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Pharmacologic class: Podophyllotoxin derivative
Therapeutic class: Antineoplastic
Pregnancy risk category D
Damages DNA before mitosis by inhibiting topoisomerase II enzyme. This action impairs DNA synthesis and inhibits selected cancer cell growth. Cell-cycle-phase specific.
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.
• Renal impairment
• AIDS-related Kaposi's sarcoma
• Wilms' tumor
• Malignant lymphoma
• Hodgkin's disease
• Ovarian neoplasms
• Hypersensitivity to drug or its components
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).
• 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.
CNS: drowsiness, fatigue, headache, vertigo, peripheral neuropathy
CV: hypotension (with I.V. use), heart failure, myocardial infarction
GI: nausea, vomiting, stomatitis
Hematologic: anemia, leukopenia, thrombocytopenia, bone marrow depression
Musculoskeletal: muscle cramps
Respiratory: pulmonary edema, bronchospasm
Other: alopecia, fever, phlebitis at I.V. site, allergic reactions including anaphylaxis
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
☞ 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.
• 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.