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Etoposide

Class: Antineoplastic Agents
VA Class: AN900
Chemical Name: [5R-[5α,5aβ,8aα,9β(R*)]]-9-[4,6-O-ethylidene-β-d-glucopyranosyl)oxy]5,8,8a,9-tetrahydro-5-(4-hydroxy-3,5-dimethoxyphenyl)furo[3′,4′:6,7]naphtho[2,3-d]-1,3-dioxol-6(5aH)-one
Molecular Formula: C29H32O13
CAS Number: 33419-42-0
Brands: Etopophos, Toposar, VePesid

Medically reviewed by Drugs.com on Jun 29, 2022. Written by ASHP.

Warning

    Experience of Supervising Clinician
  • For administration only under the supervision of a qualified clinician experienced in the use of antineoplastic agents.

    Myelosuppression
  • Severe myelosuppression with resulting infection or bleeding may occur. (See Myelosuppression under Cautions.)

Introduction

Antineoplastic agent; semisynthetic podophyllotoxin-derivative.

Uses for Etoposide

Testicular Cancer

Component of various combination chemotherapeutic regimens for treatment of refractory testicular tumors in patients who have already received appropriate surgery, chemotherapy, and radiation therapy.

Component of various combination chemotherapeutic regimens with cisplatin for first-line treatment of stage III or unresectable stage II nonseminomatous testicular carcinoma and for chemotherapy-refractory disease.

Combination chemotherapy with etoposide, cisplatin, and bleomycin (BEP) is recommended for initial treatment of advanced nonseminomatous testicular carcinoma.

Component of a combination chemotherapeutic regimen (ifosfamide, cisplatin, and either etoposide or vinblastine) as second-line therapy for recurrent nonseminomatous testicular carcinoma.

Component of combination chemotherapeutic regimens (with cisplatin) for initial treatment of disseminated seminoma testis and treatment-refractory disease.

Component of combination chemotherapeutic regimens (usually with cisplatin) for initial treatment of advanced extragonadal germ-cell tumors.

Small Cell Lung Cancer

Component of a combination chemotherapeutic regimen with etoposide and cisplatin or carboplatin (PE) as a preferred first-line treatment of small-cell lung cancer.

In combination with ifosfamide with mesna and cisplatin (VIP) or carboplatin (ICE) as second-line therapy for the treatment of refractory small-cell lung cancer.

In combination with cyclophosphamide and doxorubicin (or vincristine) for treatment of extensive-stage disease.

Non-small Cell Lung Cancer

Combination chemotherapy with etoposide and cisplatin has been used for second-line treatment of advanced non-small cell lung cancer, but paclitaxel-containing or other platinum-based regimens currently are preferred.

Hodgkin’s Disease

Component of combination chemotherapeutic regimens for treatment of advanced or refractory Hodgkin’s lymphoma.

Non-Hodgkin’s Lymphoma

Component of various combination chemotherapeutic regimens for treatment of advanced non-Hodgkin’s lymphoma.

Component of combination chemotherapeutic regimens (e.g., etoposide, ifosfamide, and methotrexate) for treatment of advanced diffuse lymphomas of unfavorable histology (e.g., diffuse histiocytic lymphoma).

Cutaneous T-cell Lymphoma

Has been used with transient responses in patients with cutaneous T-cell lymphoma (mycosis fungoides).

Acute Myeloid Leukemia

Used alone and in various combination chemotherapeutic regimens for treatment of refractory acute myeloid (myelogenous, nonlymphocytic) leukemia (AML, ANLL) in adults and children.

Particularly effective for the treatment of acute monocytic and myelomonocytic leukemias; may be useful when monocytoid cells are not cleared with conventional combination chemotherapy.

Acute Lymphocytic Leukemia

Has been used alone and in combination chemotherapy for remission induction in refractory acute lymphocytic (lymphoblastic) leukemia (ALL) in a limited number of children; little, if any, activity in adults.

Wilms’ Tumor

Component of a combination chemotherapeutic regimen (e.g., carboplatin with etoposide) as second-line (salvage) therapy for treatment of recurrent (relapsed or refractory) Wilms’ tumor including recurrent tumors of unfavorable histology, abdominal recurrence after radiation therapy, or recurrence within 6 months of nephrectomy or after initial combination chemotherapy.

Alternative to standard preferred regimens in patients with less severe stages of Wilms’ tumor.

Second-line high-dose therapy followed by autologous bone marrow transplantation also has been used effectively in recurrent disease.

