Version July 2025
Teniposide is a cytotoxic drug that should be administered under the supervision of a qualified health care provider experienced in the use of cancer chemotherapeutic agents. Appropriate management of therapy and complications is possible only when adequate treatment facilities are readily available.
Severe myelosuppression with resulting infection or bleeding may occur.
Hypersensitivity reactions, including anaphylaxis-like symptoms, may occur with initial dosing or at repeated exposure to teniposide. Epinephrine, with or without corticosteroids and antihistamines, has been employed to alleviate hypersensitivity reaction symptoms.
Note: Teniposide injection has been discontinued in the United States for >1 year. Patients with Down syndrome may be more sensitive to the myelosuppressive effects; administer the first course at half the usual dose and adjust dose in subsequent cycles upward based on degree of toxicities (myelosuppression and mucositis) in the previous course(s).
Acute lymphoblastic leukemia (ALL; combination therapy): Note: Although FDA approved, teniposide is generally no longer used due to improved toxicity and efficacy profiles with other combination regimens used in the treatment of ALL (Ref):
Infants ≥6 months, Children, and Adolescents: Regimens may vary: IV: 165 mg/m2 twice weekly for 8 to 9 doses or 250 mg/m2 weekly for 4 to 8 weeks
Neuroblastoma, high risk: Limited data available: Children and Adolescents: IV: 100 mg/m2/dose administered 48 hours after completion of a 6-hour cisplatin infusion dose every 3 weeks (Ref)
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Infants ≥6 months, Children, and Adolescents: There are no specific adjustments provided in the manufacturer’s labeling (has not been studied). However, dosage adjustment may be necessary in patients with significant renal impairment.
Infants ≥6 months, Children and Adolescents: There are no specific adjustments provided in the manufacturer’s labeling (has not been studied). However, dosage adjustment may be necessary in patients with significant hepatic impairment.
(For additional information see "Teniposide (United States and Canada: Not available): Drug information")
Note: Teniposide injection has been discontinued in the United States for >1 year. Patients with Down syndrome and leukemia may be more sensitive to the myelosuppressive effects; administer the first course at half the usual dose and adjust dose in subsequent cycles upward based on degree of toxicities (myelosuppression and mucositis) in the previous course(s).
Acute lymphoblastic leukemia consolidation treatment (off-label use): IV: <50 years of age: 165 mg/m2/dose on days 1, 4, 8, and 11 (in combination with cytarabine) in consolidation cycles 2, 4, 6, and 8 (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no specific dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment may be necessary in patients with significant renal impairment.
There are no specific dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment may be necessary in patients with significant hepatic impairment; use with caution.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Gastrointestinal: Mucositis (76%), diarrhea (33%), nausea and vomiting (29%; mild to moderate)
Hematologic & oncologic: Neutropenia (95%), leukopenia (89%), anemia (88%), thrombocytopenia (85%), bone marrow depression (75%)
Infection: Infection (12%)
1% to 10%:
Cardiovascular: Hypotension (2%; may be intractable; associated with rapid [<30 minutes] infusions)
Dermatologic: Alopecia (9%; usually reversible), skin rash (3%)
Hematologic & oncologic: Hemorrhage (5%)
Hypersensitivity: Hypersensitivity reaction (5%; includes bronchospasm, chills, dyspnea, fever, flushing, hypertension, hypotension, tachycardia, or urticaria)
Miscellaneous: Fever (3%)
<1%, postmarketing, and/or case reports: Cardiac arrhythmia, central nervous system depression, confusion, fluid and electrolyte disturbance, headache, hepatic insufficiency, metabolic acidosis, neuropathy (severe), neurotoxicity, renal insufficiency, thrombophlebitis, weakness
Hypersensitivity to teniposide, polyoxyl 35/polyoxyethylated castor oil (Cremophor EL), or any component of the formulation
Concerns related to adverse effects:
• Bone marrow suppression: [US Boxed Warning]: Severe myelosuppression resulting in infection or bleeding may occur; may be dose-limiting; monitor blood counts during and after treatment.
