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etoposide

etoposide

Restricted Medications IV Chemotherapy

Brand names: Toposar, VePesid, VP-16

Form	Strength
CAPSULE, ORAL	50 mg
SOLUTION, INTRAVENOUS	20 mg/mL

Display Antineoplastic Agents Class: 100000

High Alert Drug : Policy

Medication comments:

Chemo rounding - may round chemo DOWN to nearest vial if dose within ≤ 5% of ordered dose.
Chemo doses will not be rounded up. (Approved 12/18)

High Alert Drug: Chemotherapeutic Agents - Parenteral
• Stored separately in pharmacy. • Pharmacist reviews literature in order to to verify calculations and dose prescribed. • Two pharmacists independently verify preparation. • No telephone orders. Pre-printed order sheet available. • Chemo is administered by specially trained RNs. • 2 RNs independently verify pump settings and drug on continuous infusions prior to administration. • IV sites are assessed every 2 hours. • Drugs are transported in plastic bags/designated transport containers labeled with sticker indicating CHEMOTHERAPY DRUG.

High Alert Drug: Chemotherapeutic Agents - Parenteral

• Stored separately in pharmacy.
• Pharmacist reviews literature in order to to verify calculations and dose prescribed.
• Two pharmacists independently verify preparation.
• No telephone orders. Pre-printed order sheet available.
• Chemo is administered by specially trained RNs.
• 2 RNs independently verify pump settings and drug on continuous infusions prior to administration.
• IV sites are assessed every 2 hours.
• Drugs are transported in plastic bags/designated transport containers labeled with sticker indicating CHEMOTHERAPY DRUG.

High Alert Drug: Chemotherapeutic Agents - Oral
• Stored separately in pharmacy. • Drugs are transported in plastic bags/designated transport containers labeled with sticker indicating CHEMOTHERAPY DRUG.

Per policy, these medications require cardiac and/or special monitoring. (KEY: "Y" = may be given as described on chart. "N" = may NOT be given except in Rapid Response/Code Blue situations or as otherwise described in Exceptions section of Policy.
generic (Brand) / Notes
cytotoxic agents (chemotherapy) IV Push, IV Infusion (chemotherapy) Key: certified RN and 1N designated staff only	Y (CCU only)	N	N	Y (1N only)	N	N	Y	N

Per policy, these hazardous drugs have special waste requirements.
Generic (Brand)	Waste Requirements
etoposide (Toposar, VePesid, VP-16)	If > 3% by weight of drug remains ⇒ BLACK BUCKET Trace amounts/uncontaminated PPE ⇒ YELLOW BUCKET

Medications Requiring Filters
Medication	Preparation Filter	Administration Filter
etoposide (Toposar)	Not required.	May be administered without loss of potency through a 0.22 micron inline filter.

USP <800> Hazardous Drugs
Per Policy, these drugs have special handling requirements (any drug with an "AOR" is exempt from these requirements under normal circumstances).
generic (Brand) Route	Risk Level	AOR?	Warnings (hover over entry for details)
etoposide (Toposar, Vepesid) PO	High	No	IARC-1 FDA-D
Receiving	• Gloves: Single
Pharmacy: Preparation	• Gloves: Double
	• Gown: Yes
	• Ventilated Engineering controls: Yes
	• Closed System Transfer Device: ---
Nursing: Administration	• Gloves: Single: (Intact Tablets or Capsules); Double: (Oral Liquid or Tube Feeding)
	• Gown: Yes, (Oral Liquid or Tube Feeding)
	• Eye/face protection: Yes, if potential vomit or spit up
	• Closed System Transfer Device: ---
etoposide (Toposar, Vepesid) IV	High	No	IARC-1 FDA-D
Receiving	• Gloves: Single
Pharmacy: Preparation	• Gloves: Double
	• Gown: Yes
	• Ventilated Engineering controls: Yes, Class II bio-safety cabinet or compounding aseptic containment isolator
	• Closed System Transfer Device: Yes
Nursing: Administration	• Gloves: Double
	• Gown: Yes
	• Eye/face protection: ---
	• Closed System Transfer Device: Yes

Adult Extravasation Management
Generic (Brand)	Vesicant / irritant	Local Care
Comments / Treatment links
etoposide (VePesid)	Irritant	Warm compress

Last updated: Jun. 12, 2024

Hazard.Drug Handling(USP 800) USP<800> Hazardous Drug
Hazardous Waste BLACK BUCKET/YELLOW BUCKET
Chemotherapy
Black Box Warnings Myelosuppression risk

Pharmacy Contact Info:

Main Inpatient Pharmacy: ext 4599, 3503
Fax: 704-878-7283

Director of Pharmacy - Randi Raynor, PharmD: ext 4501
Clinical Coordinator - Laura Rollings, PharmD: ext 4597
Pharmacy Informaticist - Stephen Pringle, PharmD: ext 7645
Pharmacy Technician Supervisor - Amy Wingler, CPhT: ext 7385
Pharmacy Automation Coordinator (Omnicell) - Melissa Fulford, CPhT: ext 3556

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as to the use of this information outside of Iredell Memorial Hospital.
The content of this policy and procedure document serves as guidance to the delivery of quality patient care.
Care providers are expected to exercise critical thinking and situational awareness skills,
and in specific situations to take such action as is necessary for the delivery of quality patient care.