- 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.
- 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
- Diluted solutions stable for 24 hours at room temperature
- Solutions for infusion must be dispensed in non-PVC bags.
- DEHP-free tubing must be used to administer the drug
- Solutions Compatible: D5W, NS (preferred)
- Y-site Compatible: allopurinol, carboplatin, cisplatin, daunorubicin, ifosfamide, ondansetron, KCl, sodium bicarbonate (diluted)
Incompatible: filgrastim, idarubicin
(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 Intermittent 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: 0.2 - 0.4 mg/mL 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
- 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 |
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. 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 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