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Action/Kinetics:
Derivative of podophyllotoxin that acts in the late S or early G
2 phase of the cell cycle, preventing cells from entering mitosis. Inhibits type II topoisomerase activity resulting in both single- and double-stranded breaks in DNA and DNA:protein cross-links. Active against sublines of certain murine leukemias that have developed resistance to amsacrine, cisplatin, daunorubicin, doxorubicin, mitoxantrone, or vincristine.
Terminal t
1/2: 5 hr. Significantly bound to plasma proteins (over 99%). Metabolized in the liver and excreted mainly through the urine (4%-12% unchanged) with small amounts excreted in the feces.
Uses:
In combination with other antineoplastic agents for induction therapy in clients with refractory childhood acute lymphoblastic leukemia (ALL). Has also been used for relapsed ALL.
Contraindications:
Hypersensitivity to teniposide, etoposide, or the polyoxylethylated castor oil present in teniposide products. Lactation.
Special Concerns:
Clients with both Down syndrome and leukemia may be especially sensitive to myelosuppressive chemotherapy; thus, reduce initial dosing. A life-threatening anaphylactic reaction may occur with the first dose (incidence appears to be greater in clients with brain tumors and neuroblastoma). Use with caution in clients with impaired hepatic function. Contains benzyl alcohol associated with a fatal ``gasping'' syndrome in premature infants.
Side Effects:
Hematologic:
Severe myelosuppression leukopenia, neutropenia, thrombocytopenia, anemia.
Hypersensitivity reactions:
Anaphylaxis manifested by chills, fever,
bronchospasm dyspnea, facial flushing, hypertension or hypotension, tachycardia.
CV: Hypotension.
GI: Mucositis, N&V;, diarrhea.
Dermatologic: Alopecia (reversible), rash, hepatic dysfunction or toxicity, peripheral neurotoxicity, infection, bleeding, renal dysfunction, metabolic abnormalities.
Overdose Management:
Symptoms: Myelosuppression, hypotension, anaphylaxis.
Treatment (Anaphylaxis or Overdose):
- Treat anaphylaxis promptly with antihistamines, corticosteroids, epinephrine, IV fluids, and other supportive measures. If a client who manifested a hypersensitivity reaction must be retreated, undertake pretreatment with corticosteroids and antihistamines; carefully observe client during and after the infusion.
- If hypotension occurs, stop the infusion and give fluids. Undertake other supportive therapy as needed.
- Myelosuppression may be treated with supportive care including blood products and antibiotics.
Drug Interactions:
-
Antiemetic drugs / Acute CNS depression and hypotension in clients receiving high doses of teniposide and who were pretreated with antiemetics
-
Methotrexate /
Plasma clearance of methotrexate
-
Sodium salicylate /
Effect of teniposide due to displacement from plasma protein binding sites
-
Sulfamethizole /
Effect of teniposide due to displacement from plasma protein binding sites
-
Tolbutamide /
Effect of teniposide due to displacement from plasma protein binding sites
How Supplied:
Injection: 10 mg/mL
Dosage
?IV Infusion
Regimen 1 for childhood ALL clients failing induction therapy with cytarabine.
Teniposide, 165 mg/m
2, and cytarabine, 300 mg/m
2 IV twice weekly for eight to nine doses.
Regimen 2 for childhood ALL refractory to vincristine/prednisone-containing regimens.
Teniposide, 250 mg/m
2, and vincristine, 1.5 mg/m
2, IV weekly for 4-8 weeks, and prednisone, 40 mg/m
2 orally for 28 days.