• Extravasation: Teniposide is an irritant (ESMO/EONS [Pérez Fidalgo 2012]). For IV use only; ensure proper catheter/needle position prior to infusion; monitor infusion site; may cause local tissue necrosis and/or thrombophlebitis if extravasation occurs.
• Hypersensitivity: [US Boxed Warning]: Hypersensitivity reactions, including anaphylaxis-like reactions, have been reported; may occur with initial dosing or with repeated exposure to teniposide. Epinephrine, with or without corticosteroids and antihistamines, has been employed to alleviate hypersensitivity reaction symptoms. Hypersensitivity reactions may include bronchospasm, dyspnea, hypertension, hypotension, tachycardia, flushing, chills, fever, or urticaria. Monitor closely during infusion (observe continuously for first 60 minutes, frequently thereafter). Stop infusion for signs of anaphylaxis; immediate treatment for anaphylactic reaction should be available during administration (may require treatment with epinephrine, corticosteroids, antihistamines, pressors, or volume expanders). Patients experiencing prior hypersensitivity are at risk for recurrence; re-treat only if the potential benefit outweighs the risk of hypersensitivity; premedication (with corticosteroids and antihistamines) is recommended for re-treatment.
• Hypotension: Hypotension may occur with rapid infusion; infuse slowly over at least 30 to 60 minutes; discontinue for clinically significant hypotension. If infusion is restarted after being withheld for hypotension, reinitiate at a slower infusion rate.
• Toxicity with high doses: Acute CNS depression, hypotension and metabolic acidosis have been reported; these events occurred in patients who received high-dose teniposide (investigational protocol) and were premedicated with antiemetics, which along with the alcohol content of teniposide, may have contributed to the CNS depression.
Disease-related concerns:
• Hepatic impairment: Use with caution; may require dosage reduction in patients with significant impairment.
• Renal impairment: May require dosage reduction in patients with significant impairment.
Special populations:
• Down syndrome: Patients with Down syndrome and leukemia may be more sensitive to the myelosuppressive effects; reduced initial doses are recommended.
• Hypoalbuminemia: Since teniposide is highly bound to plasma proteins, carefully monitor patients with hypoalbuminemia.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.
• Dehydrated alcohol: Product contains ~43% alcohol.
• Polyoxyl 35/polyoxyethylated castor oil: Contains polyoxyl 35/polyoxyethylated castor oil (Cremophor EL), which is associated with hypersensitivity reactions.
Other warnings/precautions:
• Experienced physician: [US Boxed Warning]: Should be administered under the supervision of an experienced cancer chemotherapy physician. Appropriate management of therapy and complications is possible only when adequate treatment facilities are readily available.
Teniposide injection has been discontinued in the United States for >1 year.
Injectable solution may contain alcohol, benzyl alcohol, or polyoxyl 35/polyoxyethylated castor oil (Cremophor EL)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Intravenous:
Generic: 10 mg/mL (5 mL [DSC])
Yes
Solution (Teniposide Intravenous)
10 mg/mL (per mL): $599.03
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Parenteral: IV infusion: Administer slowly by IV infusion over at least 30 to 60 minutes to minimize the risk of hypotensive reactions; do not administer by rapid IV injection. Administer through non-DEHP-containing administration sets; flush infusion line with D5W or NS before and after infusion; incompatible with heparin. Precipitation may occur at any concentration; administer as soon as possible after preparation; inspect solution prior to administration. Observe patient continuously for at least the first 60 minutes of infusion, observe frequently thereafter. Stop infusion and treat accordingly for signs of anaphylaxis or clinically significant hypotension; if infusion is restarted after being withheld for hypotension, reinitiate at a slower infusion rate.
