Etoposide is a chemotherapy drug that is given as a treatment for some types of cancer. It is most commonly used to treat cancer of the lung, ovarian and testicular cancer. This information describes etoposide, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer, which give more information and advice.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

Etoposide is a colourless fluid. It is also available as pale pink capsules of 50mg and 100mg.

Etoposide may be given:

• A drip (infusion) through a fine tube (cannula) inserted into the vein. It may be given through a central line, which is inserted into a vein near the collarbone, or though a PICC line which is inserted into a vein in the crook of your arm. The infusion takes about 30–60 minutes.
• Capsules which should be swallowed whole.

Chemotherapy is usually given as a course of several sessions (or cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer for which you are being treated. Your nurse or doctor will discuss your treatment plan with you.

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given etoposide, and may be different if you are having more than one chemotherapy drug.

We have outlined the most common side effects and some of the less common ones, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Lowered resistance to infection Etoposide can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next course of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Etoposide can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with etoposide you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these effects are a problem.

Hair loss This usually starts 3–4 weeks after the first dose of etoposide, although it may happen earlier. Your hair may fall out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and all your hair will regrow once the treatment ends.

Feeling sick (nausea) and being sick (vomiting) If you do feel sick this may begin after the treatment is given and last for up to five days. It is more common when etoposide is taken as capsules than when it is given into a vein. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting. If the sickness is not controlled, or continues, tell your doctor; they can prescribe other anti-sickness drugs which may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Diarrhoea can usually be easily controlled with medicine, but tell your doctor if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

Loss of appetite A dietitian or specialist nurse at your hospital can give advice and tips on boosting appetite, coping with eating difficulties and maintaining weight.

Sore mouth and ulcers Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as special mouthwashes and medicines to prevent or clear any mouth infection can be prescribed.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Skin changes Etoposide can cause a rash, which may be itchy. Your doctor can prescribe medicine to help with this. Let your doctor know if this happens. Your skin may darken, due to excess production of pigment. It usually returns to normal a few months after the treatment has finished.

Sleeplessness, headaches and confusion These effects are very rare and only occur with high-dose treatment. If you have any of these side effects let your doctor know straightaway.

Allergic reaction Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, redness of the face, a feeling of dizziness, a headache, breathlessness, anxiety and a desire to pass urine. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these symptoms.

Second cancer Very rarely, etoposide may cause a second cancer, usually a type of acute leukaemia, to develop years later. Your nurse or doctor can discuss this with you.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines Some medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Pain at the injection site While etoposide is being given, it can cause pain at the place where the injection is given, or along the vein. If you feel pain, tell your doctor or nurse.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking etoposide, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

• It is important to take your capsules at the right times. You must take them as directed by your doctor.
• If the capsules leak, it is important not to touch their contents.
• Keep the capsules in a safe place where children can't reach them, as etoposide could harm them. The capsules should be stored in the original container and kept in the fridge.
• If your doctor decides to stop the treatment, return any remaining capsules to the pharmacist. Do not flush them down the toilet or throw them away.
• If you are sick just after taking the capsules, let your doctor know as you may need to take another dose. Do not take another capsule without first informing your doctor.
• If you forget to take a capsule do not take a double dose. Let your doctor know and keep to your regular dose schedule.
• If you have difficulty swallowing the capsules, talk to your pharmacist.

This section is based on our Etoposide factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Medicines.org.uk website – www.medicines.org.uk (November 2007). 
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott, Williams and Wilkins, 2001.

For further references, please see general bibliography.