Parenteral Manual

Etoposide phosphate (SPECIAL ACCESS PROGRAM)

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Alternate Name(s): 
ETOPOPHOS®
Classification: 
Antineoplastic, epipodophyllotoxin - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
June 2015
Indications: 
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.

Reconstitution and Stability: 
  • 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
  • After reconstitution, vial stable 24 hours at room temperature or 7 days refrigerated
  • 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
Compatibility: 

- Solutions Compatible: NS, D5W

- Y-site Compatible: carboplatin, cisplatin, daunorubicin, dexamethasone, doxorubicin, hydrocortisone sodium succinate, ifosfamide, ondansetron, potassium chloride, sodium bicarbonate (diluted), vincristine

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, RN must remain with patient for first 15 min of first infusion of each course
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
  • 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
Potential hazards of parenteral administration: 

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; refer to Treatment of Infiltration, Section H, Infusion Therapy Manual

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 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

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