Also found in: Dictionary.
trademark for a preparation of etoposide, an antineoplastic agent.
Pregnancy Category: D
Pharmacologic: podophyllotoxin derivatives
Pharmacologic: podophyllotoxin derivatives
Refractory testicular neoplasms (IV only) (used in combination with other chemotherapeutic agents in patients who have already received chemotherapy, surgery, or radiation).Small cell lung carcinoma (PO and IV) (first-line therapy; used in combination with other chemotherapeutic agents).Lymphomas and some leukemias.Uterine cancer.Brain tumors.
Damages DNA before mitosis (cycle-dependent and phase-specific).
Death of rapidly replicating cells, particularly malignant ones.
Absorption: Variably absorbed after oral administration (bioavailability ~50%). IV administration results in complete bioavailability.
Distribution: Rapidly distributed; poorly enters the CSF; probably crosses placenta; enters breast milk.
Protein Binding: 97%.
Metabolism and Excretion: Some metabolism by the liver with biliary excretion, 44% excreted in feces; 45% excreted unchanged by the kidneys.
Half-life: 4–11 hr.
Time/action profile (noted as effects on blood counts)
|PO||unknown||7–14 days (granulocytes) 9–16 days (platelets)||20 days|
|IV||unknown||7–14 days (granulocytes) 9–16 days (platelets)||20 days|
Contraindicated in: Hypersensitivity; Pregnancy; Lactation; Known intolerance to ethyl alcohol or polysorbate 80 (IV only).
Use Cautiously in: Patients with childbearing potential; Active infections; Decreased bone marrow reserve; Renal/hepatic impairment (dosage modification may be necessary); Hypoalbuminemia; Elderly (may be at increased risk of adverse effects); Children (safety and effectiveness not established); Other chronic debilitating illnesses.
Adverse Reactions/Side Effects
Central nervous system
- hypotension (IV)
- anorexia (most frequent)
- diarrhea (most frequent)
- nausea (most frequent)
- vomiting (most frequent)
- abdominal pain
- alopecia (most frequent)
- anemia (most frequent)
- leukopenia (most frequent)
- thrombocytopenia (most frequent)
- phlebitis at IV site
- peripheral neuropathy
- allergic reactions including anaphylaxis (life-threatening)
Drug-Drug interaction↑ bone marrow depression with other antineoplastics or radiation therapy.May alter immune response to live-virus vaccines and ↑ risk of adverse reactions.
Route/DosageOther regimens are usedTesticular Neoplasms
Intravenous (Adults) Dosage ranges from 50–100 mg/m2 daily for 5 days up to 100 mg/m2 daily on days 1, 3, and 5; repeat at 3–4 wk intervals.Small-Cell Carcinoma of the Lung
Oral (Adults) Dosage ranges from 70 mg/m2 daily for 4 days up to 100 mg/m2 daily for 5 days (round dose to the nearest 50 mg); repeat at 3–4 wk intervals.
Intravenous (Adults) Dosage ranges from 35 mg/m2 daily for 4 days up to 50 mg/m2 daily for 5 days; repeat at 3–4 wk intervals.
Availability (generic available)
Capsules: 50 mg
Injection: 20 mg/mL in 5–ml, 25–ml, and 50–ml vials
- Monitor BP before and every 15 min during infusion. If hypotension occurs, stop infusion and notify physician or other health care professional. After stabilizing BP with IV fluids and supportive measures, infusion may be resumed at slower rate.
- Monitor for hypersensitivity reaction (fever, chills, dyspnea, pruritus, urticaria, bronchospasm, tachycardia, hypotension). If these occur, stop infusion and notify physician. Keep epinephrine, an antihistamine, corticosteroids, volume expanders, and resuscitative equipment close by in the event of an anaphylactic reaction.
- Assess for signs of infection (fever, chills, cough, hoarseness, lower back or side pain, sore throat, difficult or painful urination). Notify physician if these symptoms occur.
- Assess for bleeding (bleeding gums, bruising, petechiae, guaiac test stools, urine, and emesis). Avoid IM injections and taking rectal temperatures. Apply pressure to venipuncture sites for 10 min.
