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Brand Name :
Toposar
(United States) [Available]Synonyms :
Etoposide
Class :
Class: Antineoplastic agents, Sub class: Topoisomerase Inhibitors
Brand Name :
Toposar
(United States) [Available]Synonyms :
Etoposide
Class :
Class: Antineoplastic agents, Sub class: Topoisomerase Inhibitors
Dosage Forms & Strengths  Â
Capsule  Â
50mg  Â
Injectable solution  Â
20mg per ml  Â
Powder for injection  Â
100mg  
for Small Cell Lung Cancer, etoposide is used in combination with other agents as a dose :
35
mg/m^2
Intravenous (IV)
over 30-60 minutes once a day for 1-4 days to 50 mg per m2 IV over 30-60 minutes once a day for 1-5 days every 3-4 weeks
Dose Adjustments
Renal Dose Adjustments
CrCl >50 ml per min: 100% of the normal dose should be administered
CrCl 15-50 ml per min: 75% of the normal dose should be administered
CrCl <15 mL/min: no data available
Liver Dose Adjustments:
no data available
Dosage Forms & Strengths  Â
Capsule  Â
50mg  Â
Injectable solution  Â
20mg per ml  Â
Powder for injection  Â
100mg  Â
off-label: If the child is less than three years, a dose :
3.3
mg/kg
once a day
IV given continuous infusion for four days If the child is more than three years, a dose of 100 mg per m² per day IV given continuous infusion for four days
etoposide: they may diminish the serum concentration of CYP3A4 inducers
etoposide: they may diminish the serum concentration of CYP3A4 inducers
etoposide: they may diminish the serum concentration of CYP3A4 inducers
etoposide: they may diminish the serum concentration of CYP3A4 inducers
etoposide: they may diminish the serum concentration of CYP3A4 inducers
may diminish the serum concentration of CYP3A4 Inducers
when both drugs are combined, there may be an increased metabolism of etoposide
when both drugs are combined, there may be an increased risk or severity of adverse effects
when both drugs are combined, there may be an increased risk or severity of infection
when both drugs are combined, there may be an increased metabolism of etoposide   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be an increased risk or severity of neutropenia    
when both drugs are combined, there may be an increased metabolism of etoposide   
when both drugs are combined, there may be an increased effect of immunosuppressive activities of fingolimod  
when both drugs are combined, there may be an increased metabolism of etoposide   
when both drugs are combined, there may be an increased metabolism of etoposide   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be a decreased therapeutic efficacy of the measles virus vaccine   
when both drugs are combined, there may be a decreased therapeutic efficacy of the mumps virus vaccine   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be a decreased metabolism of etoposide   
when both drugs are combined, there may be a decreased therapeutic efficacy of the rotavirus vaccine   
when both drugs are combined, there may be an increased risk or severity of infection   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be a decreased therapeutic efficacy of the smallpox vaccine   
when both drugs are combined, there may be a decreased level of serum concentration of etoposide   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
CYP3A strong enhancers of the small intestine may reduce the bioavailability of etoposide
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be an increased metabolism of etoposide   
when both drugs are combined, there may be a decreased metabolism of etoposide   
when both drugs are combined, there may be an increased metabolism of etoposide   
when both drugs are combined, there may be a decreased level of serum concentration of etoposide   
when both drugs are combined, there may be a decreased metabolism of etoposide   
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
when both drugs are combined, there may be a decreased metabolism of atorvastatin   
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
when both drugs are combined, there may be a decreased level of serum concentration of etoposide   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be an increased metabolism of etoposide   
when both drugs are combined, there may be a decreased metabolism of etoposide  
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be a decreased level of serum concentration of etoposide   
when both drugs are combined, there may be a decreased metabolism of etoposide   
when both drugs are combined, there may be an increased metabolism of etoposide  
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be a decreased metabolism of etoposide   
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
when both drugs are combined, there may be a decreased metabolism of etoposide   
when both drugs are combined, there may be a decreased metabolism of etoposide   
when both drugs are combined, there may be a decreased metabolism of etoposide   
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
when both drugs are combined, there may be a decreased metabolism of eliglustat   
when both drugs are combined, there may be a decreased metabolism of etoposide   
when both drugs are combined, there may be increased myelosuppressive activities of filgrastim.   