Offer patients with recurrent disease (i.e., salvage therapy failure) treatment under protocol conditions in ongoing clinical trials.

Neuroblastoma

Component of combination chemotherapeutic regimens (cyclophosphamide, doxorubicin, cisplatin, and/or etoposide or teniposide) as preferred first-line therapy for neuroblastoma.

Kaposi’s Sarcoma

Used alone or in combination chemotherapeutic regimens as second-line therapy for palliative treatment of AIDS-related Kaposi’s sarcoma.

Ovarian Cancer

Has been used orally as second-line therapy for advanced epithelial ovarian cancer.

Component of a combination chemotherapeutic regimen with bleomycin and cisplatin (BEP) as first-line therapy for ovarian germ cell tumors.

Other Uses

Component of alternating chemotherapeutic regimens (vincristine, doxorubicin and cyclophosphamide alternating with ifosfamide and mesna and etoposide) as first-line therapy for Ewing’s sarcoma.

Component of a chemotherapeutic regimen with methotrexate, dactinomycin, cyclophosphamide, and vincristine (EMA-CO), or with cisplatin as second-line therapy for gestational trophoblastic tumors (choriocarcinoma). Also has been used for treatment of chorioadenoma destruens.

May be useful for treatment of hepatoma.

May be useful as second-line therapy for treatment of rhabdomyosarcoma.

Etoposide Dosage and Administration

General

  • Consult specialized references for procedures for proper handling and disposal of antineoplastics. (See IV Administration under Dosage and Administration.)

Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer orally or IV.

Intraperitoneal and intrapleural administration is not recommended; delayed, severe (sometimes fatal) toxicity has occurred in animals following administration by these routes.

Observe closely for possible hypotensive or anaphylactoid reactions during administration of the drug. (See Hypotension and also see Sensitivity Reactions, under Cautions.)

Oral Administration

Administer etoposide capsules orally.

IV Administration

Administer diluted etoposide concentrate for injection by slow IV infusion.

Administer etoposide phosphate by IV infusion.

Use syringes with Luer-Lok fittings for handling of etoposide concentrate for injection; under pressure, needles have become displaced from etoposide-containing syringes without Luer-Lok fittings.

Plastic devices composed of acrylic or ABS (a polymer composed of acrylonitrile, butadiene, and styrene) may crack and leak when used with undiluted etoposide injection.

Etoposide solutions containing 0.1–0.4 mg/mL in 0.9% sodium chloride or 5% dextrose injection have been filtered through several commercially available filters (e.g., 0.22-µm Millex-GS or Millex-GV) without filter decomposition.

Reconstitution

Reconstitute vial containing 100 mg of etoposide phosphate powder with 5 or 10 mL sterile water for injection, 5% dextrose injection, 0.9% sodium chloride, bacteriostatic water for injection (with benzyl alcohol), or bacteriostatic sodium chloride for injection (with benzyl alcohol) to provide a solution containing 20 mg etoposide per mL (22.7 etoposide phosphate per mL) or 10 mg etoposide per mL (11.4 mg etoposide phosphate per mL), respectively.

May administer reconstituted etoposide phosphate with or without further dilution.

Dilution

Etoposide concentrate for injection must be diluted before administration.

Dilute required dose of concentrate for injection to a final concentration of 0.2 or 0.4 mg/mL in 0.9% sodium chloride or 5% dextrose injection.

Reconstituted etoposide phosphate solutions may be further diluted with either 5% dextrose injection or 0.9% sodium chloride injection to concentrations as low as 0.1 mg of etoposide per mL.

Rate of Administration

Do not administer etoposide solutions by rapid IV injection. (See Hypotension under Cautions.)

Administer etoposide IV infusions over at least 30–60 minutes to minimize the risk of hypotensive reactions. If hypotensive reaction occurs, use slower rate of infusion if restarting after discontinuance and appropriate treatment.

A longer duration of administration may be used if the volume of fluid to be infused is a concern.

Has been administered by continuous IV infusion over 5 days, but no therapeutic advantage with this method over intermittent IV infusions.

May administer etoposide phosphate solutions over 5–210 minutes.

Dosage

Available as etoposide and etoposide phosphate; dosage is expressed in terms of etoposide; 113.6 mg of etoposide phosphate is equivalent to 100 mg of etoposide.

Base dosage on the clinical and hematologic response and tolerance of the patient and whether or not other chemotherapy or radiation therapy has been or is also being used in order to obtain optimum therapeutic results with minimum adverse effects.

