Main use Active ingredient Manufacturer
Lung and testicular cancer Etoposide phosphate Bristol-Myers Squibb

How does it work?
Etopophos injection contains the active ingredient etoposide phosphate, which is an anticancer chemotherapy medicine.

Cancers form when some cells within the body multiply uncontrollably and abnormally. These cells spread, destroying nearby tissues. Etoposide works by stopping the cancer cells from multiplying.

Like normal healthy cells, cancer cells go through a continuous process of change. Each cell divides into two daughter cells. These cells grow, rest and then divide again. Etoposide prevents the cells from entering mitosis (the dividing stage) of the cell's life cycle. It also destroys cells in the previous phase before mitosis where proteins are made.

Unfortunately, etoposide can also affect normal, healthy cells, particularly those that multiply quickly, such as blood cells and hair cells. The most important side effect is on the bone marrow where blood cells are made. Etoposide can decrease the production of blood cells, leaving people susceptible to infection. Regular blood tests are therefore needed to monitor the levels of blood cells.

In most chemotherapy regimens, doses are administered in courses at various intervals to allow normal cells to recover from the adverse effects of the anticancer medicines between doses. However, during this period, cancer cells will also recover and start to replicate again. Successful treatment depends on the administration of the next course of therapy before the cancer has regrown to its previous size and the net effect is to decrease the amount of cancer with each successive course.

Etoposide is used principally in combination with other anticancer drugs, though it can also be used alone. It is usually given every day for three to five days. The course is then repeated not more frequently than at intervals of 21 days.

Etopophos injection is given as a drip into a vein (intravenous infusion). This can take between 5 minutes to 3.5 hours.

What is it used for?
Small cell lung cancer
Testicular cancer
In addition to these licensed uses, etoposide may also be used by specialists to treat other types of cancer, including leukaemia and lymphoma.
Warning!
Chemotherapy medicines can decrease the number of blood cells in your blood. A low white blood cell count can increase your susceptibility to infections; a low red blood cell count causes anaemia and a low platelet count can cause problems with blood clotting. For this reason, you will need regular blood tests to monitor your blood cells during treatment with this medicine. Tell your doctor immediately if you experience any of the following symptoms during your treatment, as they may indicate problems with your blood cells: unexplained bruising or bleeding, purple spots, sore mouth or throat, mouth ulcers, high temperature (fever) or other signs of infection, or suddenly feeling tired, breathless, or generally unwell.
Your liver function should also be monitored during treatment with this medicine. Symptoms that may suggest a liver problem include persistent nausea and vomiting, abdominal pain, or the development of jaundice (a yellow colouring to the skin and the whites of the eyes). Tell your doctor if you experience any of these symptoms.
On very rare occasions, etoposide may cause a second cancer, usually a type of acute leukaemia, to develop a few years after your treatment has finished. Your doctor or nurse can discuss the risks of this with you.
Your ability to become pregnant or father a child may be affected by treatment with this medicine. It is important to discuss fertility with your doctor before starting treatment.
Use with caution in
Decreased kidney function
Decreased liver function
Not to be used in
Severely decreased liver function
Pregnancy
Breastfeeding
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

This medicine should not be used during pregnancy as it may be harmful to the unborn baby. Women who could get pregnant should use effective contraception to prevent pregnancy, and men should use effective contraception to prevent fathering a child, both during treatment, and for at least a few months after treatment is finished. Seek medical advice from your doctor.
It is not known whether this medicine passes into breast milk. Mothers who need this medicine should not breastfeed. Seek medical advice from your doctor.
Side effects
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Decrease in the number of white blood cells in the blood (leucopenia)
Decrease in the number of platelets in the blood (thrombocytopenia)
Reversible hair loss
Nausea and vomiting
Decrease in the number of red blood cells in the blood (anaemia)
Abdominal pain
Loss of appetite
Diarrhoea or constipation
Sore mouth or throat
Changes in blood pressure
Breathing difficulties due to a narrowing of the airways (bronchospasm)
Disorder of the peripheral nerves causing weakness and numbness (peripheral neuropathy)
Sleepiness (somnolence)
Fatigue
Alteration in taste
Fever
Skin reactions such as rash, itching or darkening of skin
Difficulty swallowing
Alteration in results of liver function tests
The side effects listed above may not include all of the side effects reported by the drug's manufacturer.For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines during treatment this one, to ensure that the combination is safe.

Chemotherapy decreases the body's immune response. This means that vaccines may be less effective if given during treatment, and live vaccines may cause serious infections. Live vaccines include: measles, mumps, rubella, MMR, oral polio, oral typhoid and yellow fever. If live vaccines are needed they should be postponed until at least six months after finishing chemotherapy.

High doses of the immunosuppressant ciclosporin can increase the amount of etoposide in the blood. As this can lead to more severe side effects, including reduction in white blood cells, your doctor may prescribe a lower than normal dose of etoposide if you are also receiving ciclosporin treatment.

The removal of etoposide from the body may be increased by phenobarbital or phenytoin.

Etoposide may enhance the anti-blood-clotting effect of the anticoagulant warfarin. As this may increase the risk of bleeding, your doctor may want to perform extra monitoring of your blood clotting time (INR) while you are having treatment with this medicine.

Other medicines containing the same active ingredient
Eposin Vepesid