Etoposide (Eposin, Etopophos, Vepesid)

Etoposide is a chemotherapy drug used to treat many different types of cancer, including lung cancer, stomach cancer, non Hodgkin’s lymphoma and testicular cancer. It works by blocking an enzyme (called topoisomerase 2) which is necessary for cancer cells to divide and so grow into 2 new cells. If this enzyme is blocked, the cell's DNA gets tangled up and the cell cannot divide. DNA is the genetic code that is in the nucleus of all animal and plant cells. It controls everything the cell does. Etoposide is made from the mandrake plant.

You may have etoposide as capsules that you swallow – these are taken each day for a short while. Their brand name is Vepesid.

Some people have etoposide through a drip into a vein (intravenous infusion) over half an hour to an hour or more. Its brand name is Eposin or Etopophos. You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drug directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

Etoposide is usually given as a course of several cycles of treatment. The exact treatment plan depends on which cancer you have. To find out more about the way chemotherapy treatment is planned click on planning chemotherapy.

The side effects associated with etoposide are listed below. You can use the links (underlined) to find out more about each side effect. Or you can go to the cancer drug side effects section for general information.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Feeling or being sick happens to about 4 out of every 10 (40%) people – it is more common when etoposide is given as tablets. It is usually mild to moderate and well controlled with anti sickness medicines. If you are sick within an hour of taking etoposide capsules, don't take an extra dose but tell your doctor as soon as possible
• Hair loss happens to about 7 out of 10 (70%) people 
• Metallic taste when having the drug through a drip
• Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse immediately
• Your blood pressure can drop if etoposide is given too quickly – if you feel dizzy or faint, call your nurse straight away to slow your drip down
• Loss of appetite happens to about 1 in 8 (12%) people having etoposide
• This drug may have a harmful effect on a baby that is developing in the womb – it is not advisable to become pregnant or father a child if you are having this drug. Talk about contraception with your doctor before starting the treatment

Between 1 and 10 in every 100 people have one or more of these.

• Women may stop having periods (amenorrhoea) but this may only be temporary
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if having a baby is important to you
• Reddening of the skin in areas where you have had radiotherapy in the past, and the skin may get dry and flaky and feel sore and hot – this goes away on its own but keep affected areas out of the sun
• A skin rash can sometimes occur with etoposide
• A sore mouth
• Diarrhoea or constipation are not common, but can occur with high doses of etoposide

Fewer than 1 in 100 people have these.

• An allergic reaction with chills, fever, wheezing, racing heart, drop in blood pressure and swelling of the face happens in 1 or 2 out of every 100 (1 to 2%) people – let your doctor or nurse know if you have any of these effects
• There is a small risk that you may get a second cancer some years after etoposide treatment – if this is going to happen, it most often occurs 5 to 8 years after treatment

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.