Consult published protocols for the dosage, method, and sequence of administration of etoposide and other chemotherapeutic agents used in combination chemotherapeutic regimens.

Do not administer a repeat course until the patient’s hematologic function is within acceptable limits.

Toxicity profile of etoposide phosphate infused at doses exceeding 175 mg/m2 has not been delineated.

Adults

Testicular Cancer
Induction of Remission for Refractory Testicular Neoplasms
IV

Combination chemotherapy regimens: Usually, 50–100 mg/m2 daily for 5 consecutive days every 3–4 weeks or 100 mg/m2 daily on days 1, 3, and 5 every 3–4 weeks, for 3 or 4 courses of therapy.

When the consecutive-day dosage regimen is employed, some clinicians administer etoposide for 3–5 days, depending on the patient’s hematologic tolerance.

Small Cell Lung Cancer
Oral

Twice the IV dosage rounded to the nearest 50 mg is recommended.

IV

Combination chemotherapy regimens: Usually, ranges from 35 mg/m2 daily for 4 consecutive days to 50 mg/m2 daily for 5 consecutive days, every 3–4 weeks.

Optimum duration not clearly defined; no additional improvement in survival when duration of therapy >3–6 months for limited-stage or >6 months for extensive-stage disease.

Kaposi’s Sarcoma
AIDS-Related Kaposi’s Sarcoma†
IV

150 mg/m2 daily for 3 consecutive days every 4 weeks; repeat cycles of therapy and reduce dosage as necessary depending on the patient’s response and the myelosuppressive effect of the drug.

Special Populations

Hepatic Impairment

Use with caution; consider the need for dosage reduction.

Renal Impairment

Clcr >50 mL/minute: no initial dose modification required.

Clcr 15–50 mL/minute: administer 75% of the initial recommended dose.

Clcr <15 mL/minute: consider further dose reduction; specific data are not available.

Base subsequent doses on patient tolerance and clinical effect.

Cautions for Etoposide

Contraindications

  • Known hypersensitivity to etoposide, etoposide phosphate, or any ingredient in the formulations.

Warnings/Precautions

Warnings

Myelosuppression

Risk of dose-limiting and potentially fatal myelosuppression, manifested commonly by leukopenia (principally granulocytopenia); thrombocytopenia and anemia may also occur. Severe myelosuppression with resulting infection or bleeding may occur.

Granulocyte and platelet nadirs usually occur within 7–14 and 9–16 days, respectively, after administration of etoposide, and within 12–19 and 10–15 days, respectively, after administration of etoposide phosphate; leukocyte nadir usually occurs within 15–22 days after administration of etoposide phosphate. Bone marrow recovery is usually complete within 20 days after administration, but may occasionally require longer periods.

Monitor hematologic function frequently during and after treatment. Perform CBC (leukocyte count with differential, platelet count, hemoglobin) prior to initiation of therapy, at appropriate intervals during the course of treatment (e.g., twice weekly), and before each subsequent course of treatment.

Suspend therapy if the platelet count is <50,000/mm3 or absolute neutrophil count is <500/mm3. Resume therapy when blood counts have returned to an acceptable level, if indicated.

If severe hematologic toxicity occurs, consider supportive therapy, antibiotics for complicating infections, and blood product transfusions.

Hypotension

Transient hypotension reported following rapid IV administration of etoposide.

Observe closely for possible hypotensive reactions.

Administer IV infusions slowly (i.e., over at least 30–60 minutes) to minimize the risk of hypotensive reactions.

Hypotension occurring during administration usually subsides with infusion discontinuance, administration of IV fluids or other supportive therapy as necessary.

Use slower rate of infusion if restarting after discontinuance and appropriate treatment.

Fetal/Neonatal Morbidity and Mortality

May cause fetal harm; teratogenicity and embryolethality demonstrated in animals. Avoid pregnancy during therapy. If used during pregnancy or if patient becomes pregnant, apprise of potential fetal hazard.

Carcinogenicity

Acute leukemia (with or without a preleukemic phase) has been reported rarely in patients receiving etoposide in association with other antineoplastic agents.

Animal studies to determine the carcinogenic potential of etoposide have not been performed to date; however, the drug should be considered a potential carcinogen.

Sensitivity Reactions

Hypersensitivity Reactions

Anaphylactoid reactions consisting principally of chills, rigors, diaphoresis, pruritus, loss of consciousness, nausea, vomiting, fever, bronchospasm, dyspnea, tachycardia, hypertension, and/or hypotension reported.

