Dosing and uses of vm 26, Vumon (teniposide)
Adult dosage forms and strengths
injectable solution
- 10mg/mL
Antineoplastic
IV: 50-180 mg/sq meter once or twice weekly x4-6 weeks Or
20-60 mg/sq meter/day x 5 days
Small Cell Lung Cancer
80-90 mg/sq meter/day x 5 days q4-6Weeks
Other Indications & Uses
Refractory childhood ALL, non-hodgkin's lymphoma
Pediatric dosage forms and strengths
injectable solution
- 10mg/mL
Refractory Childhood ALL
165 mg/sq.meter IV, in combo with cytarabine 300 mg/sq.meter IV, twice/week x8-9 doses, Or
250 mg/sq.meter IV, in combo with vincristine 1.5 mg/sq.meter IV, once/week x4-8 weeks
Slow infusion (30-60 minutes)
Down syndrome patients: decrease dose by half
Withhold treatment if Plts <50 K/cu.mm or ANC <500/cu.mm
Monitor: Bp
vm 26, Vumon (teniposide) adverse (side) effects
>10%
Alopecia (31%)
Nausea (4-11%)
Vomiting (4-11%)
1-10%
Hypersensitivity (5%)
Fever (3%)
Stomatitis (3%)
Nephrotoxicity (2%)
Anorexia (1%)
Diarrhea (1%)
Frequency not defined
Infection
Myelosuppression
Warnings
Black box warnings
The drug should be administered under the supervision of an experienced cancer chemotherapy physician in a facility equipped to diagnose and manage complications
Severe myelosuppression with resulting infection or bleeding may occur
Hypersensitivity reactions including anaphylaxis-like symptoms may occur with initial dosing or with repeated exposure to teniposide. Epinephrine, with or without corticosteroids and antihistamines, has been used to treat reaction symptoms.
Contraindications
Hypersensitivity to teniposide or castor oiL
Platelets <50,000/cu.mm or ANC <500/cu.mm
Cautions
Hypersensitivity reaction variably manifested by chills, fever, urticaria, tachycardia, bronchospasm, dyspnea, hypertension or hypotension, rash, and facial flushing may occur with any dose
Acute CNS depression, hypotension, and metabolic acidosis observed in patients receiving high-dose investigational infusions who were pretreated with antiemetic drugs; thought to be caused by the antiemetic depressant and the alcohol content of high-dose teniposide
Pregnancy and lactation
Pregnancy category: D; animal studies observed a decreased sperm count and genetic damage to sperm
Lactation: not known if excreted in breast milk
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of vm 26, Vumon (teniposide)
Mechanism of action
Semisynthetic podophyllotoxin derivativeInhibits topoisomerase II to cause DNA strand breaks, preventing mitosis
Absorption
Peak Plasma: 14.3 mcg/mL
Distribution
Protein Bound: >99%
Metabolism
Hepatic (major)
Half-Life: 5-21 hr
Clearance: 7-17 mL/min/sq.meter
Excretion: Urine 44%; feces <10%
Administration
IV Incompatibilities
Y-site: idarubicin
Additive, Syringe, Y-site: heparin
IV Preparation
Must be diluted with either D5W or NS to a final concentration of 0.1, 0.2, 0.4 or 1 mg/mL
To prevent extraction of the plasticizer DEHP, prepare solutions in non-DEHP-containing containers such as glass or polyolefin
PVC is not recommended
Administer 1 mg/mL solutions within 4 hr of preparation to reduce potential for precipitation
Precipitation may occur at any concentration
IV Administration
Irritant
Slow IV infusion over >30 min
Rapid infusion may cause hypotension or incr nausea & vomiting
Flush thoroughly before & after administration
Incompatible with heparin
Do not use in-line filter during IV infusion
Storage
Store ampules in refrigerator
