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Etoposide

(eh-toe-puh-side)

Trade/other name(s): VePesid, Etopophos, Toposar, etoposide phosphate, VP-16

Why would this drug be used?

This drug is used to treat people with testicular cancer or small cell lung cancer. Your doctor may use it to treat other types of cancer as well.

How does this drug work?

Etoposide is a chemotherapy drug derived from a type of plant alkaloid known as a podophyllotoxin. It is thought to work by blocking the action of an enzyme in cells called topoisomerase II. Cells need this enzyme to keep their DNA in the proper shape when they are dividing into 2 cells. Blocking this enzyme leads to breaks in the DNA, which leads to cell death. Because cancer cells divide more quickly than normal cells, they are more likely than normal cells to be affected by etoposide.

Before taking this medicine

Tell your doctor…

  • If you are allergic to any medicines, dyes, additives, or foods.
  • If you have ever had kidney problems. This drug is cleared from the body mainly by the kidneys. Reduced kidney function may result in more drug than expected staying in the body, which could lead to worse side effects. Your doctor may need to adjust your dose accordingly.
  • If you have any other medical conditions such as liver disease (including hepatitis), heart disease, diabetes, high blood pressure, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause problems with the fetus if taken at the time of conception or during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine. In pregnant women, treatment with this drug should be used only if the potential benefit to the mother outweighs the risk to the fetus.
  • If you are breast-feeding. This drug may pass into breast milk and affect the baby. Breast-feeding is not recommended during treatment with this drug.
  • If you think you might want to have children in the future. This drug may affect fertility. Talk with your doctor about the possible risk associated with this drug and the options that may preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Cyclosporine may increase blood levels of etoposide if taken at the same time.

Any drug that can increase your risk of bleeding may pose a hazard while your blood counts are low (see "Precautions" section). Aspirin, ibuprofen, naproxen, and other pain relievers and fever reducers can have this effect. Talk with your doctor about these drugs and about blood thinners such as warfarin (Coumadin).

Etoposide may interact with other drugs as well. Check with your doctor, nurse, or pharmacist about your other medicines, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

Grapefruit and grapefruit juice can make etoposide capsules less effective. Some doctors recommend that you avoid grapefruit for 2 days before you take your pills and the day you take them. For instance, if you plan to take etoposide on Wednesday, you would skip the grapefruit Monday, Tuesday, and Wednesday.

Check with your doctor, nurse, or pharmacist about whether other foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Etoposide can either be given as an injection into a vein or taken by mouth as a capsule. When injected it is usually given over 30 to 60 minutes (sometimes longer). As a capsule it is taken once or twice a day. It is most often given every day or every other day for 5 days, followed by several weeks off. The dose depends on your body size, the type of cancer being treated, and other factors. Your doctor or nurse will likely instruct you to take anti-nausea medicine before each dose of etoposide; follow these instructions carefully.

If you are taking capsules, store the medicine in a tightly closed container away from heat and moisture and out of the reach of children and pets.

Precautions

You may have nausea and vomiting on the day you receive this drug or in the first few days afterward. Your doctor may give you medicine before your treatment to help prevent nausea and vomiting. You will likely also get a prescription for an anti-nausea medicine that you can take at home. It is important to have these medicines on hand and to take them as prescribed by your doctor.

This drug can cause serious allergic reactions in some people. Symptoms include chills, fever, feeling lightheaded or dizzy (due to low blood pressure), rapid heartbeat, coughing, wheezing, trouble breathing, or swelling of the face, tongue, or throat. Tell your doctor or nurse right away if you notice any of these symptoms as you are being given the drug. If they happen at home (while taking the pill form of the drug) call your doctor right away.

Etoposide may lower your blood pressure, especially if given by infusion over a short period of time. Symptoms might include feeling dizzy, lightheaded, or even fainting. Tell your doctor or nurse right away if you notice any of these symptoms. Your blood pressure will likely be checked regularly during treatment.

Your doctor will likely test your blood frequently throughout your treatment, looking for possible effects of the drug on blood counts or on blood chemistry levels. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether.

This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body’s ability to stop bleeding, such as aspirin or aspirin-containing medicines, pain relievers such as ibuprofen or naproxen, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. This drug may affect your immune system, which could make vaccinations not to work, or could even lead to serious infections. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine.

In rare cases this drug may cause damage to certain nerves in the body, which can lead to a condition called peripheral neuropathy. This can cause numbness, weakness, pain, or sensations of burning or tingling, usually in the hands or feet. These symptoms can sometimes progress to include trouble walking or holding something in your hands. Let your doctor know right away if you notice any of them. If your symptoms are severe enough, this drug may need to be stopped or the dose reduced until they get better.

In rare cases during an intravenous (IV) infusion, the drug may leak out of the vein and under the skin, where it may damage the tissue, causing pain, open sores, and scarring. Tell the nurse right away if you notice redness, pain, or swelling at or near the IV site.

Because of the way this drug acts on cells in the body, it may increase your long-term risk of getting a second type of cancer, such as leukemia. This is rare, but if it does occur it would likely be years after the drug is used. If you are getting this drug, your doctor feels this risk is outweighed by the risk of what might happen if you do not get this drug. You may want to discuss these risks with your doctor.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • low white blood cell count with increased risk of infection*
  • low blood platelet count with increased risk of bleeding*
  • nausea and/or vomiting*
  • loss of appetite
  • hair loss, including face and body hair

Less common

  • constipation
  • diarrhea
  • fever and chills
  • lowered red blood cell count (anemia)

Rare

  • low blood pressure while drug is being given*
  • sores in mouth and throat
  • changes in how foods taste
  • rash, which can become serious
  • itching
  • numbness and tingling in hands and/or feet*
  • allergic reactions (may include chills, fever, rapid heart rate, trouble breathing, dizziness)*
  • increased risk of a second cancer*

*See "Precautions" section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved before 1984. (FDA cannot verify dates of drugs approved before 1984.)

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.

Last Medical Review: 12/17/2009
Last Revised: 12/17/2009