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ETOPOSIDE (Systemic)

Some commonly used brand names are:

In the U.S.—

• VePesid
• Etopophos
• Toposar

In Canada—

• VePesid

Generic name product may be available in the U.S. and Canada.

Another commonly used name is VP-16 .

Category

• Antineoplastic

Description

Etoposide (e-toe-POE-side)belongs to the group of medicines known as antineoplastic agents. It is used to treat cancer of the testicles and certain types of lung cancer. It is also sometimes used to treat some other kinds of cancer in both males and females.

The exact way that etoposide acts against cancer is not known. However, it seems to interfere with the growth of the cancer cells, which are eventually destroyed. Since the growth of normal body cells may also be affected by etoposide, other effects will also occur. Some of these may be serious and must be reported to your doctor. Other effects, like hair loss, may not be serious but may cause concern. Some effects may not occur until months or years after the medicine is used.

Before you begin treatment with etoposide, you and your doctor should talk about the good this medicine will do as well as the risks of using it.

This medicine is available only with your doctor"s prescription, in the following dosage forms:

• Oral
• Capsules (U.S. and Canada)

• Parenteral
• Injection (U.S. and Canada)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For etoposide, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to etoposide.

Pregnancy—There is a good chance that this medicine will cause birth defects if it is being used at the time of conception or during pregnancy. In addition, many cancer medicines may cause sterility, which could be permanent. Although sterility has not been reported with etoposide, the possibility should be kept in mind.

Be sure that you have discussed this with your doctor before receiving this medicine. Before taking etoposide make sure your doctor knows if you are pregnant or if you may become pregnant. It is best to use some kind of birth control while you are taking etoposide. Tell your doctor right away if you think you have become pregnant while taking etoposide.

Breast-feeding—Because etoposide may cause serious side effects, breast-feeding is generally not recommended while you are receiving it.

Children—Although this medicine has been used in children, there is no specific information comparing use of etoposide in children with use in other age groups. However, children who receive high doses may be more likely to have a serious allergic reaction to this medicine.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of etoposide in the elderly with use in other age groups.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking or receiving etoposide, it is especially important that your health care professional know if you are taking any of the following:

• Amphotericin B by injection (e.g., Fungizone) or
• Antithyroid agents (medicine for overactive thyroid) or
• Azathioprine (e.g., Imuran) or
• Chloramphenicol (e.g., Chloromycetin) or
• Colchicine or
• Flucytosine (e.g., Ancobon) or
• Ganciclovir (e.g., Cytovene) or
• Interferon (e.g., Intron A, Roferon-A) or
• Plicamycin (e.g., Mithracin) or
• Zidovudine (e.g., AZT, Retrovir)
• If you have ever been treated with radiation or cancer medicines—Etoposide may increase the effects of these medicines or radiation therapy on the blood

Other medical problems—The presence of other medical problems may affect the use of etoposide. Make sure you tell your doctor if you have any other medical problems, especially:

• Chickenpox (including recent exposure) or
• Herpes zoster (shingles)—Risk of severe disease affecting other parts of the body

• Infection—Etoposide can decrease your body"s ability to fight infection

• Kidney disease or
• Liver disease—Effects of etoposide may be increased because of slower removal from the body

Proper Use of This Medicine

Take etoposide only as directed by your doctor . Do not use more or less of it, and do not use it more often than your doctor ordered. The exact amount of medicine you need has been carefully worked out. Taking too much may increase the chance of side effects, while taking too little may not improve your condition.

Etoposide is sometimes given together with certain other medicines. If you are using a combination of medicines, make sure that you take each one at the proper time and do not mix them. If you are taking some of these medicines by mouth, ask your health care professional to help you plan a way to remember to take your medicines at the right times.

Etoposide often causes nausea, vomiting, and loss of appetite, which may be severe. However, it is very important that you continue to receive the medicine, even if you begin to feel ill. Ask your health care professional for ways to lessen these effects.

If you vomit shortly after taking a dose of etoposide, check with your doctor. You will be told whether to take the dose again or to wait until the next dose.

Dosing—The dose of etoposide will be different for different patients. The dose that is used may depend on a number of things, including what the medicine is being used for, the patient"s size, whether the medicine is being given by mouth or by injection, and whether or not other medicines are also being taken. If you are taking or receiving etoposide at home, follow your doctor"s orders or the directions on the label . If you have any questions about the proper dose of etoposide, ask your doctor.

Missed dose—If you miss a dose of this medicine, do not take the missed dose at all and do not double the next one. Instead, go back to your regular dosing schedule and check with your doctor.

Storage—To store this medicine:

• Keep out of the reach of children.
• Store in the refrigerator.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

It is very important that your doctor check your progress at regular visits to make sure that etoposide is working properly and to check for unwanted effects.

While you are being treated with etoposide, and after you stop treatment with it, do not have any immunizations (vaccinations) without your doctor"s approval . Etoposide may lower your body"s resistance and there is a chance you might get the infection the immunization is meant to prevent. In addition, other persons living in your household should not take oral polio vaccine since there is a chance they could pass the polio virus on to you. Also, avoid persons who have taken oral polio vaccine within the last several months. Do not get close to them and do not stay in the same room with them for very long. If you cannot take these precautions, you should consider wearing a protective face mask that covers the nose and mouth.

Etoposide can temporarily lower the number of white blood cells in your blood, increasing the chance of your getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

• If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or have painful or difficult urination.
• Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in urine or stools; or pinpoint red spots on your skin.
• Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
• Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
• Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
• Avoid contact sports or other situations where bruising or injury could occur.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Also, because of the way these medicines act on the body, there is a chance that they might cause other unwanted effects that may not occur until months or years after the medicine is used. These delayed effects may include certain types of cancer, such as leukemia. Discuss these possible effects with your doctor.

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

This medicine often causes a temporary loss of hair. After treatment with etoposide has ended, normal hair growth should return.

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor or nurse.

Additional Information

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, etoposide is used in certain patients with the following medical conditions:

• Autoimmune deficiency syndrome (AIDS)—associated Kaposi"s sarcoma (a type of cancer of the skin and mucous membranes that is more common in patients with AIDS)
• Cancer of the adrenal cortex (the outside layer of the adrenal gland)
• Cancers of the blood and lymph system
• Cancer in the bone
• Cancer of the endometrium
• Cancer of the lung (a certain type of lung cancer usually associated with prior smoking, passive smoking, or radon exposure)
• Cancer of the lymph system (a part of the body"s immune system) that affects the skin
• Cancer of the stomach
• Cancers of the soft tissues of the body, including the muscles, connective tissues (tendons), vessels that carry blood or lymph, or fat
• Cancer of unknown primary site
• Ewing"s sarcoma (a type of cancer found in the bone)
• Gestational trophoblastic tumors (tumors in the uterus or womb)
• Hepatoblastoma (a certain type of liver cancer that occurs in children)
• Multiple myeloma (a certain type of cancer of the blood)
• Myelodysplastic syndromes (MDS)
• Neuroblastoma (a cancer of the nerves that usually occurs in children)
• Retinoblastoma (a cancer of the eye that usually occurs in children)
• Thymoma (a cancer of the thymus, which is a small organ that lies under the breastbone)
• Tumors in the brain
• Wilms" tumor (a cancer of the kidney that usually occurs in children)
• Cancer of the ovaries (a type of cancer found in the egg-making cells)

Other than the above information, there is no additional information relating to proper use, precautions, or side effects for these uses.

Revised: 02/25/2004

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