teniposide

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teniposide

 (VM-26) [ten´ĭ-po´sīd]
a semisynthetic derivative of podophyllotoxin, administered orally as an antineoplastic agent in treatment of neuroblastoma, non-Hodgkin's lymphoma, and acute lymphoblastic leukemia; administered intravenously.

teniposide

(ten-i-poe-side) ,

Vumon

(trade name)

Classification

Therapeutic: antineoplastics
Pharmacologic: podophyllotoxin derivatives
Pregnancy Category: D

Indications

Induction therapy for refractory acute lymphoblastic leukemia in children (in combination with other agents).Neuroblastoma, adult non-Hodgkin's lymphoma.

Action

Damages DNA prior to mitosis (cycle dependent and phase specific).

Therapeutic effects

Death of rapidly replicating cells, particularly malignant ones.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.
Distribution: Limited distribution into the CSF (may be increased in patients with brain tumors).
Protein Binding: >99%.
Metabolism and Excretion: 44% excreted by the kidneys. 10% or less is eliminated in feces.
Half-life: 5 hr.

Time/action profile (effects on blood counts)

ROUTEONSETPEAKDURATION
IVunknown16–18 days15 days

Contraindications/Precautions

Contraindicated in: Hypersensitivity to teniposide or polyoxyethylated castor oil; Obstetric / Lactation: Pregnancy or lactation; Pediatric: Preparations containing benzyl alcohol should be avoided in newborns.
Use Cautiously in: Patients with Down syndrome (more susceptible to the myelosuppressive effects; initial dose of first course of therapy should be ↓ by 50%); Patients with hepatic impairment, childbearing potential, active infections, ↓ bone marrow reserve, or other chronic debilitating illnesses.

Adverse Reactions/Side Effects

Central nervous system

  • acute CNS depression
  • confusion
  • headache

Cardiovascular

  • hypotension

Gastrointestinal

  • diarrhea (most frequent)
  • mucositis (most frequent)
  • nausea (most frequent)
  • vomiting (most frequent)

Dermatologic

  • alopecia
  • rash

Endocrinologic

  • gonadal suppression

Fluid and Electrolyte

  • metabolic acidosis

Hematologic

  • neutropenia (most frequent)
  • anemia (most frequent)
  • leukopenia (most frequent)
  • thrombocytopenia (most frequent)

Local

  • phlebitis at IV site

Neurologic

  • peripheral neurotoxicity

Miscellaneous

  • allergic reactions including anaphylaxis (life-threatening)
  • fever

Interactions

Drug-Drug interaction

Myelosuppression may be ↑ by sodium salicylate, tolbutamide, sulfamethizole, other antineoplastics, or radiation therapy.

Route/Dosage

Several regimens have been used. These are examples
Intravenous (Children) Teniposide 165 mg/m2 in combination with cytarabine 300 mg/m2 twice weekly for 8–9 doses. Another regimen uses teniposide 250 mg/m2 in combination with vincristine 1.5 mg/m2 weekly for 4–8 wk with prednisone 40 mg/m2/day for 28 days.

Availability

Injection: 10 mg/mL

Nursing implications

Nursing assessment

  • Monitor BP prior to and every 15 min during infusion. If hypotension occurs, stop infusion and notify health care professional. After BP is stabilized with IV fluids and supportive measures, infusion may be resumed at slower rate.
  • Monitor for hypersensitivity reaction (fever, chills, pruritus, urticaria, bronchospasm, tachycardia, rash, hypotension), especially during first 60 min after start of infusion. If these signs occur, stop infusion and notify physician. Keep epinephrine, antihistamine, and resuscitative equipment close by in the event of an anaphylactic reaction.
  • Monitor for bone marrow depression. Assess for bleeding (bleeding gums, bruising, petechiae, guaiac stools, urine, and emesis) and avoid IM injections and rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. Anemia may occur. Monitor for increased fatigue, dyspnea, and orthostatic hypotension.
  • Monitor intake and output, appetite, and nutritional intake. Teniposide causes nausea and vomiting in up to 30% of patients. Antiemetics may be used prophylactically. Adjust diet as tolerated to help maintain fluid and electrolyte balance and nutritional status.
  • Monitor infusion and infusion site frequently. Extravasation may cause tissue necrosis and/or thrombophlebitis. Occlusion of central venous access devices has occurred during 24-hr teniposide infusions in concentrations of 0.1–0.2 mg/mL.
  • Lab Test Considerations: Monitor CBC and differential prior to and periodically throughout therapy. Nadirs for leukopenia and thrombocytopenia occur on days 16–18 of therapy. Recovery occurs in approximately 15 days. Notify physician or other health care professional if the leukocyte count is <1000/mm3 or if the platelet count is <75,000/mm3. Therapy may be discontinued if platelet count is <50,000/mm3 or if absolute neutrophil count is <500/mm3.
    • Monitor liver function studies (AST, ALT, LDH, bilirubin) and renal function studies (BUN, creatinine) prior to and periodically throughout therapy to detect hepatotoxicity and nephrotoxicity.
    • May cause ↑uric acid. Monitor levels periodically during therapy.

