Generic Name

Etoposide Phosphate

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Classification

FDA Approved Indications

• Treatment of certain types of cancers such as small cell lung cancer, testicular cancer, ovarian cancer, and other malignancies as determined by the physician.

Mechanism of Action

Etoposide inhibits the enzyme topoisomerase II, leading to DNA damage and apoptosis in rapidly dividing cells, thereby exerting its anticancer effects.

Dosage and Administration

Adult: Dosage varies based on the specific indication, often given as an intravenous infusion; typical doses range from 50 to 100 mg/m² per day for 3 to 5 days per cycle.

Pediatric: Dose individualized based on body surface area and clinical condition; consult specific pediatric guidelines.

Geriatric: Use with caution; assume increased risk of toxicity due to decreased organ function and comorbidities.

Renal Impairment: Adjust dose based on renal function; specific guidelines are recommended.

Hepatic Impairment: Use with caution; no specific dosage adjustments are well established.

Pharmacokinetics

Absorption: Administered intravenously; not relevant for oral absorption.

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

Metabolism: Partially metabolized in the liver to inactive metabolites.

Excretion: Primarily excreted via the urine.

Half Life: Approximate half-life ranges from 4 to 12 hours, depending on individual patient factors.

Contraindications

• Hypersensitivity to etoposide or related compounds.
• Patients with severe myelosuppression.

Precautions

• Use cautiously in patients with impaired bone marrow function, infections, or who are receiving other myelosuppressive treatments.
• Monitor blood counts regularly.
• Pregnancy category D: risk to fetus; use contraception during treatment.

Adverse Reactions - Common

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

Adverse Reactions - Serious

• Secondary leukemias (therapy-related AML or meningeal leukemia) (Rare)
• Severe hypersensitivity reactions (Rare)
• Hepatic toxicity (Rare)

Drug-Drug Interactions

• Corticosteroids, other myelosuppressive drugs, live vaccines.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Report signs of infection, bleeding, or unusual symptoms immediately.
• Use precautions to prevent infection. Follow specific instructions for hydration and managing side effects.
• Avoid live vaccines during therapy.
• Ensure adequate nutrition and rest.

Special Considerations

Black Box Warnings:

• Secondary malignancies, including therapy-related AML or acute leukemia.

Genetic Factors: N/A

Lab Test Interference: N/A

Overdose Management

Signs/Symptoms: Severe bone marrow suppression, mucositis, nausea, vomiting.

Treatment: Supportive care including growth factors, transfusions, and symptomatic management; no specific antidote.

Storage and Handling

Storage: Store at room temperature away from moisture and light.

Stability: Stable when stored properly; discard after the expiration date.