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These brands contain the same active ingredient (Etoposide). Strength and form may differ — confirm substitution with your doctor or pharmacist before switching.
Indications & Uses
Etopor is indicated for:
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Adults:
Small cell lung cancer: When used together with other approved chemotherapy drugs, the dose ranges from 35 mg/m2 per day for 4 days to 50 mg/m2 per day for 5 days, or as directed by a registered physician. In patients with impaired renal function: The initial dose should be adjusted according to the measured creatinine clearance. If clearance is above 50 mL/min, give 100% of the dose; if it is 15 to 50 mL/min, give 75% of the dose. Later Etoposide doses should be guided by how well the patient tolerates treatment and by the clinical response. No data are available for patients with a creatinine clearance below 15 mL/min, and a further dose reduction should be considered in these patients.
Side Effects
The following information on side effects is based on both oral and intravenous use of Toposide as a single agent, using several different dose schedules for the treatment of a wide variety of malignancies. Hematologic toxicity: Myelosuppression is dose related and dose limiting. Granulocyte nadirs occur 7 to 14 days after the drug is given, and platelet nadirs occur 9 to 16 days after the drug is given. Bone marrow recovery is usually complete by day 20, and no cumulative toxicity has been reported. Fever and infection have also been reported in patients with neutropenia. Death associated with myelosuppression has been reported. Acute leukemia, with or without a preleukemic phase, has rarely been reported in patients treated with Toposide together with other antineoplastic agents. Gastrointestinal toxicity: Nausea and vomiting are the main gastrointestinal toxicities. They are generally mild to moderate, and treatment has to be stopped in 1% of patients. Nausea and vomiting can usually be controlled with standard antiemetic therapy. Mild to severe mucositis or esophagitis may occur. Gastrointestinal toxicities are slightly more frequent after oral administration than after intravenous infusion. Hypotension: Transient hypotension following rapid intravenous administration has been reported in 1% to 2% of patients. It has not been associated with cardiac toxicity or electrocardiographic changes, and no delayed hypotension has been noted. To prevent this rare occurrence, Toposide should be given by slow intravenous infusion over 30 to 60 minutes. If hypotension occurs, it usually responds to stopping the infusion and giving fluids or other supportive therapy as appropriate. When the infusion is restarted, a slower rate should be used. Allergic reactions: Anaphylactic-like reactions, characterized by chills, fever, tachycardia, bronchospasm, dyspnea and/or hypotension, have been reported in 0.7% to 2% of patients receiving intravenous Toposide and in less than 1% of patients treated with the oral capsules. These reactions have usually responded promptly to stopping the infusion and giving pressor agents, corticosteroids, antihistamines or volume expanders as appropriate; however, the reactions can be fatal. Hypertension and/or flushing have also been reported. Blood pressure usually returns to normal within a few hours after the infusion is stopped. Anaphylactic-like reactions have occurred during the initial infusion of Toposide. Facial or tongue swelling, coughing, diaphoresis, cyanosis, tightness in the throat, laryngospasm, back pain and/or loss of consciousness have sometimes occurred along with these reactions. In addition, an apparent hypersensitivity-associated apnea has rarely been reported. Rash, urticaria and/or pruritus have infrequently been reported at recommended doses. At investigational doses, a generalized pruritic erythematous maculopapular rash, consistent with perivasculitis, has been reported. Alopecia: Reversible alopecia, sometimes progressing to total baldness, was observed in up to 66% of patients. Other toxicities: The following adverse reactions have been reported infrequently: abdominal pain, aftertaste, constipation, dysphagia, asthenia, fatigue, malaise, somnolence, transient cortical blindness, optic neuritis, interstitial pneumonitis or pulmonary fibrosis, fever, seizure (occasionally associated with allergic reactions), Stevens-Johnson syndrome, toxic epidermal necrolysis, pigmentation, and a single report of radiation recall dermatitis.
Cautions & Contraindications
Warnings & Precautions
Patients being treated with Toposide must be watched closely for bone marrow suppression, both during and after treatment. Cases of fatal myelosuppression have been reported, and dose limiting suppression of the bone marrow is the most serious toxicity linked to Toposide therapy. For this reason, platelet count, hemoglobin, white blood cell count, and differential should be checked at the start of therapy and before every subsequent cycle. If the platelet count falls below 50,000/mm3 or the absolute neutrophil count falls below 500/mm3, further therapy should be withheld until blood counts have recovered sufficiently. Physicians should also be alert to the possible occurrence of an anaphylactic reaction, which can show up as chills, fever, rapid heartbeat, bronchospasm, difficulty breathing, and low blood pressure. Anaphylactic like reactions have occurred more often in children given infusions at concentrations higher than those recommended, though it is not clear whether the concentration or the rate of infusion is responsible for this effect. Management of such a reaction is symptomatic: the infusion should be stopped right away, and pressor agents, corticosteroids, antihistamines, or volume expanders should be given as the physician judges appropriate. When given by injection, Toposide should only be administered by slow intravenous infusion, usually over a period of 30 to 60 minutes, since rapid intravenous injection has been associated with low blood pressure. Whenever Toposide is being considered for chemotherapy, the physician needs to weigh its expected benefit against the risk of adverse reactions. Most adverse reactions are reversible if caught early. If a severe reaction occurs, the dose should be lowered or the drug stopped, with appropriate corrective steps taken based on the physician's clinical judgment. Should Toposide therapy be restarted, this should be done carefully, with the continuing need for the drug weighed against the possibility that toxicity could recur. Patients with low serum albumin may face a higher risk of toxicity from Toposide.
Contraindications
Etoposide should not be used by anyone who has previously had an allergic reaction to it or to any of the other ingredients in the formulation.