Generic Name

Teniposide

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Classification

FDA Approved Indications

• Treatment of acute lymphoblastic leukemia (ALL) in pediatric patients

Mechanism of Action

Teniposide inhibits topoisomerase II enzyme, leading to DNA strand breaks and apoptosis of rapidly dividing cancer cells.

Dosage and Administration

Adult: Dose varies based on protocol; usually 100 mg/m² IV on days 1-3 of a treatment cycle.

Pediatric: Dose is calculated based on body surface area; typical dose 100 mg/m² IV on days 1-3.

Geriatric: Adjust dose based on renal and hepatic function, caution due to increased toxicity risk.

Renal Impairment: Use caution; dose adjustment may be necessary based on severity.

Hepatic Impairment: Use caution; monitor liver function; adjust dose as needed.

Pharmacokinetics

Absorption: Not orally active; administered intravenously.

Distribution: Widely distributed; crosses blood-brain barrier to some extent.

Metabolism: Hepatic metabolism; exact pathways not fully characterized.

Excretion: Primarily via biliary/fecal routes, some urinary excretion.

Half Life: Approximately 4-8 hours.

Contraindications

• Hypersensitivity to teniposide or other podophyllotoxin derivatives.

Precautions

• Patients with bone marrow suppression, hepatic impairment, or concurrent radiotherapy. Use caution in patients with infections or history of signs of sepsis.

Adverse Reactions - Common

• Myelosuppression (neutropenia, thrombocytopenia, anemia) (Very common)
• Alopecia (Common)
• Nausea and vomiting (Common)

Adverse Reactions - Serious

• Severe myelosuppression leading to infection or bleeding (Serious)
• Hypersensitivity reactions, including anaphylaxis (Rare)
• Secondary leukemia (long-term risk) (Very rare)

Drug-Drug Interactions

• Other myelosuppressive agents, anthracyclines, radiation therapy

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Report fever, chills, bleeding, or signs of infection immediately.
• Avoid contact with people with contagious illnesses.
• Follow instructions regarding hair loss and infection prevention.

Special Considerations

Black Box Warnings:

• Potential for severe myelosuppression resulting in infection and bleeding; monitor blood counts diligently.

Genetic Factors: Not specifically documented.

Lab Test Interference: May cause transient elevations in liver enzymes; may affect blood counts.

Overdose Management

Signs/Symptoms: Severe myelosuppression, mucositis, hypersensitivity reactions.

Treatment: Supportive care; no specific antidote. Hematopoietic growth factors or transfusions may be necessary.

Storage and Handling

Storage: Store refrigerated at 2-8°C.

Stability: Stable under recommended storage conditions; protect from light.