etoposide, vinorelbine) has both antitumorigenic and antiangiogenic effect on tumor endothelial tumor cell. Etoposide injection and/or capsules in combination with other approved chemotherapeutic agents as first line treatment in patients with small cell lung cancer. It has a molecular weight of 588.58 and a molecular formula of C29H32O13. Phytoside is a medication that belongs to a subgroup of anticancer drugs used for treatment in oncology. Myelosuppression resulting in death has been reported. If this drug is used during pregnancy, or if the patient becomes pregnant while receiving this drug, the patient should be apprised of the potential hazard to the fetus. The mean volumes of distribution at steady state fall in the range of 18 to 29 liters or 7 to 17 L/m2. Found inside – Page 709Contraindications and Precautions Etoposide should not be given to patients with a known hypersensitivity to the drug or teniposide , the other ... Metabolic acidosis has also been reported in patients receiving higher doses. Do not freeze. . It is very soluble in methanol and chloroform, slightly soluble in ethanol, and sparingly soluble in . Fatal Found inside – Page 415Injection : Single - dose vial containing etoposide phosphate that is equivalent to 100 mg etopo- Contraindications and precautions side ( 20 mg etoposide ... Anaphylactic reactions have been reported in pediatric patients (see WARNINGS). Found inside – Page 523Semisynthetic podophyllotoxin 523 etoposide DOSAGE AND ROUTES Treatment for all ... malignant lymphoma (histiocytic type) CONTRAINDICATIONS: Pregnancy, ... Side Effects. Etoposide enters the CSF poorly. It is made more miscible with water by means of organic solvents. Found inside – Page 658CONTRAINDICATIONS: It should not be used if there is an allergy to etoposide or podophyllum. There is a potential adverse effect to the fetus if used by a ... However, it seems to interfere with the growth of the cancer cells, which are eventually destroyed. Found inside – Page 18Etoposide. Brand names Medication error potential Contraindications and warnings Infusion-related cautions Dosage Toposar, VePesid, VP-16, generic ISMP ... Administer as a 30-minute The nadir usually occurs between 10 and 14 days, with recovery occurring by day 21 (Perry 2012). Found inside – Page 347Etoposide One recent case study of a 61-year-old man undergoing ... CONTRAINDICATIONS AND PRECAUTIONS Contraindicated in people with allergies ... What should I know regarding pregnancy, nursing and administering etoposide to children or the elderly? Prior use of cisplatin may also result in a decrease of Etoposide total body clearance in children. Contraindicated in patients with known . Transient hypotension following rapid intravenous administration has been reported in 1% to 2% of patients. Safety and effectiveness in pediatric patients have not been established. Written by the foremost authority in the field, this volume is a comprehensive review of the multifaceted phenomenon of hepatotoxicity. . Two different dose-dependent responses are seen. Repeat cycle every 3-4 weeks for 4-6 cycles. In five single-agent studies of Etoposide phosphate in patients with a variety of tumor types, 34% of patients were age 65 years or more. Side Effects: Mouth ulcers, low blood pressure and nausea. Women of childbearing potential should be advised to avoid becoming pregnant. There is a Black Box Warning for this drug as shown here. The severity of such nausea and vomiting is generally mild to moderate with treatment discontinuation required in 1% of patients. The dosage should be modified to take into account the myelosuppressive effects of other drugs in the combination or the effects of prior x-ray therapy or chemotherapy which may have compromised bone marrow reserve. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Etoposide binding ratio correlates directly with serum albumin in patients with cancer and in normal volunteers. Guidelines and recommendations for safe handling of antineoplastic agents. In medical practice, the drug is usually used as an anticancer agent. Note: Wear disposable surgical gloves when preparing or disposing of etoposide. It is also present in human plasma, presumably as the trans isomer. Patients being treated with etoposide Injection USP must be frequently observed for myelosuppression both during and after therapy. At low doses, it inhibits cells from entering cell cycle and at high doses, cells entering mitosis are lysed. The use of etoposide requires an experienced clinician knowledgeable in administering chemotherapy. Data are not available in patients with creatinine clearances <15 mL/min and further dose reduction should be considered in these patients. Also, it is contraindicated in patients having severe leukopenia, thrombocytopenia and severe hepatic and/or renal impairment. When advanced age was determined to be a prognostic factor for response or survival in these studies, comparisons between treatment groups were performed for the elderly subset. Found inside – Page 591CONTRAINDICATIONS Hypersensitivity to etoposide, etoposide phosphate, or any other component of the formulations. PRECAUTIONS Follow guidelines for handling ... Etoposide Capsules are contraindicated in patients who have demonstrated a previous hypersensitivity to etoposide or any component of the formulation. Novaplus is a registered trademark of Vizient, Inc. Etoposide Injection, USP 100 mg/5 mL Label, Must be diluted before Intravenous infusion, methotrexate, Keytruda, cyclophosphamide, fluorouracil, carboplatin, Avastin, pembrolizumab, paclitaxel, Taxol, doxorubicin. endstream
