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ALERT: U.S. Boxed Warning
The FDA-approved labeling includes a boxed warning. See Warnings/Precautions section for a concise summary of this information. For verbatim wording of the boxed warning, consult the product labeling or www.fda.gov.
Medication Safety Issues
Sound-alike/look-alike issues:
Etoposide may be confused with teniposide
VePesid® may be confused with Versed
High alert medication: The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs which have a heightened risk of causing significant patient harm when used in error.
Pronunciation
(e toe POE side)
U.S. Brand Names
Index Terms
Generic Available
Yes
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Treatment of refractory testicular tumors; treatment of small cell lung cancer
Use: Unlabeled/Investigational
Treatment of lymphomas, acute nonlymphocytic leukemia (ANLL); lung, bladder, and prostate carcinoma; hepatoma, rhabdomyosarcoma, uterine carcinoma, neuroblastoma, mycosis fungoides, Kaposi's sarcoma, histiocytosis, gestational trophoblastic disease, Ewing's sarcoma, Wilms' tumor, brain tumors
Pregnancy Risk Factor
D
Pregnancy Considerations
Animal studies have demonstrated teratogenicity and fetal loss. There are no adequate and well-controlled studies in pregnant women. Women of childbearing potential should be advised to avoid pregnancy.
Lactation
Enters breast milk/contraindicated
Contraindications
Hypersensitivity to etoposide or any component of the formulation; pregnancy
Warnings/Precautions
Boxed warnings:
• Bone marrow suppression: See “Concerns related to adverse effects” below.
• Experienced physician: See “Other warnings/precautions” below.
Special handling:
• Hazardous agent: Use appropriate precautions for handling and disposal.
Concerns related to adverse effects:
• Anaphylactic reaction: May cause anaphylactic reaction manifested by chills, fever, tachycardia, bronchospasm, dyspnea, and hypotension. In children, the use of concentrations higher than recommended were associated with higher rates of anaphylactic-like reactions. Infusion should be interrupted and medications for the treatment of anaphylaxis should be available for immediate use.
• Bone marrow suppression: [U.S. Boxed Warning]: Severe myelosuppression with resulting infection or bleeding may occur. Treatment should be withheld for platelets <50,000/mm3 or absolute neutrophil count (ANC) <500/mm3.
Disease-related concerns:
• Hepatic impairment: Use with caution in patients with hepatic impairment; dosage should be adjusted.
• Renal impairment: Use with caution in patients with renal impairment; dosage should be adjusted.
Dosage form specific issues:
• Benzyl alcohol: May contain benzyl alcohol which has been associated with "gasping syndrome" in neonates.
• Polysorbate 80: Injectable formula contains polysorbate 80; do not use in premature infants.
Other warnings/precautions:
• Administration: Must be diluted; do not give I.V. push, infuse over at least 30-60 minutes; hypotension is associated with rapid infusion.
• Experienced physician: [U.S. Boxed Warning]: Should be administered under the supervision of an experienced cancer chemotherapy physician.
