Ciclosporin: 50% reduction in etoposide clearance ADMINISTRATION <\/H3> Reconstition<\/H4>5\u201310 mL of infusion fluid or water for injection Route <\/H4>Oral, IV Rate of Administration <\/H4> IV infusion <\/H4>: 5 minutes \u2013 3.5 hours Comments<\/H4>Dilute with sodium chloride 0.9% or glucose 5% to give a solution concentration as low as 100 mcg\/mL of etoposide OTHER INFORMATION <\/H4>Avoid skin contact Liver metabolised, yielding inactive metabolites. Approximately 45% of an administered dose is excreted in the urine, 29% being excreted unchanged in 72 hrs. Up to 16% is recovered in the faecesOne study suggested that patients with serum creatinine >130 \u00b5mol\/L require a 30% dose reduction. (Joel S, Clark P, Slevin M. Renal function and etoposide pharmacokinetics: is dose modification necessary? Am Soc Clin Oncol. 1991; 10: 103) This dose adjustment was calculated to result in equivalent total dose exposure in patients with reduced renal function. Patients with a raised bilirubin and\/or decreased albumin may have an increase in free etoposide and hence greater myelosuppressionReaches high concentration in kidney: possible accumulation in renal impairmentPlasma clearance is reduced and volume of distribution increased in renal impairmentKintzel PE, Dorr RT. Anticancer drug renal toxicity and elimination: dosing guidelines for altered renal function. Can Treat Rev. 1995; 21: 33\u201364. \u2013 provides dose modifications listed in \u2018dose in renal impairment\u2019Has been used without any problems in a haemodialysis patient, using a dose .290 EToPosidEthat increased gradually to 250 mg per treatment. (Holthius JJM, Van de Vyver FL, Van Oort WJ, et al. Pharmacokinetic evaluation of increased dosages of etoposide in a chronic haemodialysis patient. Cancer Treat Rep. 1985; 69(11): 1279\u201382.)Bristol-Myers Squibb advise giving 75% of dose if GFR is 15\u201350 mL\/min.
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