Observe closely for possible anaphylactic reactions.

Appropriate equipment for maintenance of an adequate airway and other supportive measures and agents for the treatment of these reactions should be readily available whenever etoposide is administered.

Stevens-Johnson syndrome, rash, pigmentation, urticaria, and severe pruritus occur infrequently.

If a hypersensitivity reaction occurs during administration, discontinue infusion and institute appropriate therapy (e.g., antihistamines, epinephrine, oxygen, corticosteroids) as necessary.

The role of infusion concentration or rate in the development of hypersensitivity reactions is uncertain.

General Precautions

Toxicity

Highly toxic drug with a low therapeutic index; therapeutic response is not likely to occur without some evidence of toxicity.

Administer only under constant supervision by clinicians experienced in therapy with cytotoxic agents and only when the potential benefits outweigh the possible risks.

Most adverse effects are reversible if detected promptly.

Discontinue or reduce dosage and institute appropriate measures as necessary when severe adverse effects occur.

Reinstitute therapy with caution, considering further need for the drug and possible toxicity recurrence.

Specific Populations

Pregnancy

Category D. (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

Lactation

Not known whether etoposide is distributed into milk. Discontinue nursing or the drug.

Pediatric Use

Safety and efficacy not established.

Higher rates of anaphylactoid reactions reported in children receiving infusions at higher than recommended concentrations. (See Hypersensitivity Reactions under Cautions.)

Has been used with encouraging results for refractory acute myelogenous leukemia, has shown some activity against refractory acute lymphocytic leukemia and other pediatric malignancies, but additional evaluation is needed.

Each mL of etoposide concentrate for injection contains 30 mg of benzyl alcohol. Although a causal relationship has not been established, injections preserved with benzyl alcohol have been associated with toxicity in neonates.

Concentrate for injection contains polysorbate 80A complex; potentially fatal syndrome (e.g., thrombocytopenia, ascites, and renal, pulmonary, and hepatic failure) has occurred in several premature infants who received a vitamin E product (IV) with polysorbate 80.

Hepatic Impairment

Effects of hepatic impairment on etoposide elimination have not been fully evaluated.

Toxicity of rapidly infused etoposide phosphate in hepatic impairment has not been adequately evaluated.

Use with caution, consider the need for dosage reduction; more severe hematologic toxicity reported with elevated serum bilirubin concentrations in one study. Some evidence of reduced total plasma clearance and elimination.

Renal Impairment

Dosage adjustments recommended based on degree of renal impairment. (See Renal Impairment under Dosage and Administration.)

Toxicity of rapidly infused etoposide phosphate in renal impairment has not been adequately evaluated.

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether safety and efficacy for treatment of testicular tumors in geriatric patients differ from safety and efficacy in younger adults.

Response in patients ≥65 years of age with small cell lung cancer similar to that in younger adults.

Substantially eliminated by kidneys; assess renal function periodically since geriatric patients more likely to have decreased renal function. Dosage adjustments may be required. (See Renal Impairment under Dosage and Administration.)

Geriatric patients may be particularly susceptible to etoposide-induced adverse effects.

Common Adverse Effects

Leukopenia, thrombocytopenia, neutropenia, anemia, nausea, vomiting, anorexia, mucositis, diarrhea, alopecia, asthenia/malaise, fatigue, chills and/or fever.

Interactions for Etoposide

Specific Drugs

Drug

Interaction

Comments

Antineoplastic agents (cisplatin, carmustine, cytarabine, cyclophosphamide)

Potential additive or synergistic antineoplastic activity

Cisplatin

Possible decreased etoposide elimination

Limited data, further documentation needed; consider potential effect when administering etoposide to patients who received prior cisplatin therapy

Cyclosporine (high-dose)

Possible decreased total body clearance of etoposide with concomitant use of oral etoposide and high-dose cyclosporine

Inhibitors of phosphatase activity (e.g., levamisole HCl)

Use caution with etoposide phosphate

Etoposide Pharmacokinetics

Absorption

Bioavailability

Oral capsules: about 50% (range: 25–75%).

Distribution

Extent

Not fully characterized. Following IV administration, distributed minimally into pleural fluid and has been detected in the saliva, liver, spleen, kidney, myometrium, healthy brain tissue, and brain tumor tissue.

Does not readily penetrate the CNS; variable CSF concentrations generally ranging from undetectable to <5% of concurrent plasma concentrations

Apparently crosses the placenta in animals, not known whether distributed into milk.