Adverse Reactions
>10%:
Dermatologic: Alopecia (8% to 66%)
Endocrine & metabolic: Ovarian failure (38%), amenorrhea
Gastrointestinal: Nausea/vomiting (31% to 43%), anorexia (10% to 13%), diarrhea (1% to 13%), mucositis/esophagitis (with high doses)
Hematologic: Leukopenia (60% to 91%; grade 4: 3% to 17%; onset: 5-7 days; nadir: 7-14 days; recovery: 21-28 days), thrombocytopenia (22% to 41%; grades 3/4: 1% to 20%; nadir 9-16 days), anemia (up to 33%)
1% to 10%:
Cardiovascular: Hypotension (1% to 2%; due to rapid infusion)
Gastrointestinal: Stomatitis (1% to 6%), abdominal pain (up to 2%)
Hepatic: Hepatic toxicity (up to 3%)
Neuromuscular & skeletal: Peripheral neuropathy (1% to 2%)
Miscellaneous: Anaphylactic-like reaction (I.V. infusion: 1% to 2%; including chills, fever, tachycardia, bronchospasm, dyspnea)
<1%: Anovulatory cycles, back pain; blindness (transient, cortical); CHF, constipation, cough, cyanosis, diaphoresis, dysphagia, erythema; extravasation (induration, necrosis, swelling); facial swelling, fatigue, fever, headache, hepatic toxicity, hepatitis, hyperpigmentation, hypersensitivity, hypersensitivity-associated apnea, hypomenorrhea, interstitial pneumonitis, laryngospasm, maculopapular rash, malaise, metabolic acidosis, MI, optic neuritis, perivasculitis, pruritus, pulmonary fibrosis, radiation-recall dermatitis, rash, seizure, somnolence, Stevens-Johnson syndrome, tachycardia, taste perversion, thrombophlebitis, tongue swelling, toxic epidermal necrolysis, urticaria, weakness
Metabolism/Transport Effects
Substrate of CYP1A2 (minor), 2E1 (minor), 3A4 (major); Inhibits CYP2C9 (weak), 3A4 (weak)
Drug Interactions
Barbiturates: May increase the metabolism of Etoposide. Risk C: Monitor therapy
CycloSPORINE: May decrease the metabolism of Etoposide. Risk D: Consider therapy modification
CYP3A4 Inducers (Strong): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
CYP3A4 Inhibitors (Moderate): May decrease the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
CYP3A4 Inhibitors (Strong): May decrease the metabolism of CYP3A4 Substrates. Risk D: Consider therapy modification
Dasatinib: May increase the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapy
Deferasirox: May decrease the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapy
Echinacea: May diminish the therapeutic effect of Immunosuppressants. Risk D: Consider therapy modification
Herbs (CYP3A4 Inducers): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
Leflunomide: Immunosuppressants may enhance the adverse/toxic effect of Leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Management: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Patients receiving both leflunomide and another immunosuppressant should be monitored for bone marrow suppression at least monthly. Risk D: Consider therapy modification
Natalizumab: Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased. Risk X: Avoid combination
P-Glycoprotein Inducers: May decrease the serum concentration of P-Glycoprotein Substrates. P-glycoprotein inducers may also further limit the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Risk C: Monitor therapy
P-Glycoprotein Inhibitors: May increase the serum concentration of P-Glycoprotein Substrates. P-glycoprotein inhibitors may also enhance the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Risk C: Monitor therapy
Phenytoin: May increase the metabolism of Etoposide. Risk C: Monitor therapy
Trastuzumab: May enhance the neutropenic effect of Immunosuppressants. Risk C: Monitor therapy
Vaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Risk C: Monitor therapy
Vaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of Vaccines (Live). Vaccinial infections may develop. Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live virus vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants. Risk X: Avoid combination
Vitamin K Antagonists (eg, warfarin): Antineoplastic Agents may enhance the anticoagulant effect of Vitamin K Antagonists. Antineoplastic Agents may diminish the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy
Vitamin K Antagonists (eg, warfarin): Etoposide may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy
Ethanol/Nutrition/Herb Interactions
Ethanol: Avoid ethanol (may increase GI irritation).
Herb/Nutraceutical: Avoid concurrent St John's wort; may decrease etoposide levels.
Storage
Store intact vials of injection at 15°C to 30°C (59°F to 86°F). Protect from light. Store oral capsules at 2°C to 8°C (36°F to 46°F). Solutions for infusion, at room temperature, in D5W or NS in polyvinyl chloride, the concentration is stable as follows:
0.2 mg/mL: 96 hours
0.4 mg/mL: 24 hours
Etoposide injection contains polysorbate 80 which may cause leaching of diethylhexyl phthalate (DEHP), a plasticizer contained in polyvinyl chloride (PVC) bags and tubing. Higher concentrations and longer storage time after preparation in PVC bags may increase DEHP leaching. Preparation in glass or polyolefin containers will minimize patient exposure to DEHP.
Etoposide injection diluted for oral use to 10 mg/mL in NS may be stored for 22 days in plastic oral syringes at room temperature. Mix with orange juice, apple juice, or lemonade to a concentration of ?0.4 mg/mL, and use within a 3-hour period.
Reconstitution
Etoposide should be diluted to a concentration of 0.2-0.4 mg/mL in D5W or NS for administration. Diluted solutions have concentration-dependent stability: More concentrated solutions have shorter stability times. Precipitation may occur with concentrations >0.4 mg/mL.
Compatibility
Variable stability (consult detailed reference) in D5W, LR, NS.
