Topoisomerase II inhibitor Pregnancy: Etoposide can cause fetal harm when administered to pregnant women and has been shown to be teratogenic in mice and rats; there are no or limited data in pregnant women. It should not be used during pregnancy unless the clinical condition of the woman requires it. Effective contraception is required for both male and female patients during treatment and for up to 6 months after ending treatment, given the mutagenic potential. Genetic consultation is recommended if the patient wishes to have children after treatment. Etoposide is excreted in human milk and breast-feeding is a contraindication. Etoposide may decrease male fertility, so sperm preservation may be considered.

Etoposide (Specialist drug)

Brand names: Etopophos, Vepesid

Etoposide is a topoisomerase II inhibitor cytotoxic used in a range of malignancies including small-cell lung cancer, testicular cancer and lymphomas.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Oral: 100 to 200 mg/m2/day on days 1 to 5, OR 200 mg/m2/day on days 1, 3 and 5

Route: Oral — capsules should be taken on an empty stomach

Frequency: Every 3 to 4 weeks

Max: Not stated as an absolute ceiling; the SPC's highest oral figure is 200 mg/m2/day, and daily doses above 200 mg must be divided into two administrations

FORMULATION CAVEAT — READ FIRST: the fetched UK SPC is for Etoposide 100 mg Soft Capsules (ORAL). It contains no intravenous regimen. If this page covers intravenous etoposide, a clinician must source the IV SPC separately — do not extrapolate. The SPC itself states that the oral dose is based on the recommended intravenous dose taking account of dose-dependent bioavailability: a 100 mg oral dose would be comparable to a 75 mg intravenous dose, and a 400 mg oral dose would be comparable to a 200 mg intravenous dose. Within-patient variability in exposure is larger with oral than with intravenous administration (coefficient of variation around 30% oral versus 10% intravenous), and the SPC states that where cure is the intent the intravenous formulation should be used. DIVIDED DOSING: daily doses greater than 200 mg should be divided and given twice per day. COMBINATION THERAPY: the same dose (100 to 200 mg/m2/day on days 1 to 5, or 200 mg/m2/day on days 1, 3 and 5, every 3 to 4 weeks) is used in combination with other medicines approved for the disease being treated; the dose should be modified to allow for the myelosuppressive effects of the other drugs in the combination or the effects of prior radiotherapy or chemotherapy. ALTERNATIVE SCHEDULE: 50 mg/m2/day for 2 to 3 weeks, with courses repeated after a one-week rest period or upon recovery from myelosuppression. BLOOD COUNT RULES: do not begin a new cycle if the neutrophil count is less than 1,500 cells/mm3 or the platelet count is less than 100,000 cells/mm3, unless caused by malignant disease. Adjust doses after the initial dose if the neutrophil count is below 500 cells/mm3 for more than 5 days, if fever or infection occurs, or if the thrombocyte count falls below 25,000 cells/mm3 not caused by the disease. Adjust follow-up doses for grade 3 or 4 toxicities. Measure platelet count, haemoglobin, white cell count and differential at the start of therapy and before each subsequent dose. ELDERLY: no dosage adjustment is necessary in patients over 65 years other than on the basis of renal function. PAEDIATRIC: the safety and efficacy of etoposide in children below 18 years of age have not been established and no recommendation on a posology can be made. SPECIALIST USE ONLY: to be administered and monitored under the supervision of a qualified physician experienced in the use of anti-neoplastic medicinal products. SOURCE CAVEAT: SPC sections 4.4 and 4.8 were truncated at the source-fetch limit and section 4.5 (interactions) was not retrieved.

Dose adjustments

Renal

Initial dose based on measured creatinine clearance: above 50 ml/min — 100% of dose; 15 to 50 ml/min — 75% of dose. In patients with creatinine clearance below 15 ml/min and on dialysis, further dose reduction is likely to be required. Subsequent dosing in moderate and severe renal impairment should be based on patient tolerance and clinical effect. Since etoposide and its metabolites are not dialysable, it can be given pre- and post-haemodialysis. Follow-up doses should also be adjusted if creatinine clearance is below 50 ml/min.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to etoposide, to sodium ethyl parahydroxybenzoate (E215) or sodium propyl parahydroxybenzoate (E217), or to any of the excipients
Concomitant use of yellow fever vaccine or other live vaccines in immunosuppressed patients
Lactation (breast-feeding)

Side effects

Leukopenia (60 to 91%), thrombocytopenia (22 to 41%), neutropenia, anaemia and myelosuppression — dose-limiting bone marrow suppression is the most significant toxicity and fatal myelosuppression has been reported
Nausea and vomiting (31 to 43%), abdominal pain, anorexia, constipation and diarrhoea; mucositis including stomatitis and oesophagitis
Alopecia (8 to 66%) and pigmentation; pruritus, rash and urticaria
Hepatotoxicity (very common), with raised ALT, AST, alkaline phosphatase and bilirubin
Acute leukaemia (common); asthenia and malaise (very common); rarely anaphylactic reactions, interstitial pneumonitis, pulmonary fibrosis, Stevens-Johnson syndrome and toxic epidermal necrolysis

Interactions

Yellow fever vaccine and other live vaccines — concomitant use is contraindicated in immunosuppressed patients (UK SPC section 4.3)
Prior or concurrent radiotherapy or myelosuppressive chemotherapy — dosage should be modified to allow for compromised bone marrow reserve, and an adequate interval allowed for marrow recovery before starting etoposide (UK SPC sections 4.2 and 4.4)
High-dose ciclosporin A producing concentrations above 2000 ng/ml — an 80% increase in etoposide exposure and a 38% decrease in total body clearance were seen with oral etoposide (from US label Drug Interactions; UK SPC section 4.5 was not retrieved)

Clinical monograph

How it works

It inhibits topoisomerase II, stabilising the enzyme-DNA complex and causing DNA strand breaks that prevent re-ligation, leading to cell-cycle arrest and apoptosis.

Prescribing in practice

Severe, dose-limiting myelosuppression occurs, so a full blood count must be checked before each course and treatment withheld for significant cytopenias.
Administer only under specialist oncology supervision; intravenous infusion must be given slowly to avoid hypotension and infusion reactions.
There is a recognised risk of secondary acute leukaemia, and dose adjustment is needed in hepatic and renal impairment.

Monitoring

Monitor full blood count before and during each cycle, together with renal and hepatic function.

Counselling the patient

Report fever or signs of infection urgently because of the risk of low blood counts.
Hair loss is common and usually reversible after treatment ends.
Effective contraception is advised during and after treatment.

Evidence & guidelines

Etoposide is an established component of evidence-based combination regimens, including for small-cell lung and testicular cancers, supported by long-standing trial data.

Reference: SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways