Etoposid Ebewe Drug Interactions

Effects of other medicinal products on the pharmacokinetics of etoposide: High dose ciclosporin, resulting in plasma concentrations above 2000 ng/ml, administered with oral etoposide has led to an 80% increase in etoposide exposure (AUC) with a 38% decrease in total body clearance of etoposide compared to etoposide alone.
Concomitant cisplatin therapy is associated with reduced total body clearance of etoposide.
Concomitant phenytoin therapy is associated with increased etoposide clearance and reduced efficacy, and other enzyme-inducing antiepileptic therapy may be associated with increased etoposide clearance and reduced efficacy.
[For etoposide phosphate containing formulations only]: As etoposide phosphate is converted in vivo to etoposide by phosphorylation, caution should be exercised when administering etoposide phosphate with medicinal products that are known to inhibit phosphatase activity as such combination may reduce efficacy of etoposide phosphate.
In vitro plasma protein binding is 97%. Phenylbutazone, sodium salicylate, and aspirin may displace etoposide from plasma protein binding.
Effect of etoposide on the pharmacokinetics of other medicinal products: Co-administration of antiepileptic medicinal products and etoposide can lead to decreased seizure control due to pharmacokinetic interactions between the medicinal products.
Co-administration of warfarin and etoposide may result in elevated international normalized ratio (INR). Close monitoring of INR is recommended.
Pharmacodynamic interactions: There is increased risk of fatal systemic vaccinal disease with the use of yellow fever vaccine. Live vaccines are contraindicated in immunosuppressed patients (see Contraindications).
Prior or concurrent use of other medicinal products with similar myelosuppressant action as etoposide may be expected to have additive or synergetic effects (see Precautions).
Cross resistance between anthracyclines and etoposide has been reported in preclinical experiments.
Paediatric population: Interaction studies have only been performed in adults.