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1 High Alert Contraindications/Precautions

Contraindicated in: Hypersensitivity; Pregnancy; Lactation; Known intolerance to PDF Page #1
etoposide (e-toe-poe-side) ethyl alcohol or polysorbate 80 (IV only).
VePesid, VP-16 Use Cautiously in: Patients with childbearing potential; Active infections; De-
Classification creased bone marrow reserve; Renal/hepatic impairment (dosage modification may
Therapeutic: antineoplastics be necessary); Hypoalbuminemia; Elderly (may be at increased risk of adverse ef-
Pharmacologic: podophyllotoxin derivatives fects); Children (safety and effectiveness not established); Other chronic debilitating
Pregnancy Category D illnesses.
Adverse Reactions/Side Effects
Indications CNS: drowsiness, fatigue. CV: hypotension (IV). GI: anorexia, diarrhea, nausea,
Refractory testicular neoplasms (IV only) (used in combination with other chemo- vomiting, abdominal pain, stomatitis. Derm: alopecia, pruritis, rash, urticaria.
therapeutic agents in patients who have already received chemotherapy, surgery, or Endo: sterility. Hemat: anemia, leukopenia, thrombocytopenia. Local: phlebitis
radiation). Small cell lung carcinoma (PO and IV) (first-line therapy; used in combi- at IV site. Neuro: peripheral neuropathy. Misc: allergic reactions including ANA-
nation with other chemotherapeutic agents). Unlabeled Use: Lymphomas and PHYLAXIS, fever.
some leukemias. Uterine cancer. Brain tumors.
Interactions
Action Drug-Drug:qbone marrow depression with other antineoplastics or radiation
Damages DNA before mitosis (cycle-dependent and phase-specific). Therapeutic therapy. May alter immune response to live-virus vaccines andqrisk of adverse
Effects: Death of rapidly replicating cells, particularly malignant ones. reactions.
Pharmacokinetics Route/Dosage
Absorption: Variably absorbed after oral administration (bioavailability 50%). IV Other regimens are used.
administration results in complete bioavailability.
Distribution: Rapidly distributed; poorly enters the CSF; probably crosses pla- Testicular Neoplasms
centa; enters breast milk. IV (Adults): Dosage ranges from 50– 100 mg/m2 daily for 5 days up to 100 mg/m2
Protein Binding: 97%. daily on days 1, 3, and 5; repeat at 3– 4 wk intervals.
Metabolism and Excretion: Some metabolism by the liver with biliary excre- Small-Cell Carcinoma of the Lung
tion, 44% excreted in feces; 45% excreted unchanged by the kidneys.
Half-life: 4– 11 hr. PO (Adults): Dosage ranges from 70 mg/m2 daily for 4 days up to 100 mg/m2 daily
for 5 days (round dose to the nearest 50 mg); repeat at 3– 4 wk intervals.
TIME/ACTION PROFILE (noted as effects on blood counts) IV (Adults): Dosage ranges from 35 mg/m2 daily for 4 days up to 50 mg/m2 daily for
ROUTE ONSET PEAK DURATION 5 days; repeat at 3– 4 wk intervals.
PO unknown 7–14 days (granulo- 20 days
cytes) 9–16 days NURSING IMPLICATIONS
(platelets) Assessment
IV unknown 7–14 days (granulo- 20 days ● Monitor BP before and every 15 min during infusion. If hypotension occurs, stop
cytes) 9–16 days infusion and notify physician or other health care professional. After stabilizing BP
(platelets) with IV fluids and supportive measures, infusion may be resumed at slower rate.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/etoposide 02/12/2014 02:30PM
2 ● Solution should be prepared in a biologic cabinet. Wear gloves, gown, and mask
● Monitor for hypersensitivity reaction (fever, chills, dyspnea, pruritus,
urticaria, bronchospasm, tachycardia, hypotension). If these occur, stop
infusion and notify physician. Keep epinephrine, an antihistamine, cor-
ticosteroids, volume expanders, and resuscitative equipment close by in
the event of an anaphylactic reaction.
● Assess for signs of infection (fever, chills, cough, hoarseness, lower back or side
pain, sore throat, difficult or painful urination). Notify physician if these symptoms
occur.
● Assess for bleeding (bleeding gums, bruising, petechiae, guaiac test stools, urine,
and emesis). Avoid IM injections and taking rectal temperatures. Apply pressure
to venipuncture sites for 10 min.
● Monitor intake and output, appetite, and nutritional intake. Etoposide causes
mild-to-moderate nausea and vomiting. Prophylactic antiemetics may decrease
