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Etoposide (Eposin, Etopophos, Vepesid)

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This page tells you about the chemotherapy drug etoposide and its possible side effects. There is information about

 

What etoposide is

Etoposide is a chemotherapy drug mainly used to treat lung cancer and testicular cancer. Doctors can also use it to treat other types of cancer including stomach cancer and non Hodgkin lymphoma

Etoposide 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.

 

How you have etoposide

Etoposide is available as capsules or as a fluid that you have into a vein.

Etoposide capsules

You may have etoposide as capsules that you swallow – you take them each day for a short while. Their brand name is Vepesid. It is very important that you take the capsules according to the instructions your doctor or pharmacist gives you. For example, whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.

Etoposide into a vein

Some people have etoposide into their bloodstream as a slow injection or through a drip (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. You can find out how chemotherapy treatment is planned in our section about planning chemotherapy.

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

 

Common side effects

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

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

  • An 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. Contact your doctor or nurse 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

  • Tiredness (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
  • 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
  • A sore mouth and tongue swelling
 

Occasional side effects

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 – you may not be able to become pregnant or father a child after this treatment so do talk to your doctor before starting treatment if you plan to have a baby in the future
  • 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
  • Diarrhoea or constipation
  • An allergic reaction during the treatment – let your nurse know straight away if you have sudden flushing or skin rashes, swelling of the face, lips or tongue, or breathlessness
  • Abdominal (tummy) pain
  • Taste changes
  • Dizziness
  • Inflammation around the drip site caused by chemotherapy drugs leaking into the tissues around your drip site – it is important to tell your nurse or doctor if you have any stinging or burning around your drip site, leakage of fluid, or redness or swelling around your drip site during or after treatment
 

Rare side effects

Fewer than 1 in 100 people have these.

  • 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
  • Raised blood pressure
  • Liver changes – you are unlikely to notice any symptoms and your liver function will almost certainly go back to normal when treatment is finished. You will have regular blood tests to check how well your liver is working
  • Changes in lung tissue may lead to a cough or breathlessness
  • Kidney changes that are unlikely to cause symptoms – the kidneys will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your kidneys are working
  • Difficulty swallowing – let your nurse know if you have this
  • Temporary changes in eyesight
 

Important points to remember

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 they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

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

Drugs that may react with etoposide include

  • A medicine called ciclosporin
  • Some other cancer drugs

This drug may have a harmful effect on a baby 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 or nurse before starting the treatment.

Breastfeeding is not advisable during this treatment because the drug may come through in the breast milk.

 

Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these 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.

 

More information about etoposide

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.

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Updated: 21 May 2013