What’s the difference between etoposide injection and etoposide oral?

Etoposide injection is FDA approved to treat both testicular cancer and small cell lung cancer. But [etoposide oral](https://www.goodrx.com/etoposide/what-is) is only approved to treat small cell lung cancer, and is not used as commonly as the injectable version because people [aren’t able to tolerate it](https://onlinelibrary.wiley.com/doi/abs/10.1111/crj.13266) as much. While you’ll typically receive etoposide injection in a clinic or infusion center, etoposide oral can be taken at home. But be aware that etoposide oral needs to be refrigerated, so you'll need to [properly and safely store](https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy/chemotherapy-safety.html) this medication.

How can I keep my family or pets safe while I'm receiving etoposide injection?

Discuss with your provider what kind of precaution you need to take to keep your family, visitors, or pets safe while you're receiving etoposide injection. Some amount of drug waste from etoposide injection will pass from your body through body fluids, such as tears, sweat, blood, and urine. Some ways to [keep your loved ones safe](https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy/chemotherapy-safety.html) include using your own designated toilet if possible, flushing the toilet twice after you use it and keeping the lid down when it's not in use, and washing laundry that’s been soiled with any body waste separately from others' laundry.

etoposide

Generic Toposar

Used for Lung Cancer, Testicular Cancer

Etoposide injection is an chemotherapy anticancer medication used in combination with other chemotherapy medications to treat testicular cancer or small cell lung cancer. It’s also known as VP-16. Etoposide injection is infused intravenously (IV), usually daily for a few days during each chemotherapy cycle. This medication can raise your risk for infections and bleeds.

Reviewed by:

Connie Zheng, PharmD

Daisy Chau, PharmD

Last reviewed on October 30, 2022

What is Etoposide injection?

What is Etoposide injection used for?

Testicular cancer that's hard to treat (refractory)
Small cell lung cancer

How Etoposide injection works

Etoposide injection is a type of anticancer medication called a topoisomerase II inhibitor. It prevents cancer cells from growing by damaging the cancer cells’ genetic material.

Are you looking for information on etoposide oral instead?

Drug facts

Common Brands	Etopophos
Drug Class	Anticancer agent
Controlled Substance Classification	Not a controlled medication
Generic Status	Lower-cost generic available
Availability	Prescription only

Common Brands

Etopophos

Drug Class

Anticancer agent

Controlled Substance Classification

Not a controlled medication

Generic Status

Lower-cost generic available

Availability

Prescription only

Side effects of Etoposide injection

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Low white blood cell count (up to 91%)
Hair loss (up to 66%)
Low platelet count (up to 41%)
Nausea and vomiting (up to 43%)
Low red blood cell count (up to 33%)

Please note: These side effects were reported by people taking either etoposide alone, either by mouth or as an infusion. The side effects you experience might differ depending on what other anticancer medications you're taking.

Less Common Side Effects

Low appetite
Diarrhea
Mouth sores
Stomach pain
Tingling or numbness in the hands and feet

Etoposide injection serious side effects

Contact your healthcare provider immediately if you experience any of the following.

Serious infections: headache, fevers, chills, body aches, cough, trouble breathing, severe diarrhea, vomiting, painful or frequent urination
Serious bleeds: bleeding or bruising that doesn’t stop or go away, large amount of bleeding, blood in the urine, throwing up blood, bloody or black and tarry stools

Source: DailyMed

The following Etoposide injection side effects have also been reported

Side effects that you should report to your care team as soon as possible:

Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
Low red blood cell level—unusual weakness or fatigue, dizziness, headache, trouble breathing
Unusual bruising or bleeding

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

Diarrhea
Fatigue
Hair loss
Loss of appetite
Nausea
Pain, redness, or swelling with sores inside the mouth or throat
Vomiting

Get your GoodRx coupon

Avg retail price

$1526.88(Save 78.74%)

