Classifications: antineoplastic; mitotic inhibitor; Therapeutic: antineoplastic, cell-cycle specific
Pregnancy Category: D
50 mg capsules; 20 mg/mL injection; 100 mg lyophilized powder for injection
Semisynthetic derivative of May apple plant. Produces cytotoxic action by arresting G2 (resting or premitotic) phase of cell cycle; also acts on S phase of DNA synthesis. High doses cause lysis of cells entering
mitotic phase, and lower doses inhibit cells from entering prophase.
Antineoplastic effect is due to its ability to arrest mitosis (cell division).
Treatment of refractory testicular neoplasms, in patients who have already received appropriate surgical, chemotherapeutic,
and radiation therapy; for treatment of choriocarcinoma in women and small cell carcinoma of the lung.
Hodgkin's and non-Hodgkin's lymphomas, acute myelogenous (nonlymphocytic) leukemia.
Severe bone marrow depression; severe hepatic or renal impairment; existing or recent viral infection, bacterial infection;
intraperitoneal, intrapleural, or intrathecal administration; pregnancy (category D), lactation. Safe use in children is not
Impaired kidney or liver function; gout; radiation therapy.
Route & Dosage
Adult: IV 100 mg/m2/d for 5 consecutive days or 100 mg/m2 on days 1, 3, and 5 q34wk for 34 courses PO Twice the IV dose rounded to the nearest 50 mg
Small Cell Lung Carcinoma
Adult: IV 35 mg/m2/d for 4 consecutive days to 50 mg/m2/d for 5 consecutive days q34wk PO Twice the IV dose rounded to the nearest 50 mg
Total bilirubin 1.53 mg/dL: decrease by 50%, 3.15 mg/dL: decrease by 75%, over 5 mg/dL hold dose
Clcr 4560 mL/min: reduce dose 15%; 3044 mL/min: reduce dose 20%; <30 mL/min: reduce dose 25%
- Oral dose is usually in the range of 70100 mg/m2 daily, rounded to nearest 50 mg.
- Refrigerate capsules at 2°8° C (36°46° F) unless otherwise directed. Do not freeze.
- Note: Wear disposable surgical gloves when preparing or disposing of etoposide. Wash immediately with soap and water if skin comes
in contact with drug.
PREPARE: IV Infusion: Etoposide concentration for injection: Each 100 mg must be diluted with 250500 mL of D5W or NS to produce final concentrations of 0.20.4 mg/mL. Etoposide phosphate: Add 5 or 10 mL of sterile water for injection, D5W, NS, bacteriostatic water for injection, or bacteriostatic NS for injection
to yield 20 or 10 mg/mL etoposide, respectively. May be given as prepared or further diluted to as low as 0.1 mg/mL in either
D5W or NS.
ADMINISTER: IV Infusion: Give by slow IV infusion over 3060 min to reduce risk of hypotension and bronchospasm. Before administration, inspect
solution for particulate matter and discoloration. Solution should be clear and yellow. If crystals are present, discard.
INCOMPATIBILITIES Y-site: Cefepime, filgrastim, gallium, idarubicin.
- Diluted solutions with concentration of 0.2 mg/mL are stable for 96 h, and the 0.4 mg/mL solutions are stable for 48 h under
normal room fluorescent light in glass or plastic (PVC) containers.
Adverse Effects (≥1%) Body as a Whole:
Hypersensitivity (sweating, chills, fever, coryza, tachycardia; throat, back and general body pain; abdominal cramps, flushing,
substernal chest pain, dyspnea, bronchospasm
, pulmonary edema, anaphylactoid reaction
Peripheral neuropathy, paresthesias, weakness, somnolence, unusual tiredness, transient confusion. CV:
Transient hypotension; thrombophlebitis with extravasation. GI: Nausea, vomiting,
dyspepsia, anorexia, diarrhea, constipation
, stomatitis. Hematologic: Leukopenia (principally granulocytopenia), thrombocytopenia, severe myelosuppression
, anemia, pancytopenia, neutropenia. Respiratory:
Pleural effusion, bronchospasm. Skin: Reversible alopecia
(can progress to total baldness); radiation recall dermatitis; necrosis, pain at IV site.
, antiplatelet agents
may increase risk of bleeding. Avoid concurrent use of live vaccines
Approximately 50% from GI tract. Peak:
11.5 h. Distribution:
Variable penetration into CSF. Metabolism:
In liver. Elimination:
4460% in urine, 216% in feces over 3 d. Half-Life:
Assessment & Drug Effects
- Check IV site during and after infusion. Extravasation can cause thrombophlebitis and necrosis.
- Be prepared to treat an anaphylactoid reaction (see Appendix F). Stop infusion immediately if the reaction occurs.
- Monitor vital signs during and after infusion. Stop infusion immediately if hypotension occurs.
- Lab tests: Perform baseline all prior to and at regular intervals during therapy, and before each subsequent treatment course.
Tests include: CBC with differential; liver and kidney function tests (AST, ALT, serum bilirubin, LDH, BUN, serum creatinine).
- Withhold therapy when an absolute neutrophil count is below 500/mm3 or a platelet count below 50,000/mm3.
- Be alert to evidence of patient complaints that might suggest development of leukopenia (see Appendix F), infection (immunosuppression),
- Protect patient from any trauma that might precipitate bleeding during period of platelet nadir particularly. Withhold invasive
procedures if possible.
Patient & Family Education
- Learn possible adverse effects of etoposide, such as blood dyscrasias, alopecia, carcinogenesis, before treatment begins.
- Make position changes slowly, particularly from lying to upright position because transient hypotension after therapy is possible.
- Inspect mouth daily for ulcerations and bleeding. Avoid obvious irritants such as hot or spicy foods, smoking, alcohol.