VePesid


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Related to VePesid: Oncovin, etoposide

VePesid

 [ve´pe-sid]
trademark for a preparation of etoposide, an antineoplastic agent.

etoposide (VP-16-213)

Eposin (UK), Toposar, VePesid

etoposide phosphate

Etopophos

Pharmacologic class: Podophyllotoxin derivative

Therapeutic class: Antineoplastic

Pregnancy risk category D

Action

Damages DNA before mitosis by inhibiting topoisomerase II enzyme. This action impairs DNA synthesis and inhibits selected cancer cell growth. Cell-cycle-phase specific.

Availability

Capsules: 50 mg

Injection: 20 mg/ml

Powder for injection (phosphate): 100 mg in single-dose vials

Indications and dosages

Testicular cancer

Adults: 50 to 100 mg/m2 I.V. daily for 5 days. Or 100 mg/m2 I.V. on days 1,3, and 5, with course repeated q 3 to 4 weeks.

Small-cell carcinoma of lung

Adults: 70 mg/m2 (rounded up or down to nearest 50 mg) P.O. daily for 4 days, then a maximum of 100 mg/m2 (rounded up or down to nearest 50 mg) P.O. daily for 5 days every 3 to 4 weeks. Alternatively, 35 mg/m2 I.V. daily for 4 days, then a maximum of 50 mg/m2 I.V. daily for 5 days q 3 to 4 weeks.

Dosage adjustment

• Renal impairment

Off-label uses

• AIDS-related Kaposi's sarcoma

• Wilms' tumor

• Neuroblastoma

• Malignant lymphoma

• Hodgkin's disease

• Ovarian neoplasms

Contraindications

• Hypersensitivity to drug or its components

Precautions

Use cautiously in:

• active infections, decreased bone marrow reserve, renal or hepatic impairment

• pregnant patients and patients with childbearing potential

• breastfeeding patients

• children (safety and efficacy not established).

Administration

• For I.V. concentrations above 0.4 mg/ml, mix each 100 mg with 250 to 500 ml of dextrose 5% in water or normal saline solution, to help prevent crystallization.

• Give I.V. infusion over 30 to 60 minutes. Don't use in-line filter.

Avoid rapid infusion, which may cause severe hypotension and bronchospasm.

• Administer with antiemetics, as prescribed.

• Wear disposable gloves when handling. If drug comes into contact with skin, wash thoroughly with soap and water.

• Be aware that drug is given with other chemotherapeutic agents.

Adverse reactions

CNS: drowsiness, fatigue, headache, vertigo, peripheral neuropathy

CV: hypotension (with I.V. use), heart failure, myocardial infarction

GI: nausea, vomiting, stomatitis

GU: sterility

Hematologic: anemia, leukopenia, thrombocytopenia, bone marrow depression

Hepatic: hepatotoxicity

Metabolic: hyperuricemia

Musculoskeletal: muscle cramps

Respiratory: pulmonary edema, bronchospasm

Other: alopecia, fever, phlebitis at I.V. site, allergic reactions including anaphylaxis

Interactions

Drug-drug. Live-virus vaccines: increased risk of adverse reactions

Other antineoplastics: additive bone marrow depression

Drug-diagnostic tests. Hemoglobin, neutrophils, platelets, red blood cells, white blood cells: decreased values

Uric acid: increased level

Patient monitoring

Monitor blood pressure during and after infusion. Stop infusion if severe hypotension occurs.

• With I.V. use, monitor infusion rate closely to prevent infusion reactions.

• Throughout infusion, check I.V. site for extravasation, which may cause thrombophlebitis.

Keep diphenhydramine, hydrocortisone, epinephrine, and artificial airway at hand in case anaphylaxis occurs.

• Assess for CNS adverse effects. Assist patient during ambulation as needed.

Monitor for signs and symptoms of bone marrow depression.

• Monitor CBC, liver function tests, and blood urea nitrogen and creatinine levels. Report platelet count below 50,000/mm3 or neutrophil count below 500/mm3.

Patient teaching

• Instruct patient to inspect mouth daily for ulcers and bleeding gums.

Tell patient to immediately report difficulty breathing or signs and symptoms of allergic reaction.

Caution female of childbearing age to avoid pregnancy and breastfeeding during drug therapy.

• Instruct patient to move slowly when sitting up or standing, to avoid lightheadedness or dizziness from sudden blood pressure decrease.

