Etoposide

Etoposide is a drug used to treat certain types of cancer and leukaemia. This page explains what etoposide is, how it is given and some of the possible side effects. Each person reacts differently to medicines, so your child will not necessarily suffer from every side effect mentioned. If you have any questions or concerns, please speak to your doctor, nurse or pharmacist.
Etoposide may be given by mouth in the form of a capsule or a liquid. Instructions for giving the oral etoposide liquid are given at the end of this information sheet. 
 
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?

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 very bad or continues for more than a few days.

Hair loss

Your child may lose some or all of their 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 they may become anaemic (reduced blood cells), 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, 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.

Secondary cancers

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

Allergic reaction

Some people receiving etoposide have an allergic reaction to the medicine. This reaction may be mild to severe. 
 
Signs of a mild allergic 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 shortness of breath. If you are in hospital and your child shows signs of a severe 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.

Interactions with other medicines

Some medicines can interact 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.

Giving oral etoposide at home

 If your child is able to swallow capsules, etoposide may be prescribed as capsules. These should be taken according to instructions from your child’s doctor, nurse or pharmacist. Always wear gloves when handling the etoposide capsules.
  • If your child is unable to swallow capsules whole, the etoposide will be supplied to you from pharmacy in ready-filled syringes containing the dose to be given according to the prescription. This can be diluted according to instructions below to improve the taste. You will need a pair of rubber gloves for preparing the etoposide. 
  • Put on the gloves and empty the contents of the etoposide syringe into a glass (NOT a plastic beaker).
  • Add a small amount of fruit juice, squash or water but NOT grapefruit juice into the glass to make a suitable volume (not too much) for your child. 
  • Once mixed with juice, squash or water, the solution must be taken within three hours.
  • Put the syringe and cap into the sharps bin provided by the ward. 
  • 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 GOSH for disposal. Do not dispose in the household rubbish.

Accidental spillages

Spillage is unlikely as each etoposide liquid dose is supplied in capped syringes contained in a sealed bag. However, if a spillage does occur follow the advice below:
  • If contact occurs with your skin, you must wash the area immediately, using plenty of water. If the skin is sore you should contact your GP (family doctor) for advice.
  • If contact occurs with your eyes, wash immediately with plenty of water for at least 10 minutes. If your eyes are sore after this, you should go to your nearest Accident and Emergency (A&E) department.
  • If you spill any cytotoxic medicines on the work surface or floor, wearing gloves, cover the spillage with kitchen paper. Wipe the area with water then clean with household cleaner and water. Used kitchen paper and other items used to clean up the spillage should be double bagged and disposed of with the household waste.
  • If any cytotoxic medicine is spilt on clothing, the spill should be blotted dry with kitchen paper. Clothing should be removed immediately and washed separately from other items. Used kitchen paper should be disposed of as above. 
If any type of spillage occurs you should contact GOSH for advice immediately.

Important

  • 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.
Compiled by: 
The Pharmacy department in collaboration with the Child and Family Information Group
Last review date: 
September 2019
Ref: 
2019F0491

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