GoodRx discount

$324.59

See prices

Pros and cons of Etoposide injection

Pros

Can be given at a lower dose to some people with kidney problems
Infusions are given only a few days out of each chemotherapy cycle
Brand Etopophos (etoposide phosphate) can be given to those allergic to certain ingredients in the generic
Available as a lower-cost generic

Cons

Might cause fertility problems in both males and females
Infusions can last almost 4 hours
Can cause rare, but serious, skin reactions (extravasation)
High risk of side effects, such as infections and hair loss

Pharmacist tips for Etoposide injection

Ask your provider about what to expect on your etoposide injection days. Each infusion alone can take up to 3.5 hours. You also have to consider the time it takes to check-in or the time for any post-infusion observations. Please plan ahead by taking time off work or school, arriving early, and arranging for rides, if needed. Wear comfortable clothes and bring something to help you pass the time, such as music or a book.
You might experience symptoms of low blood pressure, such as dizziness and feeling light-headed, while receiving etoposide injection. If you need to stand up, do so slowly so that you don't fall. If you do feel unsteady or can’t keep your balance, let your provider know right away. This might be a sign that your infusion rate is too fast. Your provider might need to stop your infusion, treat your low blood pressure, and restart the infusion at a slower rate.
Though rare, you might experience an allergic reaction while receiving etoposide injection. If so, your healthcare team will need to stop your treatment in order to treat your reaction. Let your provider know right away if you feel your face flushing, itching, or trouble breathing.
If you feel nauseous from etoposide injection, let your provider know. They can prescribe you anti-nausea medications, such as ondansetron (Zofran), to ease your symptoms. They can also give you tips, like eating smaller meals throughout the day or eating food that's more bland, to lower your risk for nausea.
Receiving etoposide treatment can put you at higher risk for infections because it lowers your immune system. Protect yourself from infections by avoiding crowds or people who are sick. Also, wash your hands before you eat and after you use the restroom. Let your provider know right away if you have any symptoms of an infection, such as fever, sore throat, or cough.

Common questions about Etoposide

Etopophos is FDA approved to treat both testicular cancer and small cell lung cancer. But etoposide oral is only approved to treat small cell lung cancer, and is not used as commonly as the injectable version because people aren’t able to tolerate it as much. While you’ll typically receive Etopophos in a clinic or infusion center, etoposide oral can be taken at home. But be aware that etoposide oral needs to be refrigerated, so you'll need to properly and safely store this medication.

Hair loss is a common side effect experienced by people who receive Etopophos. This is because etoposide is a chemotherapy that works by killing fast-growing cancer cells. Unfortunately, it also harms healthy cells, including hair cells. Usually, hair loss is temporary and your hair should grow back once treatment is done. But in the meantime, there are some ways that you might be able to minimize hair loss while receiving Etopophos, such as wearing a cooling cap, not brushing your hair too much, and avoiding heat (e.g., blow drying or hair straightening). Ask your provider if you have any questions about etoposide and hair loss.

Etopophos, as well as other anticancer agents, can cause mouth sores. You typically start noticing symptoms about a week after your infusion. And the sores last for about 1 to 2 weeks. If you get mouth sores, they can make it more difficult for you to eat or drink, and might affect your dental health. Let your provider know if you're concerned about mouth sores. They can talk with you about possible treatment options, such as a mouth rinse to ease the pain. They can also give you tips to lower your risk for sores, such as sucking on ice chips during Etopophos.

Discuss with your provider what kind of precaution you need to take to keep your family, visitors, or pets safe while you're receiving Etopophos. Some amount of drug waste from Etopophos will pass from your body through body fluids, such as tears, sweat, blood, and urine. Some ways to keep your loved ones safe include using your own designated toilet if possible, flushing the toilet twice after you use it and keeping the lid down when it's not in use, and washing laundry that’s been soiled with any body waste separately from others' laundry.