Y-site administration: Compatible: Allopurinol, amifostine, aztreonam, cladribine, doxorubicin liposome, fludarabine, gemcitabine, granisetron, melphalan, ondansetron, paclitaxel, piperacillin/tazobactam, sargramostim, sodium bicarbonate, teniposide, thiotepa, topotecan, vinorelbine. Incompatible: Cefepime, filgrastim, idarubicin.
Compatibility when admixed: Compatible: Carboplatin, cisplatin, cisplatin with cyclophosphamide, cisplatin with floxuridine, cytarabine, cytarabine with daunorubicin, floxuridine, fluorouracil, hydroxyzine, ifosfamide, ifosfamide with carboplatin, ifosfamide with cisplatin, ondansetron. Variable (consult detailed reference): Cisplatin with mannitol and potassium chloride, doxorubicin with vincristine.
Mechanism of Action
Etoposide has been shown to delay transit of cells through the S phase and arrest cells in late S or early G2 phase. The drug may inhibit mitochondrial transport at the NADH dehydrogenase level or inhibit uptake of nucleosides into HeLa cells. It is a topoisomerase II inhibitor and appears to cause DNA strand breaks. Etoposide does not inhibit microtubular assembly.
Pharmacodynamics/Kinetics
Absorption: Oral: 25% to 75%; significant inter- and intrapatient variation
Distribution: Average Vd: 7-17 L/m2; poor penetration across the blood-brain barrier; CSF concentrations <10% of plasma concentrations
Protein binding: 94% to 97%
Metabolism: Hepatic to hydroxy acid and cislactone metabolites
Bioavailability: Oral: ?50% (range: 25% to 75%)
Half-life elimination: Terminal: 4-11 hours; Children: Normal renal/hepatic function: 6-8 hours
Time to peak, serum: Oral: 1-1.5 hours
Excretion:
Children: Urine (?55% as unchanged drug)
Adults: Urine (42% to 67%; 8% to 35% as unchanged drug) within 24 hours; feces (up to 44%)
Dosage
Refer to individual protocols:
Children (unlabeled uses): I.V.: 60-120 mg/m2/day for 3-5 days every 3-6 weeks
AML:
Remission induction: 150 mg/m2/day for 2-3 days for 2-3 cycles
Intensification or consolidation: 250 mg/m2/day for 3 days, courses 2-5
Brain tumor: 150 mg/m2/day on days 2 and 3 of treatment course
Neuroblastoma: 100 mg/m2/day over 1 hour on days 1-5 of cycle; repeat cycle every 4 weeks
BMT conditioning regimen used in patients with rhabdomyosarcoma or neuroblastoma: I.V. continuous infusion: 160 mg/m2/day for 4 days
Conditioning regimen for allogenic BMT: 60 mg/kg/dose as a single dose
Adults:
Small cell lung cancer (in combination with other approved chemotherapeutic drugs):
Oral: Due to poor bioavailability, oral doses should be twice the I.V. dose, rounded to the nearest 50 mg given once daily
I.V.: 35 mg/m2/day for 4 days or 50 mg/m2/day for 5 days every 3-4 weeks
IVPB: 60-100 mg/m2/day for 3 days (with cisplatin)
CIV: 500 mg/m2 over 24 hours every 3 weeks
Testicular cancer (in combination with other approved chemotherapeutic drugs):
IVPB: 50-100 mg/m2/day for 5 days repeated every 3-4 weeks
I.V.: 100 mg/m2 every other day for 3 doses repeated every 3-4 weeks
BMT/relapsed leukemia (unlabeled uses): I.V.: 2.4-3.5 g/m2 or 25-70 mg/kg administered over 4-36 hours
Dosing adjustment in renal impairment:
The FDA-approved labeling recommends the following adjustments:
Clcr 15-50 mL/minute: Administer 75% of dose
Clcr <15 mL minute: Data not available; consider further dose reductions
The following guidelines have been used by some clinicians:
Aronoff, 2007:
Clcr 10-50 mL/minute: Children and Adults: Administer 75% of dose
Clcr <10 mL minute: Children and Adults: Administer 50% of dose
Hemodialysis:
Children: Administer 50% of dose
Adults: Supplemental dose is not necessary
Continuous ambulatory peritoneal dialysis (CAPD):
Children: Administer 50% of dose
Adults: Supplemental dose is not necessary
Continuous renal replacement therapy (CRRT): Children and Adults: Administer 75% of dose
Kintzel, 1995:
Clcr 46-60 mL/minute: Administer 85% of dose
Clcr 31-45 mL/minute: Administer 80% of dose
Clcr <30 mL/minute: Administer 75% of dose
Dosing adjustment in hepatic impairment: The FDA-approved labeling does not contain dosing adjustment guidelines. The following adjustments have been used by some clinicians:
Donelli, 1998: Liver dysfunction may reduce the metabolism and increase the toxicity of etoposide. Normal doses of I.V. etoposide should be given to patients with liver dysfunction (dose reductions may result in subtherapeutic concentrations); however, use caution with concomitant liver dysfunction (severe) and renal dysfunction as the decreased metabolic clearance cannot be compensated by increased renal clearance.
