Etoposide injection should be given only under the supervision of a doctor with experience in the use of chemotherapy medications.

Etoposide can cause a severe decrease in the number of blood cells in your bone marrow. Your doctor will order laboratory tests regularly before and during your treatment. A decrease in the number of blood cells in your body may cause certain symptoms and may increase the risk that you will develop a serious infection or bleeding. If you experience any of the following symptoms, call your doctor immediately: fever, sore throat, ongoing cough and congestion, or other signs of infection; unusual bleeding or bruising; bloody or black, tarry stools; bloody vomit; or vomiting blood or brown material that resembles coffee grounds.

Etoposide injection is used in combination with other medications to treat cancer of the testicles that has not improved or that has worsened after treatment with other medications or radiation therapy. Etoposide injection is also used in combination with other medications to treat a certain type of lung cancer (small cell lung cancer; SCLC). Etoposide is in a class of medications known as podophyllotoxin derivatives. It works by slowing or stopping the growth of cancer cells in your body.

Etoposide injection comes as a comes as a solution (liquid) or as a powder to be mixed with liquid to be slowly injected intravenously (into a vein) by a doctor or nurse in a medical facility. The length of treatment depends on the types of drugs you are taking, how well your body responds to them, and the type of cancer you have.

Etoposide injection is also sometimes used to treat Hodgkin’s lymphoma (Hodgkin’s disease), non-Hodgkin’s lymphoma (types of cancer that begin in a type of white blood cells that normally fights infection), and certain types of leukemia (cancer of the white blood cells), including acute myeloid leukemia (AML, ANLL) and acute lymphoblastic leukemia (ALL) in children. It is also sometimes used to treat Wilms tumor (a type of kidney cancer that occurs in children), neuroblastoma (a cancer that begins in nerve cells and occurs mainly in children), ovarian cancer (cancer that begins in the female reproductive organs where eggs are formed), another type of lung cancer (non-small cell lung cancer; NSCLC), and Kaposi’s sarcoma related to acquired immunodeficiency syndrome (AIDS). Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before receiving etoposide injection,

• tell your doctor and pharmacist if you are allergic to etoposide, etoposide phosphate (Etopophos), any other medications, or any of the ingredients in etoposide or etoposide phosphate injection. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: cisplatin (Platinol), cyclosporine (Gengraf, Neoral, Sandimmune). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with etoposide, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
• tell your doctor if you have or have ever had kidney disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. You should not become pregnant or breast-feed while you are receiving etoposide injection. If you become pregnant while receiving etoposide injection, call your doctor. Etoposide may harm the fetus.

Unless your doctor tells you otherwise, continue your normal diet.

Etoposide injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• swelling, pain, redness, or burning at the injection site
• nausea
• vomiting
• sores in the mouth and throat
• stomach pain
• diarrhea
• constipation
• loss of appetite or weight
• unusual tiredness or weakness
• pale skin
• fainting
• dizziness
• hair loss
• pain, burning, or tingling in the hands or feet
• eye pain

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical treatment:

• rash
• hives
• itching
• difficulty breathing or swallowing
• fast, irregular, or pounding heartbeat
• seizures
• yellowing of the skin or eyes

Etoposide may increase the risk that you will develop other cancers. Talk to your doctor about the risks of taking this medication.

Etoposide may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain tests to check your body’s response to etoposide.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

• Etopophos^®
• Toposar^®¶
• Vepesid^®¶

• VP-16