Etoposide

Brand Teva

In stock 1441 Items

Available since: 2019-09-19

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Clinical Pharmacology

Antitumor agent. Etoposide-Ebeve is a semi-synthetic derivative of podophyllotoxin. The mechanism of action is associated with inhibition of topoisomerase II. Inhibits mitosis, blocks cells in the S-G2-interphase of the cell cycle, in higher doses acts in the G2-phase. A cytotoxic effect on normal healthy cells is observed only with high doses of etoposide.

Indications

Germinogenic tumors (testicular tumors, choriocarcinoma), ovarian cancer, small cell and non-small cell lung cancer, lymphogranulomatosis, non-Hodgkin's lymphomas, stomach cancer (for monotherapy and as part of a combination therapy), Ewing's sarcoma, Kaposi's sarcoma, neuroblastoma, cancer of the stomach, neuroblastoma, prostate cancer, neuroblastoma, prostate cancer, neuroblastoma, prostate cancer, neuroblastoma, prostate cancer, neuroblastoma, prostate cancer, neuroblastoma, prostate cancer, neuroblastoma, prostate cancer, neuroblastoma, prostate cancer, neuroblastoma, prostate cancer, neuroblastoma, prostate cancer, neuroblastoma, neoplasm of the stomach liver, pleura), acute non-lymphoblastic leukemia, mesothelioma.

Etoposide is marketed under different brands and generic names, and comes in different dosage forms:

Brand name	Manufacturer	Country	Dosage form
Etoposide-Teva	Teva	Israel	solution concentrate
Etoposide-Lance	Lance farm	Russia	solution concentrate
Etoposide-Ebeve	Ebeve Pharma	Austria	solution concentrate

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Dosage and Administration

Etoposide is a part of many chemotherapy regimens, and therefore in choosing the route of administration, regimen and doses in each individual case, one should be guided by the data of special literature.

Doses make 50-100 mg / m² per day for 5 days, with repeated cycles every 3-4 weeks.

Also often used mode of administration through the day - in the 1st, 3rd and 5th days. Repeated courses are held only after the normalization of peripheral blood.

When choosing a dose, one should consider the myelosuppressive effect of other drugs in combination, as well as the effect of previous radiotherapy and chemotherapy.

Before use, make a visual assessment of the solution for particulate matter or discoloration.

Before administration, etoposide is diluted with 0.9% sodium chloride solution or 5% dextrose / glucose solution to a final concentration of 0.2 or 0.4 mg / ml. Do not allow contact with buffer aqueous solutions with a pH above 8.

Etoposide is administered by 30-60 minutes intravenous infusion.

Adverse reactions

From the hemopoietic system: a decrease in the number of leukocytes and platelets depends on the dose and is the main toxic dose-limiting manifestation of etoposide. The maximum decrease in the number of granulocytes is usually observed at 7-14 days after drug administration. Thrombocytopenia occurs less frequently, and the maximum decrease in platelets is observed at 9-16 days after administration of etoposide. Recovery of blood parameters usually occurs on the 20th day after the introduction of the standard dose. Anemia is observed infrequently.

From the digestive system: nausea and vomiting occur in about one third of patients. Usually these phenomena are moderate, and they rarely resort to withdrawal of treatment because of them. Antiemetic drugs are shown to control these side effects. In addition, diarrhea, abdominal pain, stomatitis, esophagitis, dysphagia, and anorexia were noted. Sometimes there is a slight temporary hyperbilirubinemia and an increase in the level of transaminases in the blood serum. This happens more often when using doses higher than recommended.

Since the cardiovascular system: with a rapid on / in the introduction of 1-2% of patients there is a temporary decrease in blood pressure, which is usually restored when the infusion is stopped and the introduction of fluids or other supportive therapy. If it is necessary to resume the administration of etoposide, the rate of administration should be reduced.

Allergic reactions: anaphylactic-like symptoms such as chills, fever, tachycardia, bronchospasm, shortness of breath, apnea. These reactions are usually observed during or immediately after the administration of etoposide and stop when the infusion is stopped. However, deaths associated with bronchospasm have been reported. When such reactions occurred, the therapy was stopped and, if necessary, vasopressor drugs, corticosteroids, antihistamines were administered and infusion-transfusion therapy was performed.

From the skin and skin appendages: reversible alopecia, sometimes resulting in complete hair loss, occurs in about 66% of patients. The appearance of pigmentation, itching, and urticaria are also noted. In one case, a relapse of radiation dermatitis was observed.

Other toxic effects: peripheral neuropathy, drowsiness, fatigue, residual taste in the mouth, fever, transient blindness of cortical genesis are rarely observed.

Contraindications

Hypersensitivity to the drug;
severe myelosuppression;
severe liver dysfunction;
acute infections;
pregnancy and lactation period.
use in children: safety and efficacy not established.

Drug interactions

The antitumor effect of etoposide is enhanced when it is used in combination with cisplatin, but it must be borne in mind that in patients previously treated with cisplatin, etoposide clearance may be impaired.

Etoposide can not be mixed with other drugs in the same solution.

Pregnancy and Lactation

It is contraindicated to use the drug during pregnancy and lactation.

Special instructions

Since etoposide is a cytotoxic anticancer drug, it is necessary to follow the measures for proper use and handling.Infusions can be carried out only by medical professionals with sufficient experience with anticancer drugs. Medical personnel are advised to wear gloves. In case of contact with skin or mucous membrane, the affected areas should be washed immediately with soap and water.

The suppression of bone marrow function is the dose-limiting effect of etoposide. Regular monitoring of the composition of the blood should be carried out before the start of treatment, in the intervals and before each subsequent course of etoposide. If radiotherapy and / or chemotherapy were performed before etoposide therapy, a sufficient interval between these two types of therapy should be observed to ensure the recovery of bone marrow function. In the case of reducing the number of platelets below 50,000 / mm³ and / or the absolute number of neutrophils up to 500 / mm3, the therapy should be stopped until full recovery of blood parameters.

If anaphylactic reactions occur, administration of etoposide should be stopped and treatment with corticosteroids and / or antihistamines, infusion therapy should be initiated.

Care must be taken when prescribing the drug to patients with hepatic or renal insufficiency.

Since this drug has mutagenic potential, it can cause damage to the chromosomes of human spermatozoa; therefore, men receiving etoposide therapy should use contraception.

Occasionally, patients receiving etoposide therapy in combination with other anticancer drugs may develop acute leukemia, both with and without the pre-leukemic phase.

Etoposide is intended only for administration in the form of intravenous infusion, other routes of administration are not permitted. The introduction of the drug should be carried out with caution to prevent extravasation during infusion. However, if extravasation has occurred, the following measures are taken:

Perfusion should be stopped as soon as there is a burning sensation;
around the affected area to make subcutaneous injections of a corticosteroid (hydrocortisone);
apply 1% hydrocortisone ointment to the affected area until the erythema disappears;
apply a dry dressing on the affected area for 24 hours

Etoposide contains ethanol as a filler: it can be a risk factor for patients suffering from liver diseases, alcoholism and epilepsy, as well as for children.

Overdosage

Cases of overdose with the use of etoposide in humans have not yet been registered. It can be assumed that the main manifestation of overdose would be toxic effects on the blood and the gastrointestinal tract. In such cases, symptomatic therapy is indicated. There are no specific antidotes.