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Etoposide (Intravenous route)

Pronunciation:

e-TOE-poe-side

Brand Names:

  • Etopophos
  • Vepesid
  • Dom-Etoposide
  • Eposin
  • Etoposide
  • Pms-Etoposide

Dosage Forms:

  • Solution
  • Powder for Solution

Warnings:

Intravenous route(Solution)

Severe myelosuppression with resulting infection or bleeding may occur with etoposide .

Intravenous route(Powder for Solution)

Severe myelosuppression with resulting infection or bleeding may occur with etoposide phosphate .

Classifications:

Therapeutic—

Antineoplastic Agent

Pharmacologic—

Mitotic Inhibitor

Uses of This Medicine:

Etoposide injection (also known as VP-16) is used in combination with other cancer medicines to treat cancer of the testicles and small cell lung cancer. It is also sometimes used to treat some other kinds of cancer in both males and females.

Etoposide belongs to the group of medicines known as antineoplastic agents. The exact way that etoposide acts against cancer is not known. However, it seems to interfere with the growth of the cancer cells, which are eventually destroyed. Since the growth of normal body cells may also be affected by etoposide, other effects will also occur. Some of these may be serious and must be reported to your doctor. Other effects, like hair loss, may not be serious but may cause concern. Some effects may not occur until months or years after the medicine is used.

Before you begin treatment with etoposide, you and your doctor should talk about the benefits of this medicine as well as the risks of using it.

This medicine is to be administered only by or under the immediate supervision of your doctor.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, etoposide is used in certain patients with the following medical conditions:

  • Autoimmune deficiency syndrome (AIDS)—associated Kaposi's sarcoma (a type of cancer of the skin and mucous membranes that is more common in patients with AIDS).
  • Cancer in the bone.
  • Cancer of the adrenal cortex (the outside layer of the adrenal gland).
  • Cancer of the endometrium.
  • Cancer of the lung (a certain type of lung cancer usually associated with prior smoking, passive smoking, or radon exposure).
  • Cancer of the lymph system (a part of the body's immune system) that affects the skin.
  • Cancer of the ovaries (a type of cancer found in the egg-making cells).
  • Cancer of the stomach.
  • Cancer of unknown primary site.
  • Cancers of the blood and lymph system.
  • Cancers of the soft tissues of the body, including the muscles, connective tissues (tendons), vessels that carry blood or lymph, or fat.
  • Ewing's sarcoma (a type of cancer found in the bone).
  • Gestational trophoblastic tumors (tumors in the uterus or womb).
  • Hepatoblastoma (a certain type of liver cancer that occurs in children).
  • Multiple myeloma (a certain type of cancer of the blood).
  • Myelodysplastic syndromes (MDS).
  • Neuroblastoma (a cancer of the nerves that usually occurs in children).
  • Retinoblastoma (a cancer of the eye that usually occurs in children).
  • Thymoma (a cancer of the thymus, which is a small organ that lies under the breastbone).
  • Tumors in the brain.
  • Wilms' tumor (a cancer of the kidney that usually occurs in children).

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of etoposide injection in the pediatric population. Safety and efficacy have not been established.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of etoposide injection in the elderly. However, elderly patients are more likely to have unwanted side effects (e.g., infection, nausea and vomiting, hair loss), and have age-related kidney, liver, or heart problems, which may require caution in elderly patients receiving etoposide injection.

Pregnancy—

Pregnancy CategoryExplanation
All TrimestersDStudies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Rotavirus Vaccine, Live

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Adenovirus Vaccine Type 4, Live
  • Adenovirus Vaccine Type 7, Live
  • Aprepitant
  • Bacillus of Calmette and Guerin Vaccine, Live
  • Cyclosporine
  • Echinacea
  • Fosaprepitant
  • Glucosamine
  • Influenza Virus Vaccine, Live
  • Measles Virus Vaccine, Live
  • Mumps Virus Vaccine, Live
  • Rubella Virus Vaccine, Live
  • Smallpox Vaccine
  • St John's Wort
  • Typhoid Vaccine
  • Valspodar
  • Varicella Virus Vaccine
  • Warfarin
  • Yellow Fever Vaccine

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Grapefruit Juice

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Low serum albumin (protein in the blood)—May experience increased side effects.
  • Infection—Etoposide may decrease your body's ability to fight infection.
  • Kidney disease—Use with caution. The effects of etoposide may be increased because of slower removal from the body.

Proper Use of This Medicine:

A nurse or other trained health professional will give you this medicine in a hospital or cancer treatment center. This medicine is given through a needle placed in one of your veins. The medicine must be injected slowly, so your IV tube will need to stay in place for 30 to 60 minutes.

Etoposide is sometimes given together with certain other medicines. If you are using a combination of medicines, make sure that you take each one at the proper time and do not mix them. If you are taking some of these medicines by mouth, ask your doctor to help you plan a way to remember to take your medicines at the right times.

Etoposide often causes nausea, vomiting, and loss of appetite, which may be severe. However, it is very important that you continue to receive the medicine, even if you begin to feel ill. Ask your doctor for ways to lessen these effects.

Precautions While Using This Medicine:

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for unwanted effects.

Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.

Etoposide can temporarily lower the number of white blood cells in your blood, increasing the chance of your getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

  • If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or have painful or difficult urination.
  • Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in the urine or stools; or pinpoint red spots on your skin.
  • Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
  • Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
  • Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
  • Avoid contact sports or other situations where bruising or injury could occur.

This medicine may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Tell your doctor or nurse right away if you have chills; fever; lightheadedness, dizziness, or fainting; fast, pounding heartbeat; swelling of the face, tongue, and throat; or trouble with breathing after you receive the medicine.

Injection site reactions may occur while you are receiving this medicine. Tell your doctor right away if you notice swelling, pain, or redness at the injection site.

This medicine may cause leukemia (cancer of the blood or bone marrow) in rare cases. Talk with your doctor about any concerns you have about this.

Talk with your doctor before getting flu shots or other vaccines while you are receiving this medicine because there are certain vaccines that you should not receive.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common
Black, tarry stools
bleeding gums
blood in the urine or stools
chest pain
chills
cough
fever
painful or difficult urination
pale skin
pinpoint red spots on the skin
shortness of breath
sore throat
sores, ulcers, or white spots on the lips or in the mouth
swollen glands
troubled breathing with exertion
unusual bleeding or bruising
unusual tiredness or weakness
Less common
Blurred vision
confusion
cough or hoarseness, accompanied by fever or chills
difficulty with swallowing
dizziness
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
face is warm or hot to touch
fast heartbeat
headache
hives
itching
lower back or side pain, accompanied by fever or chills
nervousness
numbness or tingling in the fingers or toes
pain or redness at the site of injection
pale skin at the site of injection
pounding in the ears
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
redness to face
skin rash
slow or fast heartbeat
sweating
tightness in the chest
wheezing
Rare
Back pain
difficulty with walking
loss of consciousness
swelling of the face or tongue
tightness in the throat
Incidence not known
Abdominal or stomach pain, severe
blindness
blistering, peeling, or loosening of the skin
blue-yellow color blindness
dark urine
decreased vision
difficult with breathing
eye pain
joint or muscle pain
loss of appetite
nausea or vomiting
red, irritated eyes
red skin lesions, often with a purple center
seizures
yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
Bad, unusual, or unpleasant (after) taste
change in taste
constipation
cracked lips
hair loss or thinning of the hair
lack or loss of strength
swelling or inflammation of the mouth
weight loss

This medicine often causes a temporary loss of hair. After treatment with etoposide has ended, normal hair growth should return.

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Last Updated: 11/4/2014

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