Plasma Protein Binding

Approximately 97% at 10 mcg/mL in vitro.

Elimination

Metabolism

Metabolized principally to inactive hydroxy acid (probably the trans-hydroxy acid).

Elimination Route

Following IV infusion, excreted principally (40–60%) in urine as unchanged drug (20–30% within 24 hours, 30–45% within 48 hours) and metabolites in 48–72 hours. 2–16% is excreted in feces within 72 hours; .

Following oral administration, about 5–25% of the dose is excreted in urine within 24–48 hours.

Half-life

Biphasic, may exhibit triphasic elimination with a prolonged terminal phase.

In adults, 0.6–2 hours (range: 0.2–2.5 hours) in the initial phase and 5.3–10.8 hours (range: 2.9–19 hours) in the terminal phase.

In children, 0.6–1.4 hours in the initial phase and 3–5.8 hours in the terminal phase.

Special Populations

The effects of renal impairment on elimination have not been fully evaluated, but a substantial fraction of the drug is excreted unchanged in urine; consider dosage reductions. (See Renal Impairment under Dosage and Administration.)

Stability

Storage

Oral

Capsules

2–8°C. Do not freeze. Stable for 2 years refrigerated at 2–8°C.

Parenteral

Etoposide Injection Concentrate for IV Infusion

Room temperature (25°C). Stable for 2 years unopened at room temperature.

Following dilution to concentrations of 0.2 or 0.4 mg/mL, stable for 96 or 24 hours, respectively, at 25°C under normal room fluorescent light in glass or plastic containers.

Etoposide Phosphate Lyophilized Powder for Injection

2–8°C; store in unopened vials in original package to protect from light; stable at least 36 months.

Following reconstitution, 10 or 20 mg/mL solutions of etoposide phosphate in sterile water for injection, 5% dextrose injection, or 0.9% sodium chloride injection, bacteriostatic water for injection (with benzyl alcohol) or bacteriostatic sodium chloride for injection (with benzyl alcohol) are stable for 7 days at 2–8°C in glass or plastic containers.

10 or 20 mg/mL solutions of etoposide phosphate in sterile water for injection, 5% dextrose injection, or 0.9% sodium chloride injection are stable for 24 hours at 20–25°C.

10 or 20 mg/mL solutions of etoposide phosphate in bacteriostatic water for injection (with benzyl alcohol) or bacteriostatic sodium chloride for injection (with benzyl alcohol) are stable for 48 hours at 20–25°C.

Etoposide phosphate solutions further diluted in 5% dextrose injection or 0.9% sodium chloride injection are stable for 24 hours at 2–8°C or 20–25°C.

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Injection Concentrate for IV Infusion

Crystallization in aqueous solutions appears to be concentration dependent and may occur following dilution because etoposide is sparingly soluble in water; discard if crystallization occurs.

Solutions of etoposide prepared at concentrations >0.4 mg/mL may precipitate; concentration >0.4 mg/mL not recommended.

1 mg/mL solutions in 5% dextrose injection or 0.9% sodium chloride have crystallized etoposide within 5 minutes upon stirring or within 30 minutes upon allowing the solution to stand; 1 mg/mL solutions not recommended.

Solution CompatibilityHID (etoposide)

Compatible

Dextrose 5% in water

Ringer’s injection, lactated

Variable

Sodium chloride 0.9%

Drug Compatibility (etoposide)
Admixture CompatibilityHID

Compatible

Carboplatin

Cisplatin

Cisplatin with cyclophosphamide

Cisplatin with floxuridine

Cytarabine with daunorubicin HCl

Floxuridine

Fluorouracil

Hydroxyzine HCl

Ifosfamide

Ifosfamide with cisplatin

Mitoxantrone HCl

Ondansetron HCl

Variable

Cisplatin with mannitol and potassium chloride

Doxorubicin HCl with vincristine sulfate

Y-Site CompatibilityHID

Compatible

Allopurinol sodium

Amifostine

Aztreonam

Cladribine

Doxorubicin HCl liposome injection

Fludarabine phosphate

Gemcitabine HCl

Granisetron HCl

Melphalan HCl

Methotrexate sodium

Micafungin sodium

Mitoxantrone HCl

Ondansetron HCl

Paclitaxel

Piperacillin sodium–tazobactam sodium

Sargramostim

Sodium bicarbonate

Teniposide

Thiotepa

Topotecan HCl

Vinorelbine tartrate

Incompatible

Filgrastim

Gallium nitrate

Idarubicin HCl

Solution CompatibilityHID (etoposide phosphate)

