Etoposide (VP16)

Etoposide is a drug used to treat certain types of cancer and leukaemia.

How is etoposide given?

Etoposide may be given by mouth in the form of a capsule or a liquid.

It may also be given into a vein (intravenously or IV) through a cannula, central venous catheter or implantable port.

What are the side effects of etoposide?

Nausea and vomiting

This is usually very mild and may be more common if the drug is given by mouth. Anti-sickness drugs can be given to reduce or prevent these symptoms. Please tell your doctor or nurse if your child’s sickness is not controlled or persists.

Hair loss

Your child may lose some or all of his or her hair, or it may become thinner. This is temporary and the hair will grow back once the treatment is finished.

Bone marrow suppression

There will be a temporary reduction in how well your child’s bone marrow works. This means he or she may become anaemic, bruise or bleed more easily than usual, and have a higher risk of infection. Your child’s blood counts will be checked regularly to see how the bone marrow is working. Please tell your doctor if your child seems unusually tired, has bruising or bleeding, or any signs of infection, especially a high temperature.

Drop in blood pressure

If the etoposide is infused too quickly (in less than half an hour), your child’s blood pressure may drop temporarily. However, it is usual to give this drug over a period of a few hours, so this is unlikely to occur.

Second cancers

If your child is given etoposide for a long time, there is a very small risk of him or her developing a second cancer after many years. If you feel you would like more information, please discuss it with your doctor.

Allergic reaction

Some children receiving etoposide have an allergic reaction to the drug. This reaction may be mild to severe. Signs of a mild reaction include skin rashes and itching, high temperature, shivering, redness of the face, a feeling of dizziness or headache. If you see any of these signs, please report them to a doctor or nurse. Signs of a severe allergic reaction include any of the above, as well as difficulty in breathing or chest pain. If you are in hospital and your child shows signs of an allergic reaction, call a doctor or nurse immediately. If you are at home and your child shows signs of a severe allergic reaction, call an ambulance immediately.

Etoposide and interactions with other medicines

Some medicines can react with etoposide, altering how well it works. Always check with your doctor or pharmacist before giving your child any other medicine, including medicines on prescription from your family doctor (GP), medicines bought from a pharmacy (chemist) or any herbal or complementary medicines.

Important information you should know about etoposide

  • Keep all medicines and tablets in a safe place where children cannot reach them.
  • Etoposide should be kept in a cool, dry place away from direct sunlight or heat
  • You should handle these medicines with care, avoiding touching them where possible. If you are pregnant or think you could be pregnant, please discuss handling instructions with your doctor, nurse or pharmacist. Please see our Special handling requirements information sheet for further details.
  • If your child vomits straight after taking the dose, inform your local doctor or nurse, as your child may need to take another one. Do not give them another dose without informing the doctor or nurse.
  • If you forget to give your child a dose, do not give a double dose. Inform your doctor or nurse and keep to your child’s regular schedule.
  • Used paper towels, vomit and dirty disposable nappies should be placed inside two rubbish bags and disposed of along with your normal rubbish.
  • If the doctor decides to stop treatment or the medicine passes its expiry date, return any remaining etoposide to the pharmacist. Do not flush or throw it away.

How to give etoposide in a liquid form at home:

  • Your child’s etoposide will be supplied to you from pharmacy in screw-top glass vials contained in a plastic tub. This tub should be stored upright to prevent spillage.

  • You will need a pair of rubber gloves for preparing the etoposide.

  • Put on your gloves and pour out the contents of the etoposide vial into a glass (NOT a plastic beaker).

  • Pour a soft drink into the empty glass vial and rinse around. Pour out the washings into the glass. Add more drink to make a suitable volume (not too much) for your child.

  • Put the empty vial and lid into the sharps bin. The ward will supply you with a sharps bin.

  • Give the dose to your child.

  • Wash the glass out separately in warm soapy water and keep for the next dose of etoposide. Do not use the glass or gloves for other purposes.

  • At the end of each course or when the sharps bin is three-quarters full, take it to your local hospital or Great Ormond Street Hospital for disposal. Do not dispose in the household rubbish.

  • If you accidentally spill the mixture, wash the area thoroughly with plenty of water.

  • If the mixture accidentally gets into your eyes, wash with plenty of running water for five to ten minutes.
Compiled by: 
the Pharmacy department in collaboration with the Child and Family Information Group
Last review date: 
November 2014
Ref: 
2014F0491

Disclaimer

Please read this information sheet from GOSH alongside the patient information leaflet (PIL) provided by the manufacturer. If you do not have a copy of the manufacturer’s patient information leaflet please talk to your pharmacist. A few products do not have a marketing authorisation (licence) as a medicine and therefore there is no PIL.

For children in particular, there may be conflicts of information between the manufacturer’s patient information leaflet (PIL) and guidance provided by GOSH and other healthcare providers. For example, some manufacturers may recommend, in the patient information leaflet, that a medicine is not given to children aged under 12 years. In most cases, this is because the manufacturer will recruit adults to clinical trials in the first instance and therefore the initial marketing authorisation (licence) only covers adults and older children.  

For new medicines, the manufacturer then has to recruit children and newborns into trials (unless the medicine is not going to be used in children and newborns) and subsequently amend the PIL with the approved information. Older medicines may have been used effectively for many years in children without problems but the manufacturer has not been required to collect data and amend the licence. This does not mean that it is unsafe for children and young people to be prescribed such a medicine ‘off-licence/off-label’. However, if you are concerned about any conflicts of information, please discuss with your doctor, nurse or pharmacist.