Teniposide contains N, N-dimethylacetamide, which may be incompatible with some closed system transfer devices (CSTDs); the plastic components of some CSTDs may dissolve and result in subsequent leakage and potential infusion of dissolved plastic into the patient (Ref). Refer to the specific CSTD device manufacturer for compatibility data.
IV: Administer over at least 30 to 60 minutes; do not administer by rapid IV injection. Administer through non-DEHP-containing administration sets. Flush infusion line with D5W or NS before and after infusion (teniposide is incompatible with heparin). Administer as soon as possible after preparation (precipitation may occur at any teniposide concentration); inspect solution prior to administration.
Observe patient continuously for at least the first 60 minutes after the start of the infusion, observe frequently thereafter. Stop infusion for signs of anaphylaxis (may require treatment with epinephrine, corticosteroids, antihistamines, pressors, or volume expanders); discontinue for clinically significant hypotension during infusion; if infusion is restarted after being withheld for hypotension, reinitiate at a slower infusion rate.
Teniposide contains N, N-dimethylacetamide, which may be incompatible with some closed system transfer devices (CSTDs); the plastic components of some CSTDs may dissolve and result in subsequent leakage and potential infusion of dissolved plastic into the patient (Ref). Refer to the specific CSTD device manufacturer for compatibility data.
Hazardous agent (NIOSH 2024 [table 1]).
Use appropriate precautions for receiving, handling, storage, preparation, dispensing, transporting, administration, and disposal. Follow NIOSH and USP 800 recommendations and institution-specific policies/procedures for appropriate containment strategy (NIOSH 2023; NIOSH 2024; USP-NF 2020).
Store ampules at 2°C to 8°C (36°F to 46°F). Protect from light. Solutions diluted for infusion in D5W or NS to a concentration of 0.1, 0.2, or 0.4 mg/mL are stable at room temperature for up to 24 hours after preparation; solutions diluted to 1 mg/mL should be administered within 4 hours of preparation. Because precipitation may occur at any concentration, the manufacturer recommends administrating as soon as possible after preparation. Do not refrigerate solutions prepared for infusion.
Treatment of childhood acute lymphoblastic leukemia (ALL) refractory to induction with other therapy (FDA approved in pediatric patients ages ≥6 months). Has also been used for treatment of neuroblastoma. Note: Although FDA approved, teniposide generally is no longer used due to improved toxicity and efficacy profiles with other combination regimens used in the treatment of ALL (Salzer 2010)
Teniposide may be confused with etoposide
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drug classes (chemotherapeutic agent, parenteral and oral) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Acute Care, Community/Ambulatory Care, and Long-Term Care Settings).
A solvent in teniposide, N,N-dimethylacetamide, may be incompatible with some closed system transfer devices (CSTDs) used for preparing injectable antineoplastics. The plastic components of some CSTDs may dissolve and result in subsequent leakage and potential infusion of dissolved plastic into the patient (ISMP [Smetzer 2015]). Refer to the specific CSTD device manufacturer for compatibility data.
