| High risk lymphoblastic leukemia |
|
Acute non-lymphocytic leukemia (AML) |
| Rhabdomyosarcoma | Histiocytosis | Osteosarcoma |
| Brain tumors | Ewing's sarcoma | Ovarian tumors |
| Lymphoma | Neuroblastoma | Germ cell tumors |
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.
- Available as a 100 mg powder in single-dose vial. Refrigerate vials.
- Reconstitute vial with 5 mL Sterile Water for Injection, NS or D5W to make a 20 mg/mL solution
- Stable in syringe undiluted or diluted in minibags 24 hours at room temp or in fridge
- Can be diluted to as low as 0.1 mg/mL
- Solutions Compatible: NS, D5W
- Y-site Compatible: carboplatin, cisplatin, daunorubicin, dexamethasone, doxorubicin, hydrocortisone sodium succinate, ifosfamide, ondansetron, potassium chloride, sodium bicarbonate (diluted), vincristine
(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, RN must remain with patient for first 15 min of first infusion of each course Infusion time: 1 - 4 hours |
| IV Continuous Infusion | YES |
(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
- See individual protocols for specific dosing
- 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.
- Etoposide phosphate 113.5 mg is equivalent to etoposide 100 mg. Dosages should always be expressed, and calculated, as the desired etoposide dose
Dosage adjustment in renal failure:
- CrCl = 10-50 mL/min; give 75% of usual dose
- CrCl = < 10 mL/min; give 50% of usual dose
Dosage adjustment in hepatic failure:
- Bilirubin = 25-52 micromol/L; give 50% of usual dose
- Bilirubin > 53 micromol/L; hold drug
Immediate (within a few minutes to hours)
- Anaphylaxis, particularly chills, fever, bronchospasm, tachycardia (less frequent than with plain etoposide)
- Mild nausea and vomiting, anorexia
- Hypotension
- Rash, palmar erythema (usually with high doses)
- IRRITANT: phlebitis and pain following rapid IV infusion. If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.
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
- Monitor vital signs every 15 minutes during first infusion (vitals q15min not required for subsequent days of intermittent infusions)
- Anaphylaxis Precautions: RN must remain with patient for first 15 min of first dose. Have anaphylaxis kit available at bedside.
- Contraindicated in patients demonstrating hypersensitivity to etoposide or etoposide phosphate (may try to readminister using diphenhydramine and hydrocortisone premedication, with cardiac monitoring, 1:1 nursing). Check protocol for specifics.
- Contraindicated in patients with leukopenia or thrombocytopenia (check protocol for specific neutrophil and platelet requirements)
- Use with Caution if patient is hypotensive, administer in supine position & reduce rate of infusion.
- Cisplatin should be give before etoposide to take advantage of synergism
- After intravenous administration of etoposide phosphate, it is rapidly & completely converted to etoposide