Home Drug Guide Etoposide

Drug Guide

Generic Name

Etoposide

Brand Names Vepesid, Toposar

Classification

Therapeutic: Antineoplastic

Pharmacological: Topoisomerase II inhibitor

FDA Approved Indications

  • Small cell lung cancer
  • Testicular cancer (non-seminomatous germ cell tumors)
  • Lymphomas (Hodgkin and non-Hodgkin)
  • Ovarian cancer

Mechanism of Action

Etoposide inhibits the enzyme topoisomerase II, leading to DNA breakage and apoptosis of rapidly dividing cancer cells.

Dosage and Administration

Adult: Dosage varies based on regimen and indication; typically 50-100 mg/m² IV once daily for 5 days in each cycle.

Pediatric: Dose varies; generally calculated based on body surface area, under specialist guidance.

Geriatric: Use with caution; consider renal and hepatic function.

Renal Impairment: Adjust dose based on renal function; careful monitoring recommended.

Hepatic Impairment: No specific adjustment recommended; monitor for toxicity.

Pharmacokinetics

Absorption: Moderate bioavailability when administered orally; IV preferred for precision.

Distribution: Widely distributed; crosses blood-brain barrier to some extent.

Metabolism: Metabolized in the liver via glucuronidation and oxidation.

Excretion: Excreted primarily in urine; small amount via feces.

Half Life: Approximately 4-5 hours.

Contraindications

  • Hypersensitivity to etoposide
  • Severe myelosuppression

Precautions

  • Monitor blood counts regularly
  • Use cautiously in patients with hepatic or renal impairment
  • Pregnancy category D: risk to fetus
  • Lactation: consider discontinuing breastfeeding

Adverse Reactions - Common

  • Myelosuppression (neutropenia, thrombocytopenia, anemia) (Very common)
  • Nausea and vomiting (Common)
  • Alopecia (Common)

Adverse Reactions - Serious

  • Secondary malignancies (leukemia) (Rare)
  • Severe myelosuppression leading to infection or bleeding (Serious and common)

Drug-Drug Interactions

  • Cytotoxic agents
  • Neurotoxic agents
  • Hepatotoxic drugs

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor CBC closely, assess for signs of infection, bleeding, or anemia.

Diagnoses:

  • Risk for infections
  • Impaired tissue perfusion
  • Potential for bleeding

Implementation: Administer IV as scheduled, monitor blood counts, assess for adverse effects.

Evaluation: Evaluate patient's blood counts and response to therapy; monitor for adverse reactions.

Patient/Family Teaching

  • Report signs of infections, such as fever or sore throat.
  • Use effective contraception during and for 6 months after therapy.
  • Avoid live vaccines during treatment.
  • Maintain good hygiene to reduce infection risk.
  • Report any unusual bleeding or bruising.

Special Considerations

Black Box Warnings:

  • Secondary leukemia (therapy-related acute myeloid leukemia)

Genetic Factors: No specific genetic markers influence dosing; monitor individual response.

Lab Test Interference: May cause false elevation in serum bilirubin and transaminases.

Overdose Management

Signs/Symptoms: Severe myelosuppression, mucositis, hypotension, hemorrhage

Treatment: Supportive care, monitor blood counts, consider use of hematopoietic growth factors; no specific antidote.

Storage and Handling

Storage: Store at 20-25°C (68-77°F) in original container, protected from light.

Stability: Stable for 24 months when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.