Posted on December 4th, 2008 by
Generic Name: Teniposide (ten-i-poe-side), VM 26
Trade Name: Vumon®
How is this drug used? Teniposide is FDA approved in combination with other anticancer agents for the treatment of childhood acute lymphoblastic leukemia that has stopped responding to standard therapies. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Teniposide is a topoisomerase inhibitor. Teniposide produces its anti-cancer effects by inhibiting an enzyme, topoisomerase, which is responsible for maintaining structural function and integrity of DNA. By inhibiting the normal activity of topoisomerase, teniposide inhibits proper DNA synthesis, ultimately causing cellular death.
How is teniposide given (administered)? Teniposide is administered into a vein (intravenous), and the dose depends on several factors, including the condition being treated, the size of the patient, the particular treatment regimen being used, and the overall health of the patient. If teniposide escapes from the vein in which it is being administered it may cause serious damage to the tissue that it comes in contact with. Although patients will be monitored for this, they should tell their healthcare provider immediately if they experience pain, redness or swelling at the site in which the drug is being administered.
In addition, patients may have an allergic-type reaction to teniposide, although this is uncommon. Patients experiencing difficulty breathing, swelling of the throat, tongue or facial features, flushing, hives, itching, fever, chills, fast heart rate or dizziness should tell their healthcare provider immediately. Low blood pressure may also occur.
How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with teniposide. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy.
What are the common (occur in 30% or more of patients) side effects of treatment with teniposide?
• Low levels of white blood cells – increases risk of infection
• Low levels of red blood cells – increases risk of anemia
• Low levels of platelets – increases risk of bleeding
• Mouth sores
What are the less common (occur in 10% to 29% of patients) side effects of treatment with teniposide?
• Nausea and vomiting
This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.
Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.
What are the possible late side effects of treatment with teniposide? Patients treated with teniposide have a slightly increased risk of developing a secondary malignancy. A secondary malignancy is a new and unrelated cancer that occurs in an individual as a result of previous treatment with radiation or chemotherapy. Patients should ask their physician about the possibility of developing a secondary malignancy as a result of their treatment.
What can patients do to help alleviate or prevent discomfort and side effects?
• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If possible, patients should avoid large crowds or persons who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• For mouth sores, patients should rinse their mouth three times a day with a salt and soda solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.
• Eat small meals frequently to help alleviate nausea.
Are there any special precautions patients should be aware of before starting treatment?
• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
When should patients notify their physician?
• Signs of an allergic-type reaction - difficulty breathing, swelling of the throat, tongue or facial features, hives, itching, facial flushing, fever, chills, fast heart rate, or dizziness
• Flu or cold-like symptoms - fever, chills, sore throat, cough
• Signs of infection – redness, swelling, pus, tenderness
• Persistent or severe fatigue
• Unexplained or severe bleeding (nosebleeds, bruising, black tarry stools, blood in the urine, etc.)
• Mouth sores
• Persistent or extreme diarrhea
• Persistent or extreme nausea or vomiting
• Numbness or tingling of hands or feet
• Extreme lethargy or drowsiness
• Redness, swelling or pain at the site of administration
What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.
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