Teniposide

Teniposide is used alongside other anti-cancer medications to treat leukemia and certain types of cancers by slowing or stopping the growth of cancer cells.

Overview

Teniposide (brand name Vumon) is used in combination with other chemotherapy medications to treat acute lymphatic leukemia (ALL; a type of cancer that affects the white blood cells). It is administered to children whose conditions have not improved or have worsened after treatment with other medications. Teniposide belongs to a class of medications known as podophyllotoxin derivatives.

How teniposide works

A cancerous tumor is characterized by cell multiplication, which is out of control since it is in normal tissue. “Normal” cells stop multiplying when they come into contact with like cells, a mechanism referred to as contact inhibition. Cancer cells do not have this ability as they no longer have the normal checks and balances that regulate and limit cell multiplication. The process of cell multiplication, whether normal or cancerous cells, is through the cell cycle, which goes from the resting phase, through an active growth phase, to mitosis (multiplication).

The effectiveness of chemotherapy to destroy cancer cells depends on its ability to interrupt and stop cell multiplication. Usually, the drugs work by destroying RNA or DNA that directs the cell how to replicate itself during multiplication. Cells that are unable to multiply die. The faster the cells are multiplying, the more likely it is that chemotherapy will destroy the cells, causing the tumor to die eventually. The drugs also induce cell suicide (apoptosis or self-death).

Chemotherapy medications that affect cells only when they are multiplying are referred to as cell-cycle specific. Chemotherapy medications that affect cells when they are at rest are referred to as cell-cycle non-specific. The scheduling of chemotherapy is determined based on cell types, rate of multiplication, and the time at which a given medication is likely to be effective. This is why chemotherapy is typically administered in cycles.

Chemotherapy medications are most effective at destroying cells that are rapidly multiplying. Unfortunately, these drugs do not have a way of distinguishing cancerous cells from the normal cells. The “normal” cells eventually do grow back and be healthy, but unwelcome side effects occur. The “normal” cells that are commonly affected by chemotherapy medications are the blood cells, cells in the stomach and bowel, mouth and the hair follicles. This results in mouth sores, low blood count, diarrhea, nausea and/or hair loss. Different chemotherapy medications affect different parts of the body.

Teniposide is a podophyllotoxin and a topoisomerase II inhibitor. The podophyllotoxins are extracted from the May apple plant. Camptothecin analogs are extracted from the Asian “Happy Tree” – Camptotheca acuminate. Podophyllotoxins and camptothecin analogs are also referred to as topoisomerase inhibitors. The plant alkaloids are cell-cycle specific – they destroy cancer cells when they are in the multiplication phase.

Topoisomerase inhibitors are medications that interrupt the action of topoisomerase enzymes (topoisomerase I and II). Topoisomerase enzymes regulate the manipulation of the structure of DNA necessary for cell duplication.

Topoisomerase I inhibitors: Topotecan, Irinotecan

Topoisomerase II inhibitors: Etoposide, Amsacrine, teniposide, etoposide phosphate

Important precautions

It is important that your healthcare provider checks your progress on a regular basis to ensure that the medication is working properly. Blood tests may be taken to check for unwanted side effects.

Teniposide treatment may cause a serious type of allergic reaction referred to as anaphylaxis. Anaphylaxis can be life-threatening in some patients hence the need for urgent medical attention. Inform your healthcare provider right away if you experience severe fever, chills, dizziness or fainting, lightheadedness, swelling on the face, throat, tongue, fast pounding heartbeat, or breathing difficulty after taking this medication.

If the medicine accidentally leaks from the vein into which it is injected, it may cause tissue damage and result in scaring. Inform your healthcare provider right away if you feel pain, swelling and redness at the injection spot.

While you are on teniposide medication, and immediately after treatment, do not get immunizations without your healthcare provider’s approval. The medication may lower the body’s resistance, and you are likely to get the infection the vaccination is meant to prevent. In addition, people living in your household should avoid having the oral polio vaccine, since the chance of passing the polio virus to you may be high. Also, keep away from people who have had the polio vaccine over the last several weeks. Do not get into contact with them, and do not share a living space with them for long. If you are unable to take these precautions, consider wearing a protective face mask that covers your mouth and nose.

Teniposide medication can cause birth defects if administered to an expectant woman. Use an effective birth control form to avoid getting pregnant while on this medication. Should a pregnancy occur while on teniposide, inform your healthcare provider right away.

Teniposide may lower the patient’s sperm count, affecting a man’s ability to have children in the long term. Consider asking your healthcare provider if you can store sperm for artificial use in the future.

Low blood pressure (hypotension) may occur during teniposide treatment. Your healthcare provider should monitor your blood pressure to keep from going too low while you are on teniposide treatment.