Floyd, 2006: Bilirubin 1.5-3 mg/dL or AST >3 times ULN: Administer 50% of dose
King, 2001: Bilirubin 1.5-3 mg/dL or ALT or AST >180 units/L: Administer 50% of dose
Koren, 1992: Bilirubin 1.5-3 mg/dL or AST >180 units/L: Administer 50% of dose
Perry, 1982:
Bilirubin 1.5-3 mg/dL or AST 60-180 units/L: Administer 50% of dose
Bilirubin >3 mg/dL or AST >180 units/L: Avoid use
Dosage: Combination Regimens
Adenocarcinoma, unknown primary:
EP (Adenocarcinoma)
Paclitaxel-Carboplatin-Etoposide
PCE
Brain tumors:
CDDP/VP-16
COPE
Breast cancer: ICE-T
Gastric cancer:
EAP
EFP
ELF
Gestational trophoblastic tumor:
EMA/CO
EP/EMA
Leukemia, acute lymphocytic: Hyper-CVAD (Leukemia, Acute Lymphocytic)
Leukemia, acute myeloid:
7 + 3 + 7
DAV
EMA 86
Idarubicin, Cytarabine, Etoposide (ICE Protocol)
Idarubicin-Cytarabine (High-Dose)-Etoposide (AML)
MV
V-TAD
Lung cancer (small cell):
CAVE
EC (Small Cell Lung Cancer)
EP (Small Cell Lung Cancer)
VIP (Small Cell Lung Cancer)
VP (Small Cell Lung Cancer)
Lung cancer (nonsmall cell):
Cisplatin-Etoposide (NSCLC)
EC (NSCLC)
EP (NSCLC)
EP/PE
Lymphoma, Hodgkin's:
BEACOPP
Etoposide-Vinblastine-Doxorubicin (Hodgkin's)
mini-BEAM
Stanford V Regimen
VIM-D (Hodgkin's Lymphoma)
Lymphoma, non-Hodgkin's:
CEPP(B)
CODOX-M/IVAC
EPOCH Dose-Adjusted (AIDS-Related Lymphoma)
EPOCH Dose-Adjusted (NHL)
EPOCH (Dose-Adjusted)-Rituximab (NHL)
EPOCH (NHL)
EPOCH-Rituximab (NHL)
ESHAP
ICE (Lymphoma, non-Hodgkin's)
IMVP-16
IVAC
MINE
MINE-ESHAP
Pro-MACE-CytaBOM
RICE
Lymphoma, non-Hodgkin's (Burkitt's): CODOX-M/IVAC
Multiple myeloma: DTPACE
Neuroblastoma:
CAV-P/VP
CDDP/VP-16
CE (Neuroblastoma)
CE-CAdO
HIPE-IVAD
N6 Protocol
Regimen A2
Osteosarcoma: ICE (Sarcoma)
Ovarian cancer:
BEP (Ovarian Cancer)
BEP (Ovarian Cancer, Testicular Cancer)
Etoposide-Carboplatin (Ovarian Cancer)
Prostate cancer:
Estramustine + Etoposide
Paclitaxel + Estramustine + Etoposide
Retinoblastoma:
CCCDE (Retinoblastoma)
CE (Retinoblastoma)
Sarcoma: VAC Alternating With IE (Ewing's Sarcoma)
Sarcoma, soft tissue:
ICE (Sarcoma)
ICE-T
IE
Testicular cancer:
BEP (Ovarian Cancer, Testicular Cancer)
BEP (Testicular Cancer)
EP (Testicular Cancer)
VIP (Etoposide) (Testicular Cancer)
Administration: Oral
Doses ?400 mg/day as a single once daily dose; doses >400 mg should be given in 2-4 divided doses. If necessary, the injection may be used for oral administration.