• Tell patient drug may cause hair loss.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

etoposide

(e-toe-poe-side) ,

VePesid

(trade name),

VP-16

(trade name)

Classification

Therapeutic: antineoplastics
Pharmacologic: podophyllotoxin derivatives
Pregnancy Category: D

Indications

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.

Action

Damages DNA before mitosis (cycle-dependent and phase-specific).

Therapeutic effects

Death of rapidly replicating cells, particularly malignant ones.

Pharmacokinetics

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)

ROUTEONSETPEAKDURATION
POunknown7–14 days (granulocytes) 9–16 days (platelets)20 days
IVunknown7–14 days (granulocytes) 9–16 days (platelets)20 days

Contraindications/Precautions

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

  • drowsiness
  • fatigue

Cardiovascular

  • hypotension (IV)

Gastrointestinal

  • anorexia (most frequent)
  • diarrhea (most frequent)
  • nausea (most frequent)
  • vomiting (most frequent)
  • abdominal pain
  • stomatitis

Dermatologic

  • alopecia (most frequent)
  • pruritis
  • rash
  • urticaria

Endocrinologic

  • sterility

Hematologic

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

Local

  • phlebitis at IV site

Neurologic

  • peripheral neuropathy

Miscellaneous

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

Interactions

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/Dosage

Other 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

Nursing implications

Nursing assessment

  • 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 Diagnoses

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

Implementation

  • 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

Patient/Family Teaching

  • 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.

Evaluation/Desired Outcomes

  • Decrease in size or spread of malignancies in solid tumors.
References in periodicals archive ?
Release date- 02092019 - Clinigen Group plc (AIM: CLIN, 'Clinigen' or the 'Group'), the global pharmaceutical and services company, and CHEPLAPHARM Arzneimittel GmbH ('CHEPLAPHARM'), the family-owned pharmaceutical company based in Germany, have signed an exclusive distribution agreement for chemotherapy products Etopophos and Vepesid in Australia and New Zealand.
Clinigen has been appointed by CHEPLAPHARM to distribute Etopophos and Vepesid via the Group's extensive infrastructure in Australia and New Zealand as part of CHEPLAPHARM'S network of exclusive cooperation partners.
Etopophos and Vepesid are etoposide products, a drug which is included on the World Health Organization Model List of Essential Medicines and is considered an essential medicine for priority diseases.
- UK-based pharmaceutical and services company Clinigen Group plc (AIM: CLIN) and German pharmaceutical company Cheplapharm Arzneimittel GmbH have signed an exclusive distribution agreement for chemotherapy products Etopophos and Vepesid in Australia and New Zealand, the companies said.
Pharmaceutical company Clinigen Group plc (AIM:CLIN) said on Sunday that it plans to distribute its chemotherapy products Etopophos and Vepesid in Australia and New Zealand under an exclusive distribution agreement with CHEPLAPHARM Arzneimittel GmbH of Germany.
Via its extensive infrastructure in Australia and New Zealand, Clinigen will distribute CHEPLAPHARM's Etopophos and Vepesid under CHEPLAPHARM'S network of exclusive cooperation partners.
We also confirmed that combined chemotherapy with CDDP and cyclophosphamide; CDDP, vepesid, and doxorubicin; or CDDP, vinblastine, and recombinant interferon-[alpha]2a did not influence serum cystatin C concentration.
Etoposide Pronunciation: E-TOE-poe-side Brand names Some commonly used brand names or other names are VePesid and VP-16.
Another clinical trial involves the use of the investigational drugs ifosfamide and mesna (which reduces the side effects of ifosfamide) in addition to cisplatin and either vinblastine (Velban) or etoposide (VP-16 or VePesid).
M2 PHARMA-September 2, 2019-Clinigen enters into exclusive distribution agreement with CHEPLAPHARM to distribute Etopophos and Vepesid
For ovarian cancers that have recurred, doctors may use the chemotherapy drugs topotecan (Hycamtin), liposomal doxorubicin (Doxil), etoposide (Etopophos, Vepesid), gemcitabine (Gemzar), vinorelbine (Navelbine), and/or cyclophosphamide (Cytoxan), targeted agents such as bevacizumab (Avastin) and/or other drugs.
If the cancer relapses from two to six months after treatment, your health care professional may try Hycamtin, Camptosar, cyclophosphamide/doxorubicin/vincristine (known as the CAV regimen), Gemzar, Taxol, Taxotere, oral VePesid or Navelbine.