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
when both drugs are combined, there may be a decreased metabolism of etoposide   
when both drugs are combined, there may be a reduced metabolism of etoposide   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be an increased metabolism of ifosfamide  
when both drugs are combined, there may be a decreased metabolism of etoposide   
when both drugs are combined, there may be a reduced metabolism of etoposide   
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
when both drugs are combined, there may be a decreased metabolism of etoposide  
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
when both drugs are combined, there may be a decreased metabolism of etoposide   
when both drugs are combined, there may be a reduced level of serum concentration of etoposide   
when both drugs are combined, there may be an increased metabolism of etoposide   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be a decreased metabolism of etoposide   
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
when both drugs are combined, there may be an increased metabolism of etoposide   
when both drugs are combined, there may be a high metabolism of etoposide   
when both drugs are combined, there may be a decreased metabolism of etoposide  
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
when both drugs are combined, there may be an increased metabolism of etoposide   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be a decreased level of serum concentration of etoposide   
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
when both drugs are combined, there may be a decreased therapeutic efficacy of sipuleucel-t   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
when both drugs are combined, there may be a decreased metabolism of etoposide   
when both drugs are combined, there may be an increased level of serum concentration of etoposide   
it may diminish the metabolism when combined with zuclopenthixol
it may increase the levels of serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates
it may increase the levels of serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates
it may increase the levels of serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates
it may increase the levels of serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates
it may increase the levels of serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates
when bromazepam and etoposide are used together, there is a potential reduction in the bromazepam's metabolism
When alprazolam and etoposide is used together, this leads to reduction in the alprazolam’s metabolism
When etoposide is used together with somatotropin, this leads to a rise in etoposide metabolism
When etoposide is used together with andrographolide, this leads to enhanced risk or seriousness of bleeding
When etoposide is used together with ridaforolimus, this leads to enhanced concentration serum of etoposide
When etoposide is used together with adenine, this leads to a reduction in the etoposide’s metabolism
when both drugs are combined, there may be an increased metabolism of etoposide  
when both the drugs are combined, the risk or severity of adverse effects increases    
when both drugs are combined, there may be an increased risk or severity of adverse effects   
the effect of etoposide is decreased by lorlatinib, by altering intestinal or hepatic CYP3A4 enzyme metabolism
may enhance the serum concentrations of P-glycoprotein-ABCB1 inhibitors
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may decrease the levels of serum concentrations
may decrease the levels of serum concentrations
may decrease the levels of serum concentrations
may decrease the levels of serum concentrations
may decrease the levels of serum concentrations
may decrease the levels of serum concentrations
may decrease the levels of serum concentrations
may decrease the levels of serum concentrations
may decrease the levels of serum concentrations
may decrease the levels of serum concentrations
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
when both drugs are combined, there may be a decreased metabolism of etoposide   
when both drugs are combined, there may be a reduced metabolism of etoposide   
when both drugs are combined, there may be an increased risk or severity of adverse effects   
when both drugs are combined, there may be a decreased metabolism of etoposide  
when both drugs are combined, there may be a decreased metabolism of etoposide  
when both drugs are combined, there may be an increased metabolism of etoposide  
Etoposide works by inhibiting the enzyme topoisomerase II, which is essential for DNA replication. This drug is most active during the late S and G2 phases of the cell cycle. Normally, topoisomerase II cuts and then reseals both strands of DNA to relieve tension during replication. Etoposide interferes with this process by stabilizing the intermediate complex where DNA is cut but not rejoined, leading to DNA damage. This disruption activates pathways that lead to mutations and cell death, particularly in cancer cells that have higher levels of topoisomerase II.Â
Frequency defined  Â
 >10%  Â
Alopecia   Â
Anorexia  Â
Anemia  Â
Diarrhea  Â
Leukopenia   Â
Nausea and Vomiting   Â
Thrombocytopenia   Â
1-10%  Â
Hepatic toxicity   Â
hypersensitivity  Â
Orthostatic hypotension  Â
Pancytopenia  Â
Peripheral neuropathy   Â
Stomatitis  Â
Frequency Not Defined  Â
Asthenia  Â
Fever  Â
Hyperuricemia  Â
