Etoposide

What is Etoposide?

• Etoposide capsules (Vepesid), is a semisynthetic derivative of podophyllotoxin used in the treatment of certain neoplastic diseases.

Etoposide

Etoposide mechanism

Etoposide ball-and-stick

What are the uses of this medicine?

• Etoposide capsules (Vepesid), in combination with other approved chemotherapeutic agents as first line treatment in patients with small cell lung cancer.

How does this medicine work?

• Etoposide has been shown to cause metaphase arrest in chick fibroblasts.
• Its main effect, however, appears to be at the G2 portion of the cell cycle in mammalian cells.
• Two different dose dependent responses are seen.
• At high concentrations (10 mcg/mL or more), lysis of cells entering mitosis is observed. At low concentrations (0.3 mcg/mL to 10 mcg/mL), cells are inhibited from entering prophase.
• It does not interfere with microtubular assembly.
• The predominant macromolecular effect of etoposide appears to be the induction of DNA strand breaks by an interaction with DNA topoisomerase II or the formation of free radicals.

Who Should Not Use this medicine ?

This medicine cannot be used in patients who:

• have demonstrated a previous hypersensitivity to etoposide or any component of the formulation.

What drug interactions can this medicine cause?

• Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Be sure to mention any of the following:

• cisplatin (Platinol), cyclosporine (Gengraf, Neoral, Sandimmune).

Is this medicine FDA approved?

• Etoposide was approved for medical use in the United States in 1983.
• It is on the World Health Organization's List of Essential Medicines.

How should this medicine be used?

Recommended dosage:

• In small cell lung cancer, the recommended dose of etoposide capsules is two times the IV dose rounded to the nearest 50 mg (i.e., Two times 35 mg/m2/day for 4 days to 50 mg/m2/day for 5 days).

Administration:

• Etoposide comes as a capsule to take by mouth.
• It is usually taken once a day for 4 or 5 days in a row.
• This cycle may be repeated once every 3 to 4 weeks, depending on your response to the medication.
• The length of treatment depends on the types of drugs you are taking, how well your body responds to them, and the type of cancer you have.
• Take etoposide at around the same times every day.
• Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.
• Take etoposide exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As Etoposide Capsules, USP are available containing 50 mg of etoposide, USP.

This medicine is available in fallowing brand namesː

• Vepesid

What side effects can this medication cause?

The most common side effects of this medicine include:

• Leukopenia
• Thrombocytopenia
• Anemia
• Nausea and vomiting
• Abdominal pain
• Anorexia
• Diarrhea
• Stomatitis
• Alopecia
• Peripheral neurotoxicity
• Hypotension
• Allergic reaction
• Hypotension

Less common,but serious side effects may include:

• severe myelosuppression, neutropenic fever or sepsis and anaphylactic reactions.

What special precautions should I follow?

• Patients being treated with etoposide must be frequently observed for myelosuppression both during and after therapy. Therefore, the following studies should be obtained at the start of therapy and prior to each subsequent cycle of etoposide: platelet count, hemoglobin, white blood cell count and differential.
• Patients with low serum albumin may be at an increased risk for etoposide associated toxicities.
• It is not known whether this drug is excreted in human milk.
• Etoposide can cause fetal harm when administered to a pregnant woman. Women of childbearing potential should be advised to avoid becoming pregnant. If this drug is used during pregnancy, or if the patient becomes pregnant while receiving this drug, the patient should be warned of the potential hazard to the fetus.
• Etoposide is associated with an appreciable rate of serum enzyme elevations during therapy, and high doses have been implicated in causing clinically apparent acute liver injury including sinusoidal obstruction syndrome.

What to do in case of emergency/overdose?

• In case of overdose, call the poison control helpline of your country. In the United States, call 1-800-222-1222.

• Overdose related information is also available online at poisonhelp.org/help.
• In the event that the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services. In the United States, call 911.
• No proven antidotes have been established for etoposide overdosage.

Can this medicine be used in pregnancy?

• Pregnancy Category D.
• Etoposide can cause fetal harm when administered to a pregnant woman.
• Women of childbearing potential should be advised to avoid becoming pregnant. If this drug is used during pregnancy, or if the patient becomes pregnant while receiving this drug, the patient should be warned of the potential hazard to the fetus.

Can this medicine be used in children?

• Safety and effectiveness in pediatric patients have not been established.

What are the active and inactive ingredients in this medicine?

Active Ingredients:

• etoposide

Inactive Ingredients:

• anhydrous citric acid
• glycerin
• polyethylene glycol, unspecified
• gelatin, unspecified
• ferric oxide red
• titanium dioxide
• fd&c blue no. 1
• fd&c red no. 40
• hypromellose, unspecified
• propylene glycol

Who manufactures and distributes this medicine?

Manufactured for:

• Mylan Pharmaceuticals Inc.
• Morgantown, WV
• Made in Germany

What should I know about storage and disposal of this medication?

• Capsules are to be stored under refrigeration, between 2° to 8°C (36° to 46°F).
• Protect from freezing.
• Dispense in a tight, light-resistant container as defined in the USP using a child-resistant closure.

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• Dailymed label info on Etoposide
• FDA Etoposide

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