frequency and duration of nausea and vomiting.
● Adjust diet as tolerated to help maintain fluid and electrolyte balance and nutri-
tional status.
● Lab Test Considerations: Monitor CBC and differential before and periodi-
cally during therapy. The nadir of leukopenia occurs in 7– 14 days. Notify physi-
cian if absolute neutrophil count is ⬍1000/mm3. The nadir of thrombocytopenia
occurs in 9– 16 days. Notify physician if the platelet count is ⬍75,000/mm3. Re-
covery of leukopenia and thrombocytopenia occurs in 20 days.
● Monitor liver function studies (AST, ALT, LDH, bilirubin) and renal function stud-
ies (BUN, creatinine) before and periodically during therapy to detect hepatotox-
icity and nephrotoxicity.
Potential Nursing Diagnoses
Risk for injury (Side Effects)
Risk for infection (Side Effects)
Implementation
● High Alert: Fatalities have occurred with incorrect administration of chemother-
apeutic agents. Before administering, clarify all ambiguous orders; double check
single, daily, and course-of-therapy dose limits; have second practitioner inde-
pendently double check original order, calculations and infusion pump settings.
Do not confuse VePesid (etoposide) with Versed (midazolam). Do not confuse
etoposide (VePesid) with etoposide phosphate (Etopophos).
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while handling medication. Discard equipment in designated containers.
● Avoid contact with skin. Use Luer-Lok tubing to prevent accidental leakage. If con- PDF Page #2
tact with skin occurs, immediately wash skin with soap and water.
● PO: Capsules should be refrigerated. Capsules are stable for 24 mo when refriger-
ated.
● Intermittent Infusion: Dilute with D5W or 0.9% NaCl to achieve a final concen-
tration of 0.2– 0.4 mg/mL (concentrations ⬎ 0.4 mg/mL may result in precipita-
tion occurring). The 0.2 mg/mL solution is stable for 96 hr. The 0.4 mg/mL solu-
tion is stable for 48 hr. Discard solution if precipitate forms. Rate: Infuse slowly
over 30– 60 min. Temporary hypotension may occur with infusion rates shorter
than 30 min.
● Y-Site Compatibility: allopurinol, amifostine, aztreonam, cladribine, doxorubi-
cin liposome, fludarabine, gemcitabine, granisetron, melphalan, ondansetron,
paclitaxel, piperacillin/tazobactam, sargramostim, sodium bicarbonate, tenipo-
side, thiotepa, topotecan, vinorelbine.
● Y-Site Incompatibility: cefepime, filgrastim, idarubicin.
● Additive Compatibility: carboplatin, cisplatin, cytarabine, floxuridine, fluoro-
uracil, hydroxyzine, ifosfamide, ondansetron.
Patient/Family Teaching
● Instruct patient to take etoposide exactly as directed, even if nausea or vomiting
occurs. If vomiting occurs shortly after dose is taken, consult physician. If a dose is
missed, do not take at all.
● Advise patient to notify health care professional if fever; chills; sore throat or other
signs of infection; bleeding gums; bruising; petechiae; or blood in urine, stool, or
emesis occurs. Caution patient to avoid crowds and persons with known infec-
tions. Instruct patient to use soft toothbrush and electric razor. Caution patient not
to drink alcoholic beverages or take products containing aspirin or NSAIDs.
● Instruct patient to notify health care professional if rapid heartbeat, dif-
ficulty breathing, abdominal pain, yellow skin/eyes, weakness, pares-
thesia, or gait disturbances occur.
● Instruct patient to inspect oral mucosa for redness and ulceration. If mouth sores
occur, advise patient to use sponge brush and rinse mouth with water after eating
and drinking. Viscous lidocaine swishes may be used if pain interferes with eating.
Stomatitis pain may require treatment with opioid analgesics.
● Discuss with patient the possibility of hair loss. Explore coping strategies.
䉷 2015 F.A. Davis Company CONTINUED
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etoposide
● Advise patient to use contraception.
● Instruct patient not to receive any vaccinations without advice of physician.
● Emphasize the need for periodic lab tests to monitor for side effects.

Evaluation/Desired Outcomes
● Decrease in size or spread of malignancies in solid tumors.
Why was this drug prescribed for your patient?

⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.