Etoposide 100mg/5ml Inj, 5ml

Etoposide is a topoisomerase II inhibitor. It forms a ternary complex with topoisomerase II and DNA, preventing the enzyme from re-ligating DNA strands after DNA cleavage. This leads to accumulation of DNA strand breaks, inhibition of DNA synthesis, and ultimately, cell death (apoptosis). It acts primarily in the late S and G2 phases of the cell cycle.

Urgent Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:

Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat. In rare cases, allergic reactions can be fatal.
Signs of infection: fever, chills, severe sore throat, ear or sinus pain, cough, increased or changed sputum production, painful urination, mouth sores, or a wound that won't heal.
Signs of bleeding: vomiting or coughing up blood, coffee ground-like vomit, blood in the urine, black, red, or tarry stools, gum bleeding, abnormal vaginal bleeding, unexplained or enlarging bruises, or uncontrollable bleeding.
Signs of a severe skin reaction (Stevens-Johnson syndrome/toxic epidermal necrolysis): red, swollen, blistered, or peeling skin (with or without fever), red or irritated eyes, or sores in the mouth, throat, nose, or eyes.
Signs of high or low blood pressure: severe headache or dizziness, fainting, or changes in vision.
Shortness of breath.
Rapid heartbeat.
Flushing.
Excessive sweating.
Blue or gray skin discoloration.
Back pain.
Seizures.

If you experience any of these symptoms, notify your healthcare provider immediately. Additionally, if the medication leaks from the vein during administration, it may cause tissue damage. Inform your nurse if you notice any redness, burning, pain, swelling, blisters, skin sores, or fluid leakage at the injection site.

Other Possible Side Effects

Like all medications, this drug can cause side effects, although many people may not experience any or may only have mild symptoms. If you're bothered by any of the following side effects or if they persist, consult your doctor:

Hair loss.
Fatigue or weakness.
Mouth irritation or sores.
Diarrhea, vomiting, stomach upset, and decreased appetite are common side effects. If you experience these, discuss ways to manage them with your doctor. If they worsen, persist, or are severe, seek medical attention.

This is not an exhaustive list of possible side effects. If you have questions or concerns, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
If you have a low platelet count (thrombocytopenia) or a low white blood cell count (leukopenia).
If you have a history of kidney disease (renal impairment) or liver disease (hepatic impairment).
If you are breastfeeding. Note that you should not breastfeed while taking this medication.

This list is not exhaustive, and it is crucial to discuss all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, with your doctor and pharmacist. They will help you determine if it is safe to take this medication with your other medications and health conditions. Do not initiate, discontinue, or adjust the dosage of any medication without first consulting your doctor.

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Regular blood work and laboratory tests, as directed by your doctor, are crucial to monitor your condition.

As this medication may increase your risk of developing infections, it is vital to practice good hygiene by washing your hands frequently and avoiding close contact with individuals who have infections, colds, or flu.

You may experience an increased risk of bleeding, so it is crucial to be cautious and avoid injuries. To minimize this risk, use a soft toothbrush and an electric razor for shaving.

Before consuming alcohol, discuss the potential risks with your doctor. Additionally, consult your doctor before receiving any vaccinations, as some vaccines may not be effective or may increase the risk of infection when taken with this medication.

There is a rare possibility of developing other types of cancer later in life. If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.

This medication may affect fertility, leading to difficulties in becoming pregnant or fathering a child. If you plan to conceive, discuss the potential risks with your doctor before starting treatment.

Taking this medication during pregnancy may harm the unborn baby. If you or your partner may become pregnant, it is essential to use birth control while taking this medication and possibly for a period after the last dose. Consult your doctor to determine the necessary duration of birth control. If you or your partner becomes pregnant, notify your doctor immediately.

• Live vaccines (risk of severe infection)
• Myelosuppressive agents (additive myelosuppression)
• Warfarin (increased anticoagulant effect, increased INR)
• Cyclosporine (increased etoposide exposure)
• Phenytoin (decreased etoposide exposure)

• Other CYP3A4 inhibitors (e.g., azole antifungals, macrolide antibiotics, protease inhibitors) - potential for increased etoposide levels.
• Other CYP3A4 inducers (e.g., rifampin, carbamazepine, St. John's Wort) - potential for decreased etoposide levels.
• Highly protein-bound drugs (e.g., salicylates, sulfonamides) - potential for displacement.

• Signs of infection (fever, chills, sore throat)
• Bleeding or bruising (petechiae, epistaxis, melena)
• Fatigue or weakness
• Nausea, vomiting, diarrhea
• Oral mucositis or stomatitis
• Hair loss (alopecia)
• Peripheral neuropathy (numbness, tingling)
• Signs of hypersensitivity reaction (chills, fever, tachycardia, bronchospasm, dyspnea, hypotension)
• Signs of extravasation (pain, swelling, redness at infusion site)

Etoposide is classified as Pregnancy Category D. It can cause fetal harm when administered to a pregnant woman. It is teratogenic and embryotoxic in animals. Avoid use during pregnancy.

Etoposide is excreted in human milk. Due to the potential for serious adverse reactions in breastfed infants, breastfeeding is contraindicated during etoposide therapy.

Etoposide is used in pediatric oncology for various cancers (e.g., acute myeloid leukemia, neuroblastoma, germ cell tumors). Dosing is typically based on body surface area (BSA) and specific protocols. Children may be more susceptible to certain toxicities, such as secondary leukemias.

Elderly patients may have reduced renal or hepatic function, which could affect etoposide clearance and increase the risk of myelosuppression. Close monitoring of blood counts and organ function is recommended, and dose adjustments may be necessary.

• Administer etoposide IV infusion slowly over at least 30-60 minutes to minimize the risk of hypotension.
• Monitor blood pressure frequently during and immediately after infusion.
• Premedication with antihistamines or corticosteroids may be considered for patients with a history of hypersensitivity reactions, although it does not guarantee prevention.
• Etoposide is a vesicant/irritant; ensure proper IV access and monitor for extravasation. If extravasation occurs, stop infusion immediately and manage according to institutional guidelines.
• Dilute etoposide in D5W or NS to a concentration of 0.2 to 0.4 mg/mL to avoid precipitation.
• Secondary acute myeloid leukemia (AML) has been reported in patients treated with etoposide, often with a short latency period (1-3 years) and characteristic chromosomal abnormalities (e.g., 11q23).
• Patients should be advised about the high likelihood of alopecia, which is usually reversible.

• Other topoisomerase inhibitors (e.g., Topotecan)
• Other cytotoxic agents used in similar cancer types (e.g., platinum compounds, anthracyclines, taxanes, vinca alkaloids)
• Targeted therapies or immunotherapies depending on cancer type and specific mutations.

If your symptoms or health problems persist or worsen, it is essential to contact your doctor promptly. To ensure safe use, never share your medication with others, and do not take medication prescribed for someone else. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly; do not flush them down the toilet or pour them down the drain unless instructed to do so by a healthcare professional. If you are unsure about the correct disposal method, consult your pharmacist, who can also inform you about potential drug take-back programs in your area. Some medications may come with an additional patient information leaflet, which your pharmacist can provide. If you have any questions or concerns about your medication, discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide information about the medication taken, the quantity, and the time of ingestion.