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Cancer Chemotherapy Guidelines and Recommendations for Practice. Intravenous. Clinical studies of Etoposide for the treatment of refractory testicular tumors did not include sufficient numbers of patients aged 65 years and over to determine whether they respond differently from younger patients. US Dept of Health and Human Services, Public Health Service publication NIH 83-2621. Patients being treated with Etoposide must be frequently observed for myelosuppression both during and after therapy. Do not use live vaccines. Lactation (see section 4.6) Concomitant use of yellow fever vaccine or other live vaccines is contraindicated in immunosuppressed patients (see section 4.5). In comparison, the median PRDFS was only 7 months in the etoposide group, where all patients relapsed (hazard ratio HR 0.287, 95% KI: 0.076-0.884, p = 0.03). Oral dose is usually in the range of 70-100 mg/m 2 daily, rounded to nearest 50 mg. Refrigerate capsules at 2°-8° C (36°-46° F) unless otherwise directed. After intravenous infusion, the Cmax and AUC values exhibit marked intra- and inter-subject variability. Nausea and vomiting can usually be controlled with standard antiemetic therapy. Contraindications: Patients with known hypersensitivity to etoposide or to any component of the formulation (polysorbate 80). Reports of extravasation with swelling have been received postmarketing. (See WARNINGS.). The use of gloves is recommended. Back to top. Etoposide is teratogenic and embryocidal in rats and mice at doses of 1% to 3% of the recommended clinical dose based on body surface area. Be careful in order to avoid extravasation. Dosage should be . Etoposide Injection USP is contraindicated in patients who have demonstrated a previous hypersensitivity to etoposide or any component of the formulation. The exact way that etoposide acts against cancer is not known. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Testicular cancer- Adult: IV- The recommended dose is 50-100 mg/m 2 /day from days 1-5. Article Metrics ONS Clinical Practice Committee. In adults, the total body clearance of Etoposide is correlated with creatinine clearance, serum albumin concentration, and nonrenal clearance. This activity outlines the indications, action, and contraindications for etoposide as a valuable agent in managing various cancers listed above, Hodgkin and non-Hodgkin lymphoma and brain tumors. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function (see PRECAUTIONS: Renal Impairment for recommended dosing adjustments in patients with renal impairment). It is 4'-demethylepipodophyllotoxin 9- [4,6-O- (R)-ethylidene-β-D-glucopyranoside]. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use. WebMD provides common contraindications for etoposide oral. Other Warnings/Precautions: Patients with low serum albumin may be at an increased risk of toxicity. Etoposide has been shown to be mutagenic in Ames assay. Found inside – Page 652CONTRAINDICATIONS: Thrombophlebitis, cardiovascular disease, breast or reproductive ... pain on injection, and involuntary muscle movements. etoposide, ... It should be infused over 30-60 minutes or longer, depending on volume of . Use cautiously in patients who have had cytotoxic or radiation therapy. Contraindications and precautions Contraindicated in patients hypersensitive to etoposide, teniposide, or Cremaphor EL. Found inside – Page 536CONTRAINDICATIONS Hypersensitivity to etoposide, etoposide phosphate, or any other component of the formulations. PRECAUTIONS Follow guidelines for handling ... While their action is intended to target abnormal cells, normal cells are also affected. Found insideLook no further than the new 5th edition of the best-selling Manual for Pharmacy Technicians to master the practical skills and gain the foundational knowledge all technicians need to be successful. Reasons for etoposide substitution were: 71 (88%) cardiac contraindication, 7 (9%) prior exposure to anthracyclines and 3 (4%) other co-morbidities. CONTRAINDICATIONS: Etoposide Injection, USP is contraindicated in patients who have demonstrated a previous hypersensitivity to etoposide or any component of the formulation. No conclusive evidence exists Antioxidants Although this is a controversial area, many clinicians feel that antioxidants should not be taken while receiving chemotherapy and . This book comprehensively summarizes the current state of knowledge on malignancies of the gastrointestinal tract. Therefore, the following studies should be obtained at the start of therapy and prior to each subsequent cycle of Etoposide: platelet count, hemoglobin, white blood cell count, and differential. Guidelines for handling parenteral antineoplastics. 