 or an absolute neutrophil count less than 500/mm3 is an indication to withhold further therapy until the blood counts have sufficiently recovered. A neutrophil count less than 1,500/mm3 may also be an indication to postpone further therapy. A 50% decrease in dosage may be appropriate for patients with a serum bilirubin greater than 1.5 mg/dL. A 75% decrease in dosage may be appropriate with a serum bilirubin greater than 3 mg/dL. Safety and effectiveness have not been established in pediatric patients (less than 18 years of age). Dialysis A supplemental dose is not necessary with hemo- or peritoneal dialysis.

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