Administration: I.M.
Do not administer I.M. or SubQ (severe tissue necrosis).
Administration: I.V.
Irritant. Administer lower doses IVPB over at least 30 minutes to minimize the risk of hypotensive reactions. Etoposide injection contains polysorbate 80 which may cause leaching of diethylhexyl phthalate (DEHP), a plasticizer contained in polyvinyl chloride (PVC) tubing. Administration through non-PVC (low sorbing) tubing will minimize patient exposure to DEHP.
Administration: I.V. Detail
Concentrations >0.4 mg/mL are very unstable and may precipitate within a few minutes. For large doses, where dilution to ?0.4 mg/mL is not feasible, consideration should be given to slow infusion of the undiluted drug through a running normal saline, dextrose or saline/dextrose infusion; or use of etoposide phosphate. Etoposide solutions of 0.1-0.4 mg/mL may be filtered through a 0.22 micron filter without damage to the filter or significant loss of drug.
pH: 3-4
BMT only: The etoposide formulation contains ethanol 30.3% (v/v). Etoposide 2.4 mg/m2 delivers ethanol 45 g/m2 I.V. Adverse effects may be increased with administration of etoposide to patients with decreased creatinine clearance.
Monitoring Parameters
CBC with differential, platelet count, and hemoglobin, vital signs (blood pressure), bilirubin, and renal function tests
Patient Education
Do not take any new medication during therapy unless approved by prescriber. This medication may be administered by infusion. Report immediately any swelling, pain, burning, or redness at infusion site; swelling of extremities; palpitations, rapid heartbeat, sudden difficulty breathing or swallowing; chest pain or chills. It is important to maintain adequate hydration unless instructed to restrict fluid intake, and adequate nutrition (small, frequent meals may help). You will be more susceptible to infection (avoid crowds and exposure to infection and do not have any vaccinations without consulting prescriber). May cause nausea or vomiting (small, frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help); diarrhea; loss of hair (reversible); or mouth sores (use soft toothbrush or cotton swabs for oral care and rinse mouth frequently). Report extreme fatigue, pain or numbness in extremities, severe GI upset or diarrhea, bleeding or bruising, fever, sore throat, vaginal discharge, yellowing of eyes or skin, or any changes in color of urine or stool. Pregnancy/breast-feeding precautions: Do not get pregnant while taking this medication. Consult prescriber for appropriate contraceptive measures to use during and for 1 month following therapy. Do not breast-feed.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Mucositis (especially at high doses) and stomatitis.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May cause sedation
Mental Health: Effects on Psychiatric Treatment
May cause myelosuppression; use caution with clozapine and carbamazepine
Nursing: Physical Assessment/Monitoring
Assess potential for interactions with other pharmacological agents or herbal products patient may be taking (eg, potential for increasing/decreasing levels or effects of etoposide). Patient should be monitored closely for anaphylactic reaction (chills, fever, tachycardia, bronchospasm, dyspnea, hypotension). Emergency equipment should be available. Assess results of laboratory tests and renal function, therapeutic effectiveness, and adverse response prior to each treatment and on a regular basis throughout therapy. Teach patient possible side effects/appropriate interventions and adverse symptoms to report.
Oncology: Emetic Potential
Oral: Moderate (30% to 90%)
I.V.: Low (10% to 30%)
Oncology: Vesicant
May be an irritant
Oncology: Bone Marrow Comments
The etoposide formulation contains ethanol 30.3% (v/v). Etoposide 2.4 mg/m2 delivers ethanol 45 g/m2 I.V. Adverse effects may be increased with administration of etoposide to patients with decreased creatinine clearance. Etoposide 400-1600 mg/m2 has been drawn into plastic syringes undiluted (20 mg/mL) for administration over 3-4 hours. Etoposide 800 mg/m2 was pharmacokinetically equivalent to etoposide phosphate 910 mg/m2 in patients with refractory hematologic malignancies.