Mucous membrane inflammation  Â
Malaise  Â
Shivering  Â
Myelosuppression: Etoposide can cause dose-related bone marrow suppression, potentially leading to infection, bleeding, or death. Frequent monitoring of blood counts is required.Â
 Secondary Leukemia: There is a risk of secondary acute myeloid leukemia (t-AML), especially with prolonged use or in combination with other cytotoxic agents.Â
Contraindications:Â
Hypersensitivity Â
Severe bone marrow suppression unless the benefit outweighs the risk.Â
CautionsÂ
Liver Function: Use cautiously in patients with liver impairment, as it may alter drug clearance.Â
IV Administration: Infuse slowly over 30–60 minutes to prevent hypotension. Monitor for injection site reactions.Â
Reproductive Effects:Â
Pregnancy: Contraindicated due to risk of fetal harm.Â
Males: May cause reduced sperm count or infertility, which can be permanent. Recovery is possible; contraception is advised during treatment and for 4 months after.Â
Females: Risk of infertility and early menopause. Effective contraception is recommended during therapy and for 6 months afterward.Â
Leukemia Risk: Rare instances of secondary leukemia, with or without a preleukemic stage, have been observed. Risk increases when combined with other chemotherapy agents.Â
Pregnancy:Â Â Â
Lactation:Â Â Â
Pregnancy Categories:     Â
Etoposide is a chemotherapeutic agent that works by inhibiting topoisomerase II, an enzyme critical for DNA replication. By stabilizing the enzyme-DNA complex, etoposide prevents the rejoining of DNA strands, causing double-strand breaks that lead to cell death, especially in the S and G2 phases of the cell cycle. It is available in oral and intravenous forms, has moderate oral bioavailability, and is extensively bound to plasma proteins. The drug is primarily metabolized in the liver and eliminated through both urine and bile. Its anticancer effectiveness depends on the dose and duration of exposure, requiring careful scheduling during treatment.Â
PharmacokineticsÂ
AbsorptionÂ
Etoposide is well absorbed when taken orally, reaching peak plasma levels in about 1 to 1.5 hours. Its bioavailability averages 50%, though it can vary between 25% and 75%. There is no significant first-pass metabolism.Â
DistributionÂ
The drug follows a biphasic distribution pattern with a distribution half-life of 1.5 hours and does not effectively penetrate the cerebrospinal fluid. Its steady-state volume of distribution ranges from 18 to 29 liters. Etoposide is highly protein-bound (~97%).Â
MetabolismÂ
Metabolism occurs primarily in the liver via CYP3A4-mediated O-demethylation, as well as through glutathione (GSTT1/GSTP1) and glucuronide conjugation (UGT1A1). Prostaglandin synthases also contribute to its metabolic pathways by forming O-demethylated quinone metabolites.Â
Elimination/ExcretionÂ
Etoposide is eliminated by both renal and hepatic routes. About 56% of the drug is excreted in urine (with 45% unchanged), and approximately 44% is recovered in feces, reflecting significant biliary excretion.Â
Half-life and ClearanceÂ
Half-life: 4 to 11 hoursÂ
Total body clearance: 33–48 mL/minÂ
Renal clearance: 7–10 mL/min/m²Â
PharmacodynamicsÂ
Etoposide is a semisynthetic derivative of podophyllotoxin and functions as an antineoplastic agent. It targets DNA topoisomerase II, disrupting DNA synthesis and replication. Its action is both cell cycle-dependent and phase-specific, primarily affecting the S and G2 phases. The drug exhibits dose-dependent effects: at higher concentrations (≥10 µg/mL), it causes cell lysis during mitosis, while at lower concentrations (0.3–10 µg/mL), it blocks cells from progressing to prophase. Unlike some chemotherapeutics, etoposide does not affect microtubule formation. Its main cytotoxic effect is the induction of DNA strand breaks, either by stabilizing the DNA-topoisomerase II complex or through free radical generation.Â
Etoposide is a chemotherapy drug available in both intravenous (IV) and oral forms. It is often administered as etoposide phosphate—a water-soluble prodrug that quickly converts into the active compound. The drug distributes widely in the body and binds extensively to plasma proteins.Â
Its effectiveness depends on both dose and schedule, making timing critical in treatment protocols. A commonly used regimen involves a 30-minute daily infusion of 100 mg/m² for five consecutive days, which is generally tolerable before myelosuppression becomes dose-limiting. IV administration must be slow (30–60 minutes) due to the risk of hypotension, requiring blood pressure monitoring during infusion.Â
Pronunciation: EE-toe-poe-sideÂ
Etoposide is an anti-cancer drug used to treat a variety of lung cancers by retarding or cessing the cancerous growth.
The dose is taken orally with or without food or as directed by your physician.
Etoposide side effects include dry skin, diarrhea, mouth ulcers, muscular pain, extensive eyelash growth, nausea, vomiting, loss of appetite, abdominal pain, and dehydration.
Avoid meeting people already infected with diseases like measles, flu, and chickenpox.
Limit alcohol consumption.
Do not take the medication if you are pregnant or planning to conceive. Lactating females should not breastfeed during the treatment.
The fertile males should use protection during a sexual activity during the treatment with doxorubicin.
Pregnant females should not take this medication, and if, in due course, a female gets pregnant, she should consult the doctor.
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