Suvarna Garge (Editor)

Etoposide

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Pronunciation
  
/ˌɛtoʊˈpoʊsaɪd/

MedlinePlus
  
a684055

Molar mass
  
588.557 g/mol

Protein binding
  
97%

AHFS/Drugs.com
  
Monograph

Routes of administration
  
by mouth, intravenous

CAS ID
  
33419-42-0

Etoposide

Trade names
  
Etopophos, Toposar, others

Pregnancy category
  
AU: D US: D (Evidence of risk)

Giving etoposide chemotherapy home


Etoposide, sold under the brand name Etopophos among others, is a chemotherapy medication used for the treatments of a number of types of cancer. This includes testicular cancer, lung cancer, lymphoma, leukemia, neuroblastoma, and ovarian cancer. It is used by mouth or injection into a vein.

Contents

Side effects are very common. They can include low blood cell counts, vomiting, loss of appetite, diarrhea, hair loss, and fever. Other severe side effects include allergic reactions and low blood pressure. Use during pregnancy will likely harm the baby. Etoposide is in the topoisomerase inhibitor family of medication. It is believed to work by damaging DNA.

Etoposide was approved for medical use in the United States in 1983. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. The wholesale cost in the developing world is about 3.24 to 5.18 USD per 100 mg vial. In the United Kingdom this costs the NHS about 12.15 pounds as of 2015.

18 30 minutes left on the etoposide bag and then i m outta here


Medical uses

Etoposide is used as a form of chemotherapy for cancers such as Kaposi’s sarcoma, Ewing's sarcoma, lung cancer, testicular cancer, lymphoma, nonlymphocytic leukemia, and glioblastoma multiforme. It is often given in combination with other drugs (such as bleomycin in treating testicular cancer). It is also sometimes used in a conditioning regimen prior to a bone marrow or blood stem cell transplant.

Administration

It is given intravenously (IV) or orally in capsule or tablet form. If the drug is given IV, it must be done slowly over a 30- to 60-minute period because it can lower blood pressure as it is being administered. Blood pressure is checked often during infusing, with the speed of administration adjusted accordingly.

Side effects

Common are:

  • infusion site reactions
  • low blood pressure
  • hair loss
  • pain and or burning at the IV site
  • constipation or diarrhea
  • metallic food taste
  • Bone marrow suppression, leading to:
  • decreased white blood cell counts (leading to increased susceptibility to infections)
  • low red blood cell counts (anemia)
  • low platelet counts (leading to easy bruising and bleeding)
  • Less common are:

  • nausea and vomiting
  • allergic-type reactions
  • rash
  • fever, often occurring shortly after IV administration and not due to infection
  • mouth sores
  • Acute myeloid leukemia (which ironically can be treated with etoposide itself)
  • When given with warfarin, it may cause bleeding.

    Mechanism of action

    Etoposide forms a ternary complex with DNA and the topoisomerase II enzyme (which aids in DNA unwinding), prevents re-ligation of the DNA strands, and by doing so causes DNA strands to break. Cancer cells rely on this enzyme more than healthy cells, since they divide more rapidly. Therefore, this causes errors in DNA synthesis and promotes apoptosis of the cancer cell.

    Chemistry

    Etoposide is a semisynthetic derivative of podophyllotoxin from the rhizome of the wild mandrake (Podophyllum peltatum). More specifically, it is a glycoside of podophyllotoxin with a D-glucose derivative. It is chemically similar to the anti-cancer drug teniposide, being distinguished only by a methyl rest where teniposide has a thienyl. Both these compounds have been developed with the aim of creating less toxic derivatives of podophyllotoxin.

    The substance is a white to yellow-brown, crystalline powder. It is soluble in organic solvents.

    It is used in form of its salt etoposide phosphate.

    History

    Etoposide was first synthesized in 1966 and U.S. Food and Drug Administration approval was granted in 1983.

    The nickname VP-16 likely comes from a compounding of the last name of one of the chemists who performed early work on the drug (Von Wartbung) and podophyllotoxin. Another scientist who was integral in the development of podophyllotoxin-based chemotherapeutics was the medical pharmacologist Hartmann F. Stähelin.

    References

    Etoposide Wikipedia