Etoposide

About Etoposide

• Etoposide Phosphate was synthesized in 1966 and granted U.S. Food and Drug Administration approval in 1983, etoposide belongs to the class of mitotic inhibitors. 
• Etoposide, a topoisomerase inhibitor, is prescribed for patients with refractory testicular tumors in combination with other chemotherapeutic drugs and for small-cell lung cancer in combination with cisplatin as a first-line treatment. 
• Etoposide’s mechanism involves binding to topoisomerase II, preventing the re-ligation of broken DNA strands caused by the enzyme. 
• This action keeps DNA breaks in a state of disrepair, leading to a double-strand break that affects the cell negatively. 
• Cancer cells, which divide rapidly, heavily depend on this enzyme, making them more susceptible to errors in DNA synthesis and promoting apoptosis.

Strength: 

Etoposide injections are available in strengths of 114 mg.

Recommended Dosage:

Avoid administering Etoposide through bolus intravenous injection. Etoposide solutions can be delivered at infusion rates lasting up to 3.5 hours. Extravasation of Etoposide may lead to complications such as swelling, pain, cellulitis, and necrosis, including skin necrosis. Given its cytotoxic nature, adhere to specific handling and disposal procedures. To minimize the risk of dermal exposure, it is recommended to use gloves. In case of dermal contact, promptly wash the affected skin areas with soap and water and flush mucosa with water.

In patients with a creatinine clearance (CLcr) of 15-50 mL/min, administer 75% of the recommended dose. Further dose reduction may be considered for those with CLcr less than 15 mL/min.

• For refractory testicular tumors, the recommended dosage of Etoposide involves administering 50 to 100 mg/m2 per day intravenously over 5 minutes to 3.5 hours on days 1 through 5 of each 21-day (or 28-day cycle). 
• Alternatively, a dosage of 100 mg/m2 can be given intravenously over 5 minutes to 3.5 hours on days 1, 3, and 5 of each 21-day (or 28-day cycle).
• In the case of small cell lung cancer, the recommended Etoposide dose is either 35 mg/m2 per day administered intravenously over 5 minutes to 3.5 hours for 4 days or 50 mg/m2 per day administered intravenously over 5 minutes to 3.5 hours for 5 days.

Important:

Strict adherence to prescribed protocols plays a pivotal role in the administration of Etoposide 100mg treatment. Healthcare providers should vigilantly monitor and promptly manage any adverse reactions that may arise. Regular follow-up assessments, coupled with open and transparent communication, contribute to a responsible and effective approach. It is imperative to inform your doctor about any pre-existing conditions before initiating treatment to proactively address potential adverse effects.

Warnings & Precaution:

• Etoposide is not recommended for patients with a known history of severe hypersensitivity reactions to etoposide. 
• Vigilant monitoring for myelosuppression is crucial, necessitating complete blood counts before each treatment cycle and more frequent assessments as clinically indicated. 
• The risk of secondary leukemias is associated with prolonged use of Etoposide. 
• Additionally, hypersensitivity reactions, including the potential occurrence of anaphylaxis, may manifest. 
• Careful consideration of these contraindications and potential adverse effects is paramount in the decision-making process for Etoposide administration, ensuring patient safety and informed medical management.

Common Etoposide Side Effects:

• Neutropenia
• Nausea and vomiting (most common)
• Diarrhea
• Loss of appetite
• Constipation
• Mouth sores
• Dizziness
• Muscle and joint pain
• High blood pressure

Use in Specific Population

• Due to animal data and the drug’s mechanism, Etoposide poses a risk of fetal harm, advising women of childbearing potential to avoid pregnancy. 
• No information is available on etoposide in human milk; hence, breastfeeding is not recommended during Etoposide treatment. 
• Women of reproductive potential should use effective contraception during and for 6 months post-treatment. 
• Etoposide may harm spermatozoa, requiring males with fertile partners to use contraception for 4 months post-treatment. 
• In females, Etoposide may lead to infertility, amenorrhea, or premature menopause, with recovery linked to age. 
• In males, it may cause oligospermia, azoospermia, and permanent fertility loss. Normal sperm counts may return in some cases, even years after therapy. 
• Pediatric safety and effectiveness remain unestablished.

Storage and Handling

• Store unopened vials at 2° to 8°C (36°- 46°F). 
• Keep the vial in the outer carton to protect it from light. 
• Do not freeze the medicine. 
• Keep the medicine away from pets and children.