- Monitor intake and output, appetite, and nutritional intake. Etoposide causes mild-to-moderate nausea and vomiting. Prophylactic antiemetics may decrease frequency and duration of nausea and vomiting.
- Adjust diet as tolerated to help maintain fluid and electrolyte balance and nutritional status.
- Lab Test Considerations: Monitor CBC and differential before and periodically during therapy. The nadir of leukopenia occurs in 7–14 days. Notify physician if absolute neutrophil count is <1000/mm3. The nadir of thrombocytopenia occurs in 9–16 days. Notify physician if the platelet count is <75,000/mm3. Recovery of leukopenia and thrombocytopenia occurs in 20 days.
- Monitor liver function studies (AST, ALT, LDH, bilirubin) and renal function studies (BUN, creatinine) before and periodically during therapy to detect hepatotoxicity and nephrotoxicity.
Potential Nursing DiagnosesRisk for injury (Side Effects)
Risk for infection (Side Effects)
- high alert: Fatalities have occurred with incorrect administration of chemotherapeutic agents. Before administering, clarify all ambiguous orders; double check single, daily, and course-of-therapy dose limits; have second practitioner independently double check original order, calculations and infusion pump settings. Do not confuse VePesid (etoposide) with Versed (midazolam). Do not confuse etoposide (VePesid) with etoposide phosphate (Etopophos).
- Solution should be prepared in a biologic cabinet. Wear gloves, gown, and mask while handling medication. Discard equipment in designated containers.
- Avoid contact with skin. Use Luer-Lok tubing to prevent accidental leakage. If contact with skin occurs, immediately wash skin with soap and water.
- Oral: Capsules should be refrigerated. Capsules are stable for 24 mo when refrigerated.
- Intermittent Infusion: Dilute with D5W or 0.9% NaCl to achieve a final concentration of 0.2–0.4 mg/mL (concentrations > 0.4 mg/mL may result in precipitation occurring). The 0.2 mg/mL solution is stable for 96 hr. The 0.4 mg/mL solution is stable for 48 hr. Discard solution if precipitate forms.
- Rate: Infuse slowly over 30–60 min. Temporary hypotension may occur with infusion rates shorter than 30 min.
- Y-Site Compatibility: allopurinol, amifostine, aztreonam, cladribine, doxorubicin liposome, fludarabine, gemcitabine, granisetron, melphalan, ondansetron, paclitaxel, piperacillin/tazobactam, sargramostim, sodium bicarbonate, teniposide, thiotepa, topotecan, vinorelbine
- Y-Site Incompatibility: cefepime, filgrastim, idarubicin
- Additive Compatibility: carboplatin, cisplatin, cytarabine, floxuridine, fluorouracil, hydroxyzine, ifosfamide, ondansetron
- Instruct patient to take etoposide exactly as directed, even if nausea or vomiting occurs. If vomiting occurs shortly after dose is taken, consult physician. If a dose is missed, do not take at all.
- Advise patient to notify health care professional if fever; chills; sore throat or other signs of infection; bleeding gums; bruising; petechiae; or blood in urine, stool, or emesis occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor. Caution patient not to drink alcoholic beverages or take products containing aspirin or NSAIDs.
- Instruct patient to notify health care professional if rapid heartbeat, difficulty breathing, abdominal pain, yellow skin/eyes, weakness, paresthesia, or gait disturbances occur.
- Instruct patient to inspect oral mucosa for redness and ulceration. If mouth sores occur, advise patient to use sponge brush and rinse mouth with water after eating and drinking. Viscous lidocaine swishes may be used if pain interferes with eating. Stomatitis pain may require treatment with opioid analgesics.
- Discuss with patient the possibility of hair loss. Explore coping strategies.
- Advise patient to use contraception.
- Instruct patient not to receive any vaccinations without advice of physician.
- Emphasize the need for periodic lab tests to monitor for side effects.
- Decrease in size or spread of malignancies in solid tumors.
a trademark for an antineoplastic agent (etoposide).