Parenteral Manual

Etoposide

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
VEPESID, VP-16
Classification: 
Antineoplastic, epipodophyllotoxin - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
June 2015
Indications: 
  • Many pediatric and adult cancers

THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.

Reconstitution and Stability: 
  • Available as a clear, colorless, viscous, non-aqueous solution 20 mg/mL
  • Each mL solution contains 30 % (v/v) ethyl alcohol, 30 mg/mL benzyl alcohol
  • Solutions of 0.2 mg/mL stable 96 hrs at room temperature
  • Solutions of 0.4 mg/mL stable 24 hrs at RT.  Solutions of 0.6 mg/mL stable 8 hours.
  • Solutions for infusion must be dispensed in non-PVC bags.
  • DEHP-free tubing must be used to administer the drug
Compatibility: 

- Solutions Compatible: D5W, NS (NS preferred, especially for solutions > 0.4 mg/mL)

- Y-site Compatible: allopurinol, carboplatin, cisplatin, daunorubicin, ifosfamide, ondansetron, KCl, sodium bicarbonate (diluted)

Incompatible: filgrastim, idarubicin

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Push

NO

IV Intermittant Infusion

Yes, Non PVC bags and DEHP-free tubing must be used

RN must remain with patient for first 15 min of 1st infusion of each course

Usual dilution: < 0.4 mg/mL

Infusion time: 1 - 4 hours

IV Continuous Infusion YES

 

 

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • 100 mg/m2/day x 5 days every 3 weeks
  • 150 - 200 mg/m2/day x 3 days every 3 weeks
  • 50 - 125 mg/ m2 /day by continuous infusion x 4 days every 3 weeks
  • Children <0.5 m2 or <2 years of age should be dosed on a mg/kg basis.  To calculate mg/kg dose, divide the mg/m2 dose by 30.

Dosage in Renal Failure:

Creatinine Clearance (mL/min)

% Usual Dose

10-50

75

<10

50

Dosage in Hepatic Failure:

Bilirubin (umol/L)  

% Usual Dose

25-50

50

51-85

25

>85

Hold

Potential hazards of parenteral administration: 

Immediate (within a few minutes to hours):

  • Anaphylaxis, particularly chills, fever, bronchospasm, tachycardia
  • Transient hypotension following rapid IV infusion.
  • Fever, mild nausea and vomiting, anorexia
  • Rash, palmar erythema (usually with high doses)
  • IRRITANT: phlebitis and pain following rapid IV infusion; refer to Treatment of Infiltration, Section H, Infusion Therapy Manual. If extravasation occurs, click HERE for treatment guidelines.   

Delayed (within a few days to months):

  • Myelosuppression, notably leukopenia and thrombocytopenia, nadir: 7-16 days
  • Alopecia, partial or total (not in every patient)
  • Mild elevation of liver function tests

 - Treatment for unusual side effects are available through the study chair identified on the front page of the protocol and/or pharmacy

Notes: 
  • Monitor vital signs every 15 min during first infusion (vitals q15min not required for subsequent days of infusions)
  • Have anaphylaxis kit available at bedside.
  • Contraindicated in patients demonstrating hypersensitivity to etoposide (for subsequent  courses, use etoposide phosphate (SAP))
  • Contraindicated in leukopenia or thrombocytopenia (check protocol for neutrophil & platelet requirements)
  • Use with caution in pre-existing renal or hepatic disease
  • If patient is hypotensive, administer in supine position and reduce rate of infusion.
  • Cisplatin should be given before etoposide to take advantage of synergism

 

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