Etoposide

Etoposide is a prescription medication used for the treatment of testicular cancer and small-cell lung cancer.

• Etoposide is available under the following different brand names: VePesid, Toposar, Etopophos, vp 16

Adult and pediatric dosage

Capsule

• 50mg

Injectable solution

• 20mg/mL

Powder for injection

• 100mg

Testicular Cancer

Adult dosage

• 50-100 mg/m²/day IV on days 1-5, OR  
• 100 mg/m²/day IV on days 1, 3, 5
• Repeat every 3-4 weeks

Small-Cell Lung Cancer

Adult dosage

• 35 mg/m²/day IV for 4 days, OR  
• 50 mg/m²/day IV for 5 days; repeat every 3-4 weeks

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Etoposide include:

• nausea, 
• vomiting,
• constipation,
• fever
• trouble swallowing, or
• unusual or unpleasant taste in the mouth.

Serious side effects of Etoposide include:

• sudden chest pain or discomfort, wheezing, dry cough or hack;
• easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under the skin;
• vision problems;
• seizure (convulsions);
• liver problems--loss of appetite, stomach pain (upper right side), tiredness, itching, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
• low red blood cells (anemia)--pale skin, unusual tiredness, feeling light-headed or short of breath, cold hands and feet; or
• low white blood cell counts--fever, mouth sores, skin sores, sore throat, cough, trouble breathing.

Rare side effects of Etoposide include:

• none 

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Etoposide has severe interactions with no other drugs.
• Etoposide has serious interactions with the following drugs:
  • abametapir
  • adenovirus types 4 and 7 live, oral
  • apalutamide
  • enzalutamide
  • erdafitinib
  • fexinidazole
  • idelalisib
  • influenza virus vaccine quadrivalent, adjuvanted
  • influenza virus vaccine trivalent, adjuvanted
  • ivosidenib
  • lonafarnib
  • nefazodone
  • palifermin
  • ropeginterferon alfa 2b
  • sotorasib
  • tepotinib
  • tucatinib
  • voxelotor
• Etoposide has moderate interactions with at least 113 other drugs.
• Etoposide has minor interactions with the following drugs:
  • artemether/lumefantrine
  • grapefruit
  • hydrocortisone
  • ruxolitinib
  • ruxolitinib topical

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• Hypersensitivity to etoposide or teniposide

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Etoposide?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Etoposide?”

Cautions

• Withhold further treatment if platelet is less than 50,000/mm³ or ANC less than 500/mm³
• Use caution in hepatic impairment
• Do NOT inject rapidly (may cause hypotension); infuse over at least 30-60 min
• Injection site reactions may occur during administration; monitor closely
• Avoid pregnancy
• May result in oligospermia, azoospermia, and permanent loss of fertility; sperm counts have been reported to return to normal levels in some men, and in some cases has occurred several years after the end of therapy; may damage spermatozoa and testicular tissue, resulting in possible genetic fetal abnormalities; males with female sexual partners of reproductive potential should use condoms during therapy and for at least 4 months after the final dose
• May cause infertility in females of reproductive potential and result in amenorrhea; premature menopause can occur; recovery of menses and ovulation is related to age at treatment; advise females of reproductive potential to use effective contraception during treatment for at least 6 months after the final dose
• Occurrence of acute leukemia with or without a preleukemic phase reported in rare instances in patients treated with etoposide alone or in association with other neoplastic agents; risk of development of preleukemic or leukemic syndrome unclear
• The prescriber must consider benefits versus risk of therapy; if severe reactions occur, the dose should be reduced or discontinued and appropriate corrective measures are taken; reinstitution of therapy should be carried out with caution and with adequate consideration of the further need for drug and alertness as to possible recurrence of toxicity
• Patients with low serum albumin may be at increased risk for etoposide associated toxicities
• Anaphylactic reaction manifested by chills, fever, tachycardia, bronchospasm, dyspnea, and hypotension reported; higher rates of anaphylactic-like reactions reported in children who received infusions of etoposide at concentrations higher than those recommended; the role that concentration of infusion (or rate of infusion) plays in the development of anaphylactic-like reactions is uncertain; treatment is symptomatic; infusion should be terminated immediately, followed by administration of pressor agents, corticosteroids, antihistamines, or volume expanders at the discretion of the physician
• Reversible cases of acute renal failure reported with administration of high dose (2220 mg/m²) with total body irradiation used for hematopoietic stem cell transplantation; the formulation contains dextran 40, which has been associated with acute renal failure when administered in high doses

Pregnancy and Lactation

• Based on animal data and its mechanism of action, etoposide can cause fetal harm when administered to a pregnant woman; etoposide, the active moiety of etoposide phosphate is teratogenic in mice and rats advise pregnant women of the potential hazard to a fetus; advise women of childbearing potential to avoid becoming pregnant
• Advise females of reproductive potential to use effective contraception during treatment and for 6 months after final dose In females of reproductive potential, may cause infertility and result in amenorrhea; premature menopause can occur; recovery of menses and ovulation is related to age at treatment

Lactation

• There is no information regarding the presence of etoposide in human milk or its effects on breastfed infant milk production; because of the potential for serious adverse reactions in nursing infants, advise women not to breastfeed during treatment with etoposide