Substrate of CYP3A4 (Major with inducers), CYP3A4 (Minor with inhibitors), P-glycoprotein (Major with inhibitors), P-glycoprotein (Minor with inducers); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential;
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
5-Aminosalicylic Acid Derivatives: May increase myelosuppressive effects of Myelosuppressive Agents. Risk C: Monitor
Abrocitinib: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid
Antithymocyte Globulin (Equine): Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Antithymocyte Globulin (Equine). Specifically, these effects may be unmasked if the dose of cytotoxic chemotherapy is reduced. Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Antithymocyte Globulin (Equine). Specifically, infections may occur with greater severity and/or atypical presentations. Risk C: Monitor
Antithyroid Agents: Myelosuppressive Agents may increase neutropenic effects of Antithyroid Agents. Risk C: Monitor
Baricitinib: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Baricitinib. Risk X: Avoid
BCG Products: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of BCG Products. Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of BCG Products. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid
Brincidofovir: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Brincidofovir. Risk C: Monitor
Brivudine: May increase adverse/toxic effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid
Chikungunya Vaccine (Live): Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Chikungunya Vaccine (Live). Risk X: Avoid
Chloramphenicol (Ophthalmic): May increase adverse/toxic effects of Myelosuppressive Agents. Risk C: Monitor
Chloramphenicol (Systemic): Myelosuppressive Agents may increase myelosuppressive effects of Chloramphenicol (Systemic). Risk X: Avoid
Cladribine: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Cladribine. Risk X: Avoid
CloZAPine: Myelosuppressive Agents may increase adverse/toxic effects of CloZAPine. Specifically, the risk for neutropenia may be increased. Risk C: Monitor
Coccidioides immitis Skin Test: Coadministration of Immunosuppressants (Cytotoxic Chemotherapy) and Coccidioides immitis Skin Test may alter diagnostic results. Management: Consider discontinuing cytotoxic chemotherapy several weeks prior to coccidioides immitis skin antigen testing to increase the likelihood of accurate diagnostic results. Risk D: Consider Therapy Modification
COVID-19 Vaccine (Inactivated Virus): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of COVID-19 Vaccine (Inactivated Virus). Risk C: Monitor
COVID-19 Vaccine (mRNA): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of COVID-19 Vaccine (mRNA). Management: Give a 3-dose primary series for all patients aged 6 months and older taking immunosuppressive medications or therapies. Booster doses are recommended for certain age groups. See CDC guidance for details. Risk D: Consider Therapy Modification
COVID-19 Vaccine (Subunit): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of COVID-19 Vaccine (Subunit). Risk C: Monitor
CYP3A4 Inducers (Moderate): May decrease serum concentration of Teniposide. Risk C: Monitor
CYP3A4 Inducers (Strong): May decrease serum concentration of Teniposide. Risk C: Monitor
Deferiprone: Myelosuppressive Agents may increase neutropenic effects of Deferiprone. Management: Avoid the concomitant use of deferiprone and myelosuppressive agents whenever possible. If this combination cannot be avoided, monitor the absolute neutrophil count more closely. Risk D: Consider Therapy Modification
Dengue Tetravalent Vaccine (Live): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Dengue Tetravalent Vaccine (Live). Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Dengue Tetravalent Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid
Denosumab: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Management: Consider the risk of serious infections versus the potential benefits of coadministration of denosumab and cytotoxic chemotherapy. If combined, monitor patients for signs/symptoms of serious infections. Risk D: Consider Therapy Modification
Deucravacitinib: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid
Etrasimod: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid
Fexinidazole: Myelosuppressive Agents may increase myelosuppressive effects of Fexinidazole. Risk X: Avoid
Filgotinib: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid
Inebilizumab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Inebilizumab. Risk C: Monitor
Influenza Virus Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Influenza Virus Vaccines. Management: Administer influenza vaccines at least 2 weeks prior to initiating chemotherapy if possible. If vaccination occurs less than 2 weeks prior to or during chemotherapy, revaccinate at least 3 months after therapy discontinued if immune competence restored. Risk D: Consider Therapy Modification
