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Etoposide

Background and Method of Action

Etoposide is a derivative of podophyllotoxin which inhibits DNA topoisomerase II and thereby, DNA synthesis. It is cell cycle dependent and only works on certain phases of cellular division.1

Indications

Of the list etoposide is most commonly used in lung, ovarian and testicular cancers.

Cautions and contraindications
  • Renal impairment
  • Liver impairment - contraindicated if severe liver dysfunction
Important interactions
  • Increased anticoagulant effect with warfarin
  • Agranulocytosis risk increased with clozapine
  • Ciclosporin increases etoposide levels
  • Decreases absorption of phenytoin
Side effects
  • Mucositis and taste alteration is common
  • Nausea and vomiting and diarrhoea
  • Alopecia begins 3 weeks after first dose
  • Myelosuppression - therefore not given at intervals shorter than 3 weeks apart
  • Insomnia
  • Headaches
  • Cardiovascular: congestive cardiac failure and myocardial ischemia reported6
  • Hepatotoxicity rarely7
Administration

It can be given orally or via intravenous infusion (daily for up to a week).


Document References
  1. American Cancer Society; What are the different types of chemotherpy drugs? Apr 2005
  2. Ciombor KK, Rocha Lima CM; Management of small cell lung cancer.; Curr Treat Options Oncol. 2006 Jan;7(1):59-68. [abstract]
  3. Stewart DJ; Topotecan in the first-line treatment of small cell lung cancer.; Oncologist. 2004;9 Suppl 6:33-42. [abstract]
  4. Cheson BD; What is new in lymphoma?; CA Cancer J Clin. 2004 Sep-Oct;54(5):260-72. [abstract]
  5. Jones RH, Vasey PA; Part II: testicular cancer--management of advanced disease.; Lancet Oncol. 2003 Dec;4(12):738-47. [abstract]
  6. Rang, H.P., Dale, M.M., Ritter, J.M. and Moore, P.K. (2003) Pharmacology, 5th ed, Bath, Churchill Livingstone.
  7. Summary of Product Characteristics - Eposin, Medac GmbH (updated 10 Jan 2005) electronic Medicines Compendium

Internet and Further Reading AcknowledgementsEMIS is grateful to Dr Gurvinder Rull for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2007.
DocID: 321
Document Version: 2
DocRef: bgp25260
Last Updated: 4 Sep 2007
Review Date: 3 Sep 2008
















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PS - Health and Poverty

Perhaps the biggest cause of ill health in the world is poverty. Help to Make Poverty History. For example, why not lend some of your money to disadvantaged communities to enable them to trade their way out of poverty through schemes such as Shared Interest.

See also MAKEPOVERTYHISTORY North East for details and links to campaigns against poverty.

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