Etoposide (Eposin)

How does it work?

Eposin injection contains the active ingredient etoposide, which is a chemotherapy medicine used to treat cancer.

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 the dividing stage (mitosis) of their life cycle. It also destroys cells in the 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.

What is it used for?

  • Small cell lung cancer.
  • Testicular cancer.
  • Acute myeloid leukaemia.
  • In addition to these licensed uses, etoposide may also be used by specialists to treat other types of cancer, including lymphomas.

Etoposide is used principally in combination with other anticancer drugs, though it can also be used alone.

How is this treatment given?

  • Eposin injection is given as a drip into a vein (intravenous infusion) over 30 to 60 mintues.
  • If etoposide leaks into the tissues around the vein, it can cause damage to the tissue there. For this reason, it is important to tell the doctor or nurse administering the medicine if you feel any burning or stinging around the vein or if you notice any fluid leaking out of the injection site.
  • Etoposide is usually given every day for three to five days. This course is then usually repeated at intervals of 21 days.
  • The length of your treatment and the number of cycles you have will depend on the type of cancer you are being treated for, how well it responds and how well your body copes with the chemotherapy.


  • 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 to have 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.
  • This medicine may be harmful to a developing 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 six months after treatment is finished.
  • Your ability to get pregnant or father a child may be affected by taking this medicine. It is important to discuss fertility with your doctor before starting treatment.
  • Treatment with etoposide may increase the risk of developing leukaemia (cancer of the white blood cells). After your treatment you will have regular blood tests which will detect any possible leukaemic changes early, if they do occur. Your doctor or nurse can discuss the risks of this with you.

Use with caution in

  • People with decreased kidney or liver function.
  • Liver disease.
  • Alcoholism.
  • Epilepsy.
  • People with brain injury or disease.
  • Children.

Not to be used in

  • People with a very low number of white blood cells, red blood cells or platelets in their blood (for example as a result of previous radiotherapy or chemotherapy treatments).
  • People with severely decreased liver function.
  • People with severely decreased kidney function.
  • Premature or newborn babies.
  • 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 may be harmful to a developing baby. It should not be used during pregnancy unless considered essential by your doctor for treating life-threatening disease.
  • Women who could get pregnant should use effective contraception to prevent pregnancy, and men should use effective contraception to avoid fathering a child, both during treatment, and for at least six months after treatment is finished. Ask your doctor for further advice.
  • This medicine passes into breast milk and could have harmful effects on a nursing infant. Mothers who need treatment with 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. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Very common (affect more than 1 in 10 people)

  • Feeling or being sick. You will be given medicines to help prevent this.
  • Reversible hair loss.
  • Loss of appetite.
  • Decrease in the number of healthy white blood cells, red blood cells or platelets in the blood (leucopenia, anaemia and thrombocytopenia) -– see warning section above.
  • Fatigue.
  • Drowsiness.

Common (affect between 1 in 10 and 1 in 100 people)

  • Abdominal pain.
  • Diarrhoea.
  • Sore mouth.
  • Problems with liver function.
  • Allergic-type reactions.
  • Low blood pressure.

Uncommon (affect between 1 in 100 and 1 in 1000 people)

  • Skin reactions such as rash, itching or darkening of skin.
  • Problems with the peripheral nerves, causing weakness, tingling sensations and numbness (peripheral neuropathy).
  • Inflammation of the membranes lining the foodpipe or intestines.
  • Coughing.
  • Breathing difficulties due to a narrowing of the airways (bronchospasm).
  • Irregular heartbeats or heart attack.

Rare (affect between 1 in 1000 and 1 in 10,000 people)

  • Feeling weak.
  • Constipation.
  • Difficulty swallowing.
  • Inflammation or scarring in the lungs (pneumonitis or pulmonary fibrosis).
  • Reversible loss of vision.
  • Alteration in taste.
  • Inflammation of the vein into which the medicine is administered.

The side effects listed above may not include all of the side effects reported by the medicine'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 make sure that the combination is safe.

Vaccines may be less effective in people receiving chemotherapy. This is because chemotherapy medicines reduce the activity of the immune system and can prevent the body forming adequate antibodies. Live vaccines should be postponed until at least six months after finishing chemotherapy because they may cause infection. Live vaccines include the following: oral polio; rubella; measles, mumps and rubella (MMR); BCG; chickenpox; yellow fever and oral typhoid vaccines.

There may be an increased risk of side effects on the blood cells if this medicine is used in combination with other medicines which can also affect blood cell counts, for example other chemotherapy medicines or the antipsychotic clozapine.

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.

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.

Other medicines containing the same active ingredient

Etopophos Vepesid