Class: Podophyllotoxin derivative
- Injection, concentrate 50 mg per 5 mL
Teniposide is a phase-specific cytotoxic drug, acting in the late S or early G 2 phase of the cell cycle, thus preventing cells from entering mitosis. Teniposide causes single- and double-stranded breaks in DNA and DNA-protein cross-links. The mechanism of action appears to be related to the inhibition of type II topoisomerase activity.
The volume of distribution is 3 to 11 L in children and 8 to 44 L/m 2 in adults. Teniposide is highly protein bound (greater than 99%).
Teniposide half-life is about 5 h. Total body Cl is approximately 25%; 44% is recovered in urine within 120 h after dosing, and 0% to 10% is recovered in feces after 72 h.
Special PopulationsHepatic Function Impairment
Exercise caution in patients with hepatic function impairment.
Indications and Usage
In combination with other approved anticancer agents, indicated for induction therapy in patients with refractory childhood lymphoblastic leukemia.
Adult acute lymphocytic leukemia, non-Hodgkin lymphoma.
Hypersensitivity to teniposide or Cremophor EL (polyoxyethylated castor oil).
Dosage and Administration
IV Teniposide 165 mg/m 2 and cytarabine 300 mg/m 2 twice weekly for 8 to 9 doses or, in patients refractory to vincristine/prednisone-containing regimens, teniposide 250 mg/m 2 (in combination with vincristine 1.5 mg/m 2 ) IV weekly for 4 to 8 wk and prednisone 40 mg/m 2 orally for 28 days.Renal or hepatic function impairment
Dosage adjustments may be necessary in patients with renal or hepatic impairment.
- Contact of undiluted teniposide with plastic equipment or devices to prepare solutions for infusions may result in softening or cracking and possible drug product leakage. This has not been reported with diluted solutions.
- Dilute with either dextrose 5% injection or sodium chloride 0.9% injection.
- Administer over at least a 30- to 60-min period.
Store refrigerated at 36° to 46°F. Protect form light. Diluted solutions in concentrations of 0.1, 0.2, or 0.4 mg/mL are stable at room temperature for up to 24 hours after preparation. Solutions prepared at a final concentration of 1 mg/mL should be administered within 4 h of preparation.
Teniposide plasma concentrations may be reduced, decreasing the efficacy.Methotrexate
Plasma Cl of methotrexate may be slightly increased.Phenytoin
May increase Cl of teniposide, resulting in decreased therapeutic effects.Sodium salicylate, sulfamethizole, and tolbutamide
May displace protein bound teniposide.
Laboratory Test Interactions
None well documented.
Alopecia (9%); rash (3%).
Mucositis (76%); diarrhea (33%); nausea/vomiting (29%).
Neutropenia (95%); leukopenia (89%); anemia (88%); thrombocytopenia (85%); nospecified myelosuppression (75%); bleeding (5%).
Hypersensitivity reactions characterized by bronchospasm, chills, dyspnea, fever, flushing, hypertension or hypotension, and tachycardia (5%).
Infection (12%); fever (3%).
Severe cases resulting in infection or bleeding may occur.Hypersensitivity
Reactions, including anaphylaxis-like symptoms, may occur with initial or repeated exposure.Administration
Administer under the supervision of a qualified health care provider experienced in use of cancer chemotherapeutic agents.
Perform CBCs and assess renal and hepatic function prior to and periodically during treatment.
Category D .
Studies involved 303 patients (age range, 0.5 mo to 20 yr of age) who received teniposide as a single agent.
Hypersensitivity reactions to polyoxyethylated castor oil have been reported.
Dosage reduction is advised in patients with renal function impairment. Specific recommendations are currently unavailable.
Exercise caution in patients with hepatic dysfunction. Dosage reduction is advised in patients with hepatic function impairment. Specific recommendations are currently unavailable.
Special Risk Patients
Patients with both Down syndrome and leukemia may be especially sensitive to myelosuppressive chemotherapy; therefore, reduce the initial dose of teniposide in these patients.
Anaphylaxis manifested by chills, fever, tachycardia, bronchospasm, dyspnea, facial flushing, hypertension, or hypotension may occur.
Injection solution contains benzyl alcohol as a preservative, which has been associated with a fatal gasping syndrome in premature infants.
Local irritation or phlebitis may occur. Refer to your institution-specific protocol.
Administer by slow IV infusion because hypotension may occur with rapid IV injection.
Bone marrow suppression.
- Contraceptive measures are recommended during treatment.
- Notify health care provider of the following: chills; difficult breathing; fever; rapid heartbeat.
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