Potential Nursing Diagnoses

Risk for injury (Side Effects)
Risk for infection (Side Effects)

Implementation

  • high alert: Fatalities have occurred with 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, dose calculations and infusion pump settings.
  • Avoid contact with skin. Use Luer-Lok tubing to prevent accidental leakage. If contact with skin occurs, immediately wash skin with soap and water.
    • Solution should be prepared in a biologic cabinet. Wear gloves, gown, and mask while handling medication. Discard equipment in designated containers (see ).
    • Administration of live-virus vaccines to immunocompromised patients should be avoided.
  • Intravenous Administration
  • Intermittent Infusion: Diluent: Dilute with D5W or 0.9% NaCl. Concentration: Final concentration will be 0.1, 0.2, 0.4, or 1 mg/mL depending on amount of diluent added. Concentrations of 1 mg/mL should be administered within 4 hr of dilution.Concentrated teniposide is clear but may develop a slight opalescence when diluted in solution. Precipitation may occur at recommended concentrations. Solution must be prepared and administered in nonplastic equipment to prevent cracking of plastic and possible drug leakage. Glass or polyolefin plastic bags or containers should be used; PVC containers are not recommended. Diluted solutions are stable for 24 hr at room temperature. Do not refrigerate.
  • Rate: Administer over 30–60 min or longer. Do not give by rapid infusion; may result in hypotension.
  • Y-Site Compatibility: ayclovir, alemtuzumab, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B colloidal, amphotericin B lipid complex, ampicillin, ampicillin/sulbactam, anidulafungin, argatroban, atracurium, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium acetate, calcium chloride, calcium gluconate, carboplatin, carmustine, caspofungin, cefazolin, cefoperazone, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, chlorpromazine, ciprofloxacin, cisatracurium, cisplatin, cladribine, clindamycin, cyclophosphamide, cyclosporine, cytarabine, dacarbazine, dactinomycin, daptomycin, daunorubicin hydrochloride, dexamethasone sodium phosphate, dexmedetomidine, dexrazoxane, diazepam, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxacurium, doxorubicin, doxycycline, droperidol, enalaprilat, ephedrine, epinephrine, epirubicin, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl+, floxuridine, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, hetastarch, hydralazine, hydrocortisone, hydromorphone, ifosfamide, imipenem/cilastatin, insulin, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin calcium, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, metaraminol, methotrexate, methyldopate, methylprednisolone, metoclopramide, metoprolol, metronidazole, midazolam, milrinone, mitomycin, mitoxantrone, morphine, nafcillin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, paclitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, pentamidine, pentazocine, pentobarbital, phenobarbital, phentolamine, phenylephrine, piperacillin/tazobactam, potassium acetate, potassium chloride, potassium phosphates, procainamide, prochlorperazine edisylate, promethazine, propranolol, quinupristin/dalfopristin, ranitidine, remifentanil, rituximab, rocuronium, sargramostim, sodium acetate, sodium bicarbonate, sodium phosphates, streptozocin, succinylcholine, sufentanil, tacrolimus, theophylline, thiopental, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, topotecan, trastuzumab, trimethoprim/sulfamethoxazole, vancomycin, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, voriconazole, zidovudine, zoledronic acid
  • Y-Site Incompatibility: amphotericin B liposome, dantrolene, phenytoin
  • Additive Incompatibility: Do not admix with other medications or solutions.

Patient/Family Teaching

  • Advise patient to notify health care professional if fever; chills; sore throat; 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.
  • Patient should be cautioned not to drink alcoholic beverages or take products containing aspirin or NSAIDs.
  • Instruct patient to notify health care professional if abdominal pain, yellow skin, 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.
  • Discuss with patient the possibility of hair loss. Explore coping strategies.
  • Instruct patient not to receive any vaccinations without advice of health care professional.
  • Advise patient to use a nonhormonal method of contraception throughout therapy.
  • Emphasize the need for periodic lab tests to monitor for side effects.

Evaluation/Desired Outcomes

  • Improvement of hematologic status in leukemias.

teniposide

/ten·i·po·side/ (ten-ĭ-po´sīd) a semisynthetic antineoplastic used in the treatment of neuroblastoma, non-Hodgkin's lymphoma, and acute lymphoblastic leukemia.

teniposide

Vumon® Oncology An epipodophyllotoxin-type chemotherapeutic used in children with relapsed ALL and neuroblastomas, and adults with lymphoproliferative disorders Adverse effects Myelosuppression, N&V. See ALL.