Teniposide can temporarily lower the patient’s white blood cells count, resulting in an increased chance of getting an infection. It can also lower the number of platelets, which are required for proper clotting. Should this occur, there are certain precautions that you should take, especially if you have low blood count, to reduce the risk of bleeding and infection:

  • Avoid people with infections as much as possible. Check with your healthcare provider immediately if you suspect you are developing an infection or if you get persistent chills or fever, lower back or side pain, cough or hoarseness, or painful or difficult urination.
  • Check with your healthcare provider immediately if you notice any unusual bruising or bleeding, black, tarry stools, pinpoint red spots on the skin, or blood in stool and urine.
  • Exercise caution when using a regular toothbrush, toothpick, or dental floss. Your healthcare provider may show you other ways of cleaning your teeth and gums. Check with your healthcare provider before having any dental work done.
  • Avoid touching your eyes or inside of your nose with unwashed hands.
  • Be careful not to cut yourself when using sharp objects such as fingernail or toenail cutters and safety razors.
  • Avoid contact sports or situations that may make you vulnerable to bruising or injury.

Conditions treated

  • Acute lymphocytic leukemia (particularly in children)

Type of medicine

  • Topoisomerase II inhibitor

Side effects

Along with the intended effects, teniposide may cause some undesired side effects. Although not all side effects may be experienced, the patient may seek medical attention if these side effects are severe or life-threatening.

Check with your healthcare provider immediately if you experience any of the following side effects:

  • Blood in urine and stool
  • Black, tarry stool
  • Cough or hoarseness
  • Chills and fever
  • Hives
  • Painful or difficult urination
  • Lower back or side pain
  • Pinpoint red spots on the skin
  • Tightness of chest or wheezing
  • Breathing problems
  • Unusual bleeding or bruising

Some teniposide side effects may not require medical attention. These side effects tend to go away during treatment as the body adjusts to the medication. Also, your healthcare provider may tell you how to manage these side effects. Check with your healthcare provider if any of the following side effects persist or if you have questions about them:

  • Nausea and vomiting
  • Diarrhea

Teniposide treatment often causes temporary hair loss. Normal hair growth should return after treatment.

Hematologic side effects

Hematologic side effects of teniposide include bone marrow suppression, which is one of the most significant toxicity effects associated with teniposide treatment. Others include neutropenia, anemia, leukopenia, thrombocytopenia, and myelosuppression. Fatal sepsis may result from severe myelosuppression.

Hypersensitivity

Hypersensitivity is a rare side effect of teniposide. This includes a potentially life-threatening hypersensitivity reaction with anaphylaxis-like symptoms. Hypersensitivity reactions are common in patients with brain tumors and neuroblastoma. These reactions may include urticaria, chills and fever, tachycardia, dyspnea, bronchospasm, facial flushing and hypertension or hypotension. Management of severe hypersensitivity may include the use of corticosteroids, antihistamines, intravenous fluids, epinephrine, and other supportive medications.

Cardiovascular side effects

Rare cases of hypotension have been reported, including cases of sudden death attributed to probable arrhythmia and intractable hypotension.

Oncologic side effects

The risk of developing secondary acute nonlymphocytic leukemia is higher in patients treated with this medication.

Gastrointestinal side effects

These include mucositis, nausea and vomiting, and diarrhea.

Dermatologic side effects

Alopecia and rashes have been reported in patients on this medication.

Dosage

Teniposide is administered intravenously in the hospital or cancer treatment facility. The medicine is administered through a needle placed in one of the patient’s veins. Teniposide should be given slowly, so the IV tube must remain in place for 30-60 minutes.

Teniposide may sometimes be administered together with other medicines. If you receive a combination of medication, it is important that you receive each one at the proper time. If you are taking some of these medications orally, ask your healthcare provider to help you plan a way to take them at the appropriate times.

Teniposide may cause severe nausea, vomiting and loss of appetite. However, it is important that you continue with treatment, even if you are feeling ill. Ask your doctor for ways to manage side effects.

How it is given

  • As already mentioned, teniposide is administered intravenously.
  • The medication may cause irritation. Also, the medicine may cause tissue damage if it escapes from the vein. Alert your healthcare provider immediately if you notice redness and swelling at the spot of injection.
  • The amount of teniposide that a patient receives depends on a number of factors as well as the type of cancer or condition being treated. Your healthcare provider will determine your dose and schedule.

Teniposide preparation for intravenous administration

The medicine must be diluted with either 5 percent Dextrose Injection, USP or 0.9 percent Sodium Chloride injection, USP, to produce a final teniposide concentrations of 0.1mg/mL, 0.4mg/mL, 0.4mg/mL, or 1.0mg/mL. The prepared solutions are stable at room temperature for 4 hours after preparation. Teniposide concentration prepared at 1.0mg/mL should be administered within four hours of preparation to reduce the potential for precipitation. Refrigeration of the prepared solution is not recommended.

