Etoposide Disease Interactions

Because of their cytotoxic effects on rapidly proliferating tissues, antineoplastic agents frequently can, to varying extent, induce myelosuppression. The use of these drugs may be contraindicated in patients with known infectious diseases. All patients should be instructed to immediately report any signs or symptoms suggesting infection such as fever, sore throat, or local infection during antineoplastic therapy. Close clinical monitoring of hematopoietic function is recommended.

Etoposide induces dose-related myelosuppression. Leukopenia, thrombocytopenia, and anemia have been reported during etoposide therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Therapy should be administered cautiously in patients whose bone marrow reserve may be severely depressed and should be withheld if an absolute neutrophil counts fall below 500/mm3 and/or platelet counts fall below 50,000/mm3. Clinical monitoring of hematopoetic function is recommended. Periodic complete blood counts should be done during the course of etoposide treatment and it should be performed prior to each cycle of therapy and at appropriate intervals during and after therapy. At least one determination should be done prior to each dose.

Etoposide is primarily eliminated by the kidney. Less than 50% is eliminated as unchanged drug in the urine. Reduced clearance, increased AUC, and decreased volume of distribution have been noted in patients with impaired renal function. Therapy should be administered cautiously and dosages reduced in patients with compromised renal function. Patients with a creatinine clearance between 15 to 50 mL/min should receive 75% of the recommended dosage of etoposide. Data are not available in patients with creatinine clearances <15 mL/min and further dosage reductions are recommended. Clinical monitoring of renal function is recommended.