Compatible

Dextrose 5% in water

Sodium chloride 0.9%

Drug Compatibility (etoposide phosphate)
Admixture CompatibilityHID

Compatible

Doxorubicin HCl with vincristine sulfate

Y-Site CompatibilityHID

Compatible

Acyclovir sodium

Amikacin sulfate

Aminophylline

Ampicillin sodium

Ampicillin sodium–sulbactam sodium

Anidulafungin

Aztreonam

Bleomycin sulfate

Bumetanide

Buprenorphine HCl

Butorphanol tartrate

Calcium gluconate

Carboplatin

Carmustine

Caspofungin acetate

Cefazolin sodium

Cefotaxime sodium

Cefotetan disodium

Cefoxitin sodium

Ceftazidime

Ceftriaxone sodium

Cefuroxime sodium

Ciprofloxacin

Cisplatin

Clindamycin phosphate

Co-trimoxazole

Cyclophosphamide

Cytarabine

Dacarbazine

Dactinomycin

Daunorubicin HCl

Dexamethasone sodium phosphate

Diphenhydramine HCl

Dobutamine HCl

Dopamine HCl

Doripenem

Doxorubicin HCl

Doxycycline hyclate

Droperidol

Enalaprilat

Famotidine

Floxuridine

Fluconazole

Fludarabine phosphate

Fluorouracil

Furosemide

Ganciclovir sodium

Gemcitabine HCl

Gentamicin sulfate

Granisetron HCl

Haloperidol lactate

Heparin sodium

Hydrocortisone sodium succinate

Hydromorphone HCl

Hydroxyzine HCl

Idarubicin HCl

Ifosfamide

Leucovorin calcium

Linezolid

Lorazepam

Magnesium sulfate

Mannitol

Meperidine HCl

Mesna

Methotrexate sodium

Metoclopramide HCl

Metronidazole

Mitoxantrone HCl

Morphine sulfate

Nalbuphine HCl

Ondansetron HCl

Oxaliplatin

Paclitaxel

Piperacillin sodium–tazobactam sodium

Potassium chloride

Promethazine HCl

Ranitidine HCl

Sodium bicarbonate

Streptozocin

Teniposide

Thiotepa

Ticarcillin disodium–clavulanate potassium

Tobramycin sulfate

Vancomycin HCl

Vinblastine sulfate

Vincristine sulfate

Zidovudine

Incompatible

Amphotericin B

Cefepime HCl

Chlorpromazine HCl

Imipenem–cilastatin sodium

Methylprednisolone sodium succinate

Mitomycin

Prochlorperazine edisylate

Actions

  • Exact mechanism(s) of action is not known; apparently produces cytotoxic effects by damaging DNA and thereby inhibiting or altering DNA synthesis.

  • Induces single-stranded DNA breaks indirectly, possibly through endonuclease activation, inhibition of intranuclear type II topoisomerase, or formation of a free-radical metabolite via an enzymatic reaction involving the hydroxyl group at the C-4′ position of the E ring.

  • Cell-cycle dependent and cycle-phase specific, inducing G2-phase arrest, and preferentially killing cells in the G2 and late S phases.

  • At 0.3–10 mcg/mL in vitro, cells are inhibited from entering prophase; at concentrations of ≥10 mcg/mL, lysis of cells entering mitosis occurs. Does not inhibit microtubule assembly.

Advice to Patients

  • Importance of advising patients and/or their parents or guardians of adverse effects and associated manifestations.

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.

  • Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Etoposide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules, liquid-filled

50 mg

Etoposide Capsules

VePesid

Bristol-Myers Squibb

Parenteral

For injection concentrate, for IV infusion only

20 mg/mL (100, 150, 200, 250, and 500 mg)*

Etoposide for Injection

Toposar

Pfizer

VePesid

Bristol-Myers Squibb

20 mg/mL (1 g) pharmacy bulk package*

Etoposide for Injection

VePesid

Bristol-Myers Squibb

Etoposide Phosphate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

For injection

500 mg (of etoposide) pharmacy bulk package

Etopophos

Bristol-Myers Squibb

1 g (of etoposide) pharmacy bulk package

Etopophos

Bristol-Myers Squibb

For injection, for IV infusion

100 mg (of etoposide)

Etopophos

Bristol-Myers Squibb

AHFS DI Essentials™. © Copyright 2022, Selected Revisions July 9, 2013. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

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