Point to note

Contact of undiluted teniposide with plastic equipment or the device used for preparing solutions for infusion may result in softening or cracking and possible drug leakage. This effect, however, has not been reported with diluted teniposide solutions. That said, teniposide solutions should be administered with non-DEHP containing intravenous administration sets.

Teniposide overdose

Overdose is uncommon. However, if you suspect teniposide overdose, contact the Poison Control Center at 1-800-222-1222.

Missed dose

For the best possible result, it is essential that you receive each dose of this medication as scheduled. In an event of missed dosage, contact your healthcare provider to set a new dosing schedule. Never double dose to make up for missed dosage.

Interactions

When taking teniposide, it is especially important that you alert your healthcare provider if you are taking any of the medications listed below. Your healthcare provider may decide to change some of the medications in order to reduce the interactions.

  • Measles Virus Vaccine, Live
  • Rotavirus Vaccine, Live
  • Varicella Virus Vaccine, Live
  • Mumps Virus Vaccine, Live
  • Rubella Virus Vaccine, Live

Using teniposide with any of the following medications is not recommended, but may be necessary at times. If both medications are prescribed together, your healthcare provider may adjust the dosage or frequency of taking one or both medications.

  • Adenovirus Vaccine
  • Cholera Vaccine, Live
  • Yellow Fever Vaccine
  • Smallpox Vaccine
  • Typhoid Vaccine
  • Dasabuvir
  • Bacillus of Calmette and Guerin Vaccine, Live
  • Glucosamine
  • Influenza Virus Vaccine, Live
  • Phenobarbital
  • Poliovirus Vaccine, Live

Other interactions

Using certain foods, alcohol or tobacco with certain medications may cause interactions to occur. Discuss with your healthcare provider the use of teniposide with food, alcohol, or tobacco. Also, inform your doctor of any supplements as well as herbal medications you are on while taking teniposide.

Other medical problems

Certain pre-existing medical conditions may affect the use of teniposide. Be sure to tell your doctor if you have any of the following medical conditions:

  • Blood disorders as a result of bone marrow depression
  • Infections
  • Chickenpox, including recent exposures
  • Central nervous system depression
  • Herpes zoster (shingles)
  • Metabolic acidosis
  • Hypotension
  • Down syndrome
  • Kidney disease
  • Hypoalbuminemia
  • Liver disease

Warnings

  • Before starting teniposide medication, be sure to inform your doctor about any other medications you are currently on (including over-the-counter prescriptions, herbal medications, vitamins, and mineral supplements). Avoid Aspirin and products containing it unless permitted by your doctor.
  • Do not receive any kind of vaccination without your doctor’s consent when on teniposide treatment.
  • Teniposide is inadvisable if you have had hypersensitive (allergic) reactions to the drug.
  • Inform your healthcare provider if you are pregnant prior to taking this medication.
  • For both men and women, do not conceive while on this medication.
  • Avoid breastfeeding while on teniposide medication.

Important self-care tips

  • Take a lot of water while on this medication (at least 3 quarts of fluid every 24 hours).
  • Clean your hands often.
  • You may be at risk of infection so try to avoid crowds or people who are ill. Report infections or signs of infection immediately to your doctor.
  • Use a soft toothbrush to avoid mouth sores
  • Avoid contact sports and activities that might cause injury.
  • Teniposide may cause a little nausea. Should you experience nausea, take anti-nausea medications as directed by your healthcare provider. Eating small, frequents meals and sucking lozenges may also help.
  • Avoid alcohol and tobacco products completely.
  • Maintain good diet and get adequate rest.

For more precautions, see the 'Overview' section above.

Storage

The medication should be stored in unopened ampules under refrigeration (2 – 8 degrees C). All unused and expired medications should be disposed of appropriately.

Summary

Teniposide is a semi-artificial derivative of podophyllotoxin. The medicine is used for treating leukemia as well as other forms of cancer. However, teniposide may lower the ability of the patient’s bone marrow to produce blood cells that are required by the body. This may lead to a need for regular blood transfusion during the medication period.

It is important that your doctor monitors your progress closely while on this medication. Blood tests may also be necessary to look out for unwanted effects.

The drug may cause a life-threatening allergic reaction called anaphylaxis. Inform your healthcare provider right away if you notice chills, lightheadedness, fever, and irregular and fast heartbeats.

Teniposide can also weaken the body’s immune system. As such, patients on this treatment are advised to avoid certain vaccinations as well as crowds and people with illnesses such as colds. It can also lower the number of platelets, which are essential for proper blood clotting.

 

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Last Reviewed:
December 22, 2017
Last Updated:
December 22, 2017
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