1987. Found inside – Page 27... Etoposide (VP-16) Standard dosage Contraindications Main drug interactions Main side effects Doxorubicin Standard dosage Irinotecan Standard dosage 5. (etoposide phosphate) for injection, for intravenous use . Hypertension and/or flushing have also been reported. At high concentrations (10 mcg/mL or more), lysis of cells entering mitosis is observed. Etoposide belongs to the group of medicines known as antineoplastic agents. Do not freeze. Etoposide has been shown to cause metaphase arrest in chick fibroblasts. Etoposide (also commonly known as VP-16) is a semisynthetic derivative of podophyllotoxin used in the treatment of certain neoplastic diseases. These drugs act on and kill altered human cells. 2/day (etoposide equivalent) on days 1 to 5 or 100 to 120 mg/m2 on days 1, 3, and 5 every 3 to 4 weeks in combination with other drugs indicated in the disease to be treated. Found inside – Page 463PRECAUTIONS Contraindications: Hypersensitivity to etoposide. Cautions: Hepatic/renal impairment, myelosuppression, low serum albumin. elderly, ... High concentrations of the drug cause lysis of cells in the premitoticheskoj phase. Etoposide (oral) is a chemotherapeutic agent that is FDA approved for the treatment of small cell lung cancer. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment. VePesid® (etoposide) (also commonly known as VP-16) is a semisynthetic derivative of podophyllotoxin used in the treatment of certain neoplastic diseases. Biliary excretion of unchanged drug and/or metabolites is an important route of Etoposide elimination as fecal recovery of radioactivity is 44% of the intravenous dose. Acute myeloid leukemia etoposide cardiac disease. Use cautiously in patients who have had cytotoxic or radiation therapy. Contraindications Etoposide is contraindicated in: Bone marrow suppression (e.g., neutropenia, thrombocytopenia) is a dose-limiting toxicity with etoposide therapy and has resulted in severe infection, bleeding, and death. The unbound fraction of Etoposide significantly correlated with bilirubin in a population of cancer patients. Wash immediately with soap and water if skin comes in contact with . If Etoposide solution contacts the skin or mucosa, immediately and thoroughly wash the skin with soap and water and flush the mucosa with water. In a study determining the effect of other therapeutic agents on the in vitro binding of carbon-14 labeled Etoposide to human serum proteins, only phenylbutazone, sodium salicylate, and aspirin displaced protein-bound Etoposide at concentrations achieved in vivo. Glucuronide and/or sulfate conjugates of etoposide are also excreted in human urine. The effect of renal disease on plasma Etoposide clearance is not known. Patients with low serum albumin may be at an increased risk for Etoposide associated toxicities. Hypersensitivity to the active substance or to any of the excipients listed in section 6.1. Patients then receive sodium thiosulfate IV over 15 minutes at 4 and 8 hours after carboplatin. Hypotension following rapid intravenous administration has been reported; hence, it is recommended that the Etoposide solution be administered over a 30- to 60-minute period. Procedures for proper handling and disposal. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from Etoposide, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. QC@�l�yB��8 Za���&��0i�Iͪ��
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�Q*4��IC^t�iZ��yb`khm�����a�熅p�����y�y 7X���;cx� }�%��g� This medication . ). (and other disorders when applicable). Note: Plastic devices made of acrylic or ABS (a polymer composed of acrylonitrile, butadiene, and styrene) have been reported to crack and leak when used with undiluted Etoposide Injection. 1985;253:1590-1591. The occurrence of acute leukemia with or without a preleukemic phase has been reported rarely in patients treated with Etoposide in association with other antineoplastic agents. In all instances where the use of Etoposide is considered for chemotherapy, the physician must evaluate the need and usefulness of the drug against the risk of adverse reactions. The dose of Vepesid is based on the recommended dose for the intravenous etoposide medicines, with a 100 mg oral dose being comparable to a 75 mg intravenous one. If hypotension occurs, it usually responds to cessation of the infusion administration of fluids or other supportive therapy as appropriate. Found insideCONTRAINDICATIONS: Etoposide is contraindicated in patients who have demonstrated a previous hypersensitivity to etoposide or any component of the ... Several guidelines on this subject have been published.1-8 There is no general agreement that all of the procedures recommended in the guidelines are necessary or appropriate. No proven antidotes have been established for Etoposide overdosage. Contraindications. Herb and Supplement Interactions with Cancer Treatment Kim DeRhodes, RPh N-acetyl cysteine Do not take while taking cisplatin Alpha lipoic acid Theoretically, may interfere with chemotherapy as it acts as an antioxidant. Warnings Only 8% or less of an intravenous dose is excreted in the urine as radiolabeled metabolites of 14C-Etoposide. No delayed hypotension has been noted. It is in the topoisomerase II inhibitor class of medications. Unopened vials of Etoposide Injection are stable for 24 months at room temperature (25°C). Found inside – Page 587... 6 : 194 epirubicin , 6 : 195 etoposide contraindications and side effects , 6 : 205 medicinal uses , 6 : 205 mode of action and resistance , 6 : 205–206 ... In addition, an apparent hypersensitivity-associated apnea has been reported rarely. Etoposide should not be given by rapid intravenous injection. The infusion should be terminated immediately, followed by the administration of pressor agents, corticosteroids, antihistamines, or volume expanders at the discretion of the physician. 142 0 obj
