TOPOSAR

Etoposide 20mg/1mL, Solution for injection

Grapefruit juice

· Severity: Major

· Notes for Consumers: Do not take Etoposide, VP-16 and Grapefruit Juice together without talking to your health care provider. Side effects from Etoposide, VP-16 may get worse if you take Grapefruit Juice. Discuss any new or worsening side effects with your health care provider, including unusual bruising or bleeding, unusual tiredness, fever, signs of infection, or severe nausea / vomiting.

· Notes for Professionals: Monitor for an increased incidence of etoposide-related adverse effects if used concomitantly with grapefruit juice. Grapefruit juice is a strong inhibitor of CYP3A4 as well as a P-glycoprotein (P-gp) inhibitor; etoposide, VP-16 is a CYP3A4 and P-gp substrate. Coadministration may cause accumulation of etoposide and decreased metabolism, resulting in increased etoposide concentrations. In a small crossover, randomized trial, 6 patients receiving etoposide for non-small cell lung cancer were treated with 50 mg IV etoposide, 50 mg PO etoposide, or 50 mg PO etoposide following grapefruit juice. Pretreatment with grapefruit juice resulted in a decrease in the AUC of etoposide (average 26.2%) after oral administration; interindividual variability was large in all treatment arms. One suggested mechanism for this interaction is a possible alteration of intestinal p-glycoprotein mediated transport. Due to the small number of patients in this study, no definite conclusions may be drawn.

<b>DISCLAIMER:</b><em> This drug information content is provided for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Patients should always consult their physician with any questions regarding a medical condition and to obtain medical advice and treatment. Drug information is sourced from GSDD (Gold Standard Drug Database ) provided by Elsevier.</em>