No. This medication isn’t typically given during pregnancy because it might cause harm to unborn babies. If you’re able to get pregnant, talk with your provider about birth control options. You’re recommended to use birth control while receiving Etopophos and for 6 months after your treatment ends. And if you’re a male and have a partner who can become pregnant, you’re recommended to use birth control during and for 4 months after your Etopophos treatment ends. There’s a chance this medication might damage your sperm and cause birth defects.

Etopophos isn’t recommended if you’re breastfeeding. Researchers don’t know if this medication can pass into breast milk. But if it does, it can cause serious harm to nursing infants. Let your provider know if you’re breastfeeding or considering breastfeeding.

Risks and warnings for Etoposide injection

Etoposide injection can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Low blood cell counts

Etoposide injection can cause your red blood cell (RBC), white blood cell (WBC), and platelet counts to drop, typically around 1 to 2 weeks after you start this medication. This is because etoposide injection is a chemotherapy agent that targets and kills fast-growing cancer cells. But as a side effect, it can kill fast-growing healthy cells as well, such as your blood cells. When your blood cell counts drop too low, you're at risk for problems such as infections, anemia, and bleeding or bruising. Your provider will order labs to check your blood cell counts before you start etoposide injection and before each chemotherapy cycle. If your blood cell counts drop too low, your provider will need to pause your treatment and possibly add another medication to help raise your blood counts. Let your provider know right away if you experience symptoms of low blood cell counts, such as:

Anemia (from low RBCs): headache, tiredness, feeling irritable, pale skin, brittle nails, trouble breathing
Infections (from low WBCs): fever, headache, chills, sore throat, body aches, tiredness, cough, difficulty breathing
Bleeds (from low platelets): bruising easily, bleeds that are difficult to stop, vomiting blood, tarry stool (from stomach bleeds)

Risk of blood cancer

Risk factors: Receiving etoposide injection for a long time

Though rare, receiving etoposide injection can put you at risk for developing blood cancers (leukemias). While researchers aren't clear why this happens, it's thought that etoposide injection can affect the genetic material of certain blood cells and change them into cancer cells. And the risk is higher if you receive etoposide injection for a longer period of time. If you've any questions or concerns about the risk of blood cancer, please discuss them with your healthcare provider.

Serious allergic reactions

Risk factors: Receiving etoposide injection at a higher dose | Receiving etoposide injection infusions too quickly

Some people have experienced serious allergic reactions from etoposide injection treatment. If you experience an allergic reaction, your provider will need to stop your etoposide infusion and provide medical care immediately. If your reaction is severe, you might not be able to continue etoposide treatment. Let your provider know right away if you experience symptoms of an allergic reaction, such as rash, hives, itching, chills, swelling of the face and throat, or trouble breathing.

Harm to unborn baby

Etoposide injection might cause harm to unborn babies if received by mothers during pregnancy. If you're able to get pregnant, you're recommended to use birth control while receiving etoposide injection and for 6 months after your treatment ends. Discuss with your provider about birth control options that are best for you. If you become pregnant while receiving this medication, please let your provider know right away.

If you're a male and have a partner who is able to become pregnant, you should also use birth control while receiving etoposide injection and for 4 months after your treatment ends. Etoposide injection might damage your sperm, which can lead to birth defects if your partner becomes pregnant.

Etoposide injection dosage

The average cost for 14 capsules of 50mg of Etoposide injection is $324.59 with a free GoodRx coupon. This is 78.74% off the average retail price of $1,526.88.

Typical dosage for Etoposide injection

Your provider will calculate your dose of etoposide injection using your body surface area (BSA, in units of m²), which takes into account your body weight and height.

Testicular cancer

The typical dose is 50-100 mg/m² infused intravenously (IV) on days 1 through 5 (or on days 1, 3, and 5) of each cycle of chemotherapy. Each cycle usually lasts either 21 or 28 days.

Small cell lung cancer

The typical dose is 35-50 mg/m² infused intravenously (IV) for 4 or 5 days.
Your provider might prescribe a different dose based on current research and updated NCCN guidelines. Ask your provider if you have any questions about your dose.