Parenteral Manual

Teniposide

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): 
VUMON, VM-26, PTG
Classification: 
Antineoplastic, epipodophyllotoxin - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
June 2015
Indications: 
  • Acute lymphocytic leukemias
  • Non-Hodgkin's lymphomas
  • Neuroblastoma

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 10 mg/mL non-aqueous solution, containing 500 mg/mL of polyoxyethylated castor oil (Cremophor-EL) as a stabilizer and 42.7% dehydrated ethyl alcohol as solubilizer.
  • Precipitation of teniposide from aqueous solutions has occurred irregularly and unpredictably even at low concentrations (ie 0.1-0.2 mg/mL).  The precipitation rate depends on the formation of crystallization nuclei.  Formation of crystallization nuclei may be accelerated by agitation, contact with incompatible drugs or material surfaces.   Therefore DO NOT SHAKE teniposide solutions. Minimize contact with other drugs or solutions.
  • Stability is concentration-dependent.  Stable in NS or D5W at room temperature:
    - 0.2 mg/mL - 96 hours
    - 0.3 mg/mL - 72 hours
    - 0.4 mg/mL - 48 hours
    - 0.5 mg/mL - 24 hours
    - 0.6 mg/mL -   8 hours
  • Teniposide is not stable in plastic containers and must be dispensed in glass bottles. 
  • Non PVC tubing must be used to administer the drug.
Compatibility: 

- Solutions Compatible: D5W, NS (preferred diluent)

- DO NOT RUN with other medications.  Run in dedicated line

Administration: 

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

SC NO
IM NO
IV Direct NO
IV Intermittent Infusion

YES, RN must remain with patient for first 15 minutes
Usual dilution: < 0.4 mg/mL
Infusion time: > 2 hours

IV Continuous Infusion NO
Dosage: 

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

  • 150-165 mg/m2 x 2 days Q 7-10 weeks
  • Must premedicate all doses with diphenhydramine and hydrocortisone, to prevent sensitivity reaction (swelling of lips, face, itching, shortness of breath, hypotension)

** Dosage may differ according to protocol

Dosage adjustment in hepatic impairement:

Bilirubin

% Usual Dose

25-51 umol/L

50%

>51 umol/L

25%

Potential hazards of parenteral administration: 

Immediate (within a few minutes to hours)

  • Anaphylaxis
  • Transient hypotension following rapid IV infusion.  Infuse over > 2 hours.
  • Nausea and vomiting (low to moderate emetogenic potential)
  • IRRITANT: extravasation may cause local tissue irritation and/or thrombophlebitis - refer to Treatment of Infiltration, Section H, Infusion Therapy Manual. If extravasation occurs, click HERE for treatment guidelines.   

Delayed (within days to weeks)

  • Myelosuppression (nadir 5-14 days)
  • Alopecia (in about 10% of patients)
  • Diarrhea, mucositis

Late (within months to years)

  • Secondary leukemias

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

Notes: 
  • RN must remain with patient for first 15 minutes of infusion.  Monitor vital signs every 15 minutes during infusion and every 30 minutes x 2 after infusion.
  • Have anaphylaxis tray at bedside (epinephrine, diphenhydramine, hydrocortisone)
  • Monitor hematologic parameters and serum electrolytes, hepatic and renal function
  • Contraindicated in renal failure
  • Contraindicated in patients with a known hypersensitivity to Cremophor EL and allergy to etoposide

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