Leflunomide: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Leflunomide. Management: Increase the frequency of chronic monitoring of platelet, white blood cell count, and hemoglobin or hematocrit to monthly, instead of every 6 to 8 weeks, if leflunomide is coadministered with immunosuppressive agents, such as cytotoxic chemotherapy. Risk D: Consider Therapy Modification
Lenograstim: Antineoplastic Agents may decrease therapeutic effects of Lenograstim. Management: Avoid the use of lenograstim 24 hours before until 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Risk D: Consider Therapy Modification
Linezolid: May increase myelosuppressive effects of Myelosuppressive Agents. Risk C: Monitor
Lipegfilgrastim: Antineoplastic Agents may decrease therapeutic effects of Lipegfilgrastim. Management: Avoid concomitant use of lipegfilgrastim and myelosuppressive cytotoxic chemotherapy. Lipegfilgrastim should be administered at least 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Risk D: Consider Therapy Modification
Lonafarnib: May increase serum concentration of P-glycoprotein/ABCB1 Substrates (High risk with Inhibitors). Risk C: Monitor
Lumacaftor and Ivacaftor: May increase serum concentration of P-glycoprotein/ABCB1 Substrates (High risk with Inhibitors or Inducers). Lumacaftor and Ivacaftor may decrease serum concentration of P-glycoprotein/ABCB1 Substrates (High risk with Inhibitors or Inducers). Risk C: Monitor
Mumps- Rubella- or Varicella-Containing Live Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Mumps- Rubella- or Varicella-Containing Live Vaccines. Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Mumps- Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid
Nadofaragene Firadenovec: Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Nadofaragene Firadenovec. Specifically, the risk of disseminated adenovirus infection may be increased. Risk X: Avoid
Natalizumab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Natalizumab. Risk X: Avoid
Ocrelizumab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Ocrelizumab. Risk C: Monitor
Ofatumumab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Ofatumumab. Risk C: Monitor
Olaparib: Myelosuppressive Agents may increase myelosuppressive effects of Olaparib. Risk C: Monitor
P-glycoprotein/ABCB1 Inhibitors: May increase serum concentration of Teniposide. Risk C: Monitor
Palifermin: May increase adverse/toxic effects of Antineoplastic Agents. Specifically, the duration and severity of oral mucositis may be increased. Management: Do not administer palifermin within 24 hours before, during infusion of, or within 24 hours after administration of myelotoxic chemotherapy. Risk D: Consider Therapy Modification
Pidotimod: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Pidotimod. Risk C: Monitor
Pimecrolimus: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid
Piperacillin: May increase hypokalemic effects of Antineoplastic Agents. Risk C: Monitor
Pneumococcal Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Pneumococcal Vaccines. Risk C: Monitor
Poliovirus Vaccine (Live/Trivalent/Oral): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Poliovirus Vaccine (Live/Trivalent/Oral). Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Poliovirus Vaccine (Live/Trivalent/Oral). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid
Polymethylmethacrylate: Immunosuppressants (Cytotoxic Chemotherapy) may increase hypersensitivity effects of Polymethylmethacrylate. Management: Use caution when considering use of bovine collagen-containing implants such as the polymethylmethacrylate-based Bellafill brand implant in patients who are receiving immunosuppressants. Consider use of additional skin tests prior to administration. Risk D: Consider Therapy Modification
Promazine: May increase myelosuppressive effects of Myelosuppressive Agents. Risk C: Monitor
Rabies Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Rabies Vaccine. Management: Complete rabies vaccination at least 2 weeks before initiation of immunosuppressant therapy if possible. If combined, check for rabies antibody titers, and if vaccination is for post exposure prophylaxis, administer a 5th dose of the vaccine. Risk D: Consider Therapy Modification
Ritlecitinib: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Ritlecitinib. Risk X: Avoid
Ropeginterferon Alfa-2b: Myelosuppressive Agents may increase myelosuppressive effects of Ropeginterferon Alfa-2b. Management: Avoid coadministration of ropeginterferon alfa-2b and other myelosuppressive agents. If this combination cannot be avoided, monitor patients for excessive myelosuppressive effects. Risk D: Consider Therapy Modification
Ruxolitinib (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Ruxolitinib (Topical). Risk X: Avoid
