Etoposide
TOPOSAR
Pronunciation: e-toe-POE-side
What it isTopoisomerase II inhibitor stabilizing the DNA-enzyme complex; small cell lung cancer and testicular cancer.
Why this oneOral and IV forms, and it is central to curative testicular regimens.
What limits itMyelosuppression is dose-limiting. Secondary leukemia; hypotension if infused too fast.
FDA label
Read the full label on DailyMed ↗
BOXED WARNING Experienced chemotherapy physician only; severe myelosuppression with infection or bleeding
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Refractory testicular tumors (combination therapy) | Adult | 50–100 mg/m²/day IV days 1–5, or 100 mg/m²/day IV days 1, 3, 5; repeat q3–4 wk | 100 mg/m²/day per labeled regimen | |
| Small cell lung cancer, first line (combination therapy) | Adult | 35 mg/m²/day IV × 4 days to 50 mg/m²/day IV × 5 days; repeat q3–4 wk | 50 mg/m²/day × 5 days per cycle |
Renal Dose adjustment recommended — label refers to PRECAUTIONS (specifics not in fetched text)
Hepatic Undefined
Instructions
- Dilute in D5W or NS to 0.2–0.4 mg/mL (precipitation above 0.4 mg/mL)
- Infuse over 30–60 min; never rapid IV injection (hypotension)
- Avoid acrylic/ABS plastic devices with undiluted drug (cracking/leaking)
- Wear gloves; wash skin/flush mucosa on contact
- Diluted solution stable 96 h (0.2 mg/mL) or 24 h (0.4 mg/mL) at room temp
- Repeat courses only after recovery from toxicity; reduce for marrow-suppressive co-therapy or prior radiation/chemo
Available strengths
- inj 100, 500 mg
- cap 50 mg
Cautions
- Myelosuppression (fatal) — CBC before each cycle; withhold if platelets <50,000/mm³ or ANC <500/mm³
- Anaphylactic-like reactions (higher in children at above-recommended concentrations)
- Hypotension with rapid IV infusion
- Fetal harm (teratogenic in animals)
- Secondary acute leukemia (potential carcinogen)
Adverse reactions
- Leukopenia <4,000 (60–91%)
- Alopecia (8–66%)
- Nausea/vomiting (31–43%)
- Thrombocytopenia <100,000 (22–41%)
- Anemia (0–33%)
- Anorexia (10–13%)
- Diarrhea (1–13%)
- Stomatitis (1–6%)
- Hypotension (1–2%)
- Allergic reaction (1–2%)
- Peripheral neurotoxicity (1–2%)
Pregnancy Can cause fetal harm; teratogenic/embryotoxic in mice and rats; advise avoiding pregnancy.
Cost
Etoposide (TOPOSAR)
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 100 mg | inj | per unit | not offered | |
| 500 mg | inj | per unit | not offered |
NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Etoposide is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.
⚠ BOXED WARNING
- Severe myelosuppression
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilityDose-limiting myelosuppression and secondary leukemia