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.