Sipuleucel-T: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Sipuleucel-T. Management: Consider reducing the dose or discontinuing the use of immunosuppressants, such as cytotoxic chemotherapy, prior to initiating sipuleucel-T therapy. Risk D: Consider Therapy Modification
Sphingosine 1-Phosphate (S1P) Receptor Modulators: May increase immunosuppressive effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk C: Monitor
Tacrolimus (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Tacrolimus (Topical). Risk X: Avoid
Talimogene Laherparepvec: Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Talimogene Laherparepvec. Specifically, the risk of infection from the live, attenuated herpes simplex virus contained in talimogene laherparepvec may be increased. Risk X: Avoid
Tertomotide: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Tertomotide. Risk X: Avoid
Tofacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Tofacitinib. Risk X: Avoid
Typhoid Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Typhoid Vaccine. Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Typhoid Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid
Ublituximab: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Ublituximab. Risk C: Monitor
Upadacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may increase immunosuppressive effects of Upadacitinib. Risk X: Avoid
Vaccines (Live): Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Vaccines (Live) may decrease therapeutic effects of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid
Vaccines (Non-Live/Inactivated/Non-Replicating): Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Give non-live/inactivated/non-replicating vaccines at least 2 weeks prior to starting chemotherapy when possible. Patients vaccinated less than 14 days before or during chemotherapy should be revaccinated at least 3 months after therapy is complete. Risk D: Consider Therapy Modification
Vimseltinib: May increase serum concentration of P-glycoprotein/ABCB1 Substrates (High risk with Inhibitors). Management: Avoid concomitant use of vimseltinib and P-gp substrates when possible. If combined, administer vimseltinib at least 4 hours before the P-gp substrate. Risk D: Consider Therapy Modification
VinCRIStine: Teniposide may increase neurotoxic effects of VinCRIStine. Risk C: Monitor
Yellow Fever Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Yellow Fever Vaccine. Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Yellow Fever Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid
Zoster Vaccine (Live/Attenuated): Immunosuppressants (Cytotoxic Chemotherapy) may increase adverse/toxic effects of Zoster Vaccine (Live/Attenuated). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may decrease therapeutic effects of Zoster Vaccine (Live/Attenuated). Risk X: Avoid
Females of reproductive potential should avoid becoming pregnant during teniposide treatment.
Adverse effects to male reproductive function and fertility were observed in animal toxicology studies; males of reproductive potential may want to consider sperm preservation prior to teniposide therapy.
Based on data from animal reproduction studies, in utero exposure to teniposide may cause fetal harm.
The European Society for Medical Oncology has published guidelines for diagnosis, treatment, and follow-up of cancer during pregnancy; the guidelines recommend referral to a facility with expertise in cancer during pregnancy and encourage a multidisciplinary team (obstetrician, neonatologist, oncology team). In general, if chemotherapy is indicated, it should be avoided in the first trimester and there should be a 3-week time period between the last chemotherapy dose and anticipated delivery, and chemotherapy should not be administered beyond week 33 of gestation (ESMO [Peccatori 2013]).
A pregnancy registry is available for all cancers diagnosed during pregnancy at Cooper Health (1-877-635-4499).
CBC with differential and platelet count, renal and hepatic function tests; blood pressure; monitor for hypersensitivity reaction (observe continuously for first 60 minutes of infusion, frequently thereafter)
Teniposide delays transit of cells through the S phase and arrests cells in late S or early G2 phase, preventing cells from entering mitosis. Teniposide is a topoisomerase II inhibitor, and appears to cause DNA strand breaks (double and single) by inhibition of strand-passing and DNA ligase action.
Distribution: Vdss: Children: 3 to 11 L/m2; Adults: 8 to 44 L/m2; mainly into liver, kidneys, small intestine, and adrenals; limited distribution into CSF <1%
Protein binding: >99%; primarily albumin
Metabolism: Extensively hepatic
Half-life elimination: Children: 5 hours
Excretion: Urine (44%, 4% to 12% as unchanged drug); feces (≤10%)
Clearance: Renal: 10% of total body clearance
Hepatic function impairment: There appears to be an association between an increase in serum alkaline phosphatase or gamma glutamyl-transpeptidase and a decrease in plasma clearance of teniposide.