Oncology: Bone Marrow - High Dose
I.V.: 750-2400 mg/m2; 10-60 mg/kg; duration of infusion is 1-4 hours to 24 hours; generally combined with other high-dose chemotherapeutic drugs or total body irradiation (TBI).
Oncology: Bone Marrow - Unique Toxicity
Cardiovascular: Hypotension (infusion-related)
Central nervous system: Confusion, somnolence, seizure activity increased
Dermatologic: Skin lesions resembling Stevens-Johnson syndrome, alopecia
Endocrine & metabolic: Metabolic acidosis, parotitis
Gastrointestinal: Severe nausea and vomiting, mucositis
Hepatic: Hepatitis
Neuromuscular & skeletal: Peripheral neuropathy, motor deficits exacerbated
Miscellaneous: Secondary malignancy, ethanol intoxication (infusion-related)
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, softgel: 50 mg
Injection, solution: 20 mg/mL (5 mL, 25 mL, 50 mL) [contains benzyl alcohol, ethanol 30.5%, polyethylene glycol 300, and polysorbate 80]
Toposar™: 20 mg/mL (5 mL, 25 mL, 50 mL) [contains dehydrated ethanol 33.2%, polyethylene glycol 300, and polysorbate 80]
References
Aronoff GR, Bennett WM, Berns JS, et al, Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children, 5th ed. Philadelphia, PA: American College of Physicians; 2007, p 99, 171.
Clark PL and Slevin ML, “The Clinical Pharmacology of Etoposide and Teniposide,” Clin Pharmacokinet, 1987, 12(4):223-52.
de Lemos ML, Hamata L, and Vu T, “Leaching of Diethylhexyl Phthalate from Polyvinyl Chloride Materials into Etoposide Intravenous Solutions,” J Oncol Pharm Pract, 2005, 11(4):155-7.
Demoré B, Vigneron J, Perrin A, et al, “Leaching of Diethylhexyl Phthalate from Polyvinyl Chloride Bags into Intravenous Etoposide Solution,” J Clin Pharm Ther, 2002, 27(2):139-42.
Donelli MG, Zucchetti M, Munzone E, et al, “Pharmacokinetics of Anticancer Agents in Patients With Impaired Liver Function,” Eur J Cancer, 1998, 34(1):33-46.
Floyd J, Mirza I, Sachs B, et al, "Hepatotoxicity of Chemotherapy," Semin Oncol, 2006, 33(1):50-67.
Hainsworth JD and Greco FA, “Etoposide: Twenty Years Later,” Ann Oncol, 1995, 6(4):325-41.
Joel SP, Shah R, and Slevin ML, “Etoposide Dosage and Pharmacodynamics,” Cancer Chemother Pharmacol, 1994, 34(Suppl):69-75.
King PD and Perry MC, “Hepatotoxicity of Chemotherapy,” Oncologist, 2001, 6(2):162-76.
Kintzel PE and Dorr RT, "Anticancer Drug Renal Toxicity and Elimination: Dosing Guidelines for Altered Renal Function," Cancer Treat Rev, 1995, 21(1):33-64.
Koren G, Beatty K, Seto A, et al, “The Effects of Impaired Liver Function on the Elimination of Antineoplastic Agents,” Ann Pharmacother, 1992, 26(3):363-71.
McLeod HL and Relling MV, “Stability of Etoposide Solution for Oral Use,” Am J Hosp Pharm, 1992, 49(11):2784-5.
Meresse P, Dechaux E, Monneret C, et al, “Etoposide: Discovery and Medicinal Chemistry,” Curr Med Chem, 2004, 11(18):2443-66.
Perry MC, “Hepatotoxicity of Chemotherapeutic Agents,” Semin Oncol, 1982, 9(1):65-73.
Toffoli G, Corona G, Basso B, et al “Pharmacokinetic Optimisation of Treatment with Oral Etoposide,” Clin Pharmacokinet, 2004, 43(7):441-66.
Trissel L, Handbook of Injectable Drugs, 13th ed, Bethesda, MD: American Society of Health-System Pharmacists; 2005, p 590-6.
International Brand Names
Lexi-Comp.com
Last full review/revision October 2009
Content last modified October 2009
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