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Etoposide (also commonly known as VP-16) is a semisynthetic derivative of podophyllotoxin used in the treatment of certain neoplastic diseases. Etoposide has been shown to be teratogenic in mice and rats. The drug blocks mitosis,causing the death of cells in the G2 phase and late S phase mitoticeski cycle. Maternal weight gain was not affected. Pittsburgh, PA: Oncology Nursing Society; 1999:32-41. Etoposide injection and/or capsules in combination with other approved chemotherapeutic agents as first line treatment in patients with small cell lung cancer. Etoposide (50 mg) 50mg - 8 Capsules Capsule (Etoposide) drug information. Store at 20° to 25°C (68° to 77°F). 50-70 mg/m² IV cycle q3-4Weeks, depending on prior radiation therapy or chemotherapy . Etoposide is cleared by both renal and nonrenal processes, i.e., metabolism and biliary excretion. Etoposide contraindications and precautions. Rash, urticaria, and/or pruritus have infrequently been reported at recommended doses. Fludarabine contraindications •. Found inside – Page 6224 Rationale: An adverse effect specific to etoposide is orthostatic ... It is necessary to know the contraindications associated with this medication. Hypersensitivity to the active substance or to any of the excipients listed in section 6.1. WARNINGS Patients being treated with etoposide Injection USP must be frequently observed for myelosuppression both during and after therapy. Found inside – Page 361... rhabdomyosarcoma , Wilms ' tumor and brain tumors Pregnancy Risk Factor D Contraindications Hypersensitivity to etoposide or any component Warnings ... 72 (89%) patients received rituximab as part of the treatment, 25 (31%) received partial treatment with R-CHOP and then switched to R-CEOP and 56 (69%) received no anthracycline therapy. Treatment is symptomatic. Etoposide Injection, USP is available for intravenous use as 20 mg/mL solution in 100 mg (5 mL), 500 mg (25 mL), and 1 g (50 mL) sterile, multiple-dose vials. Found inside – Page 134... therapy have response rates essentially the same as first line and should be treated with etoposide platinum again in the absence of contraindications. 2 DOSAGE AND ADMINISTRATION . An inverse relationship between plasma albumin levels and Etoposide renal clearance is found in children. Our objective was such a comparison in patients with poor performance status. (Contraindications) Hypersensitivity. Interactions Drug-drug. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. The mean renal clearance of Etoposide is 7 to 10 mL/min/m2 or about 35% of the total body clearance over a dose range of 80 to 600 mg/m2. Effect of etoposide on the pharmacokinetics of other drugs. Available from Louis P. Jeffrey, Chairman, National Study Commission on Cytotoxic Exposure. At low doses, it inhibits cells from entering cell cycle and at high doses, cells entering mitosis are lysed. Etoposide Injection USP is contraindicated in patients who have demonstrated a previous hypersensitivity to etoposide or any component of the formulation. Found inside – Page 652CONTRAINDICATIONS: Thrombophlebitis, cardiovascular disease, breast or reproductive ... pain on injection, and involuntary muscle movements. etoposide, ... American Society of Hospital Pharmacists. Do NOT inject rapidly (may cause hypotension); infuse over at least 30-60 min Nausea and vomiting are the major gastrointestinal toxicities. Reversible alopecia, sometimes progressing to total baldness was observed in up to 66% of patients. Hypersensitivity, pregnancy, lactation. It is in the topoisomerase II inhibitor class of medications. Contraindications. The usual dose of Etoposide Injection in testicular cancer in combination with other approved chemotherapeutic agents ranges from 50 to 100 mg/m2/day on days 1 through 5 to 100 mg/m2/day on days 1, 3, and 5. Drug Interactions. Withhold further treatment if platelet . The hydroxy acid metabolite [4’-demethylepipodophyllic acid-9-(4,6-0-(R)-ethylidene-β-D-glucopyranoside)], formed by opening of the lactone ring, is found in the urine of adults and children. Found inside – Page 404404 etoposide Bogbean, chondroitin, saw palmetto, turmeric: increased ... testicular cancer Unlabeled uses: Lymphomas CONTRAINDICATIONS: Pregnancy D, ... Description: Etoposide is a derivative of podophyllotoxin that inhibits DNA synthesis resulting in the arrest of the cell cycle. JAMA. The usual dose of Vepesid is 100 to 200 mg per m2of body surface area for 5 days in a row or 200 mg/m2/day on days 1, 3 and 5 every 3 to 4 weeks. h��Z�n��>�b�n^�7`��.�-�vKYo"�a,M�A$�0o�O����Eʒ�y���E�b�ԅ+'��)���Zi